The Treatment Of An Adult Patient With A High Angle Skeletal Class Ⅱ Malocclusion

Objective: To investigate the treatment result of four first premolar and four third molar extraction,SWA technology,TPA control molar,J hook headgear adduct incisor in skeletal class Ⅱ malocclusion adult patients with high angle.Method: One adult patient treated at Dr.Dalian dental Clinic skeletal class Ⅱ high angle.Femal,23 years old.Facial symmetrical,quarrel line straightness,convex profile,extra mentalis muscle strain.Function normal,good oral hygiene,good periodontal tissue,oral mucosa and tongue is normal.Midline is normal.Class I molar relationship.Crowding analysis:13mm crowding in upper arch and 9 mm crowding in lower arch.5mm overbite and 6mm overjet.ANB°7°,wits 5.5 shows skeletal class Ⅱ,U1-NA° 27°,U1-NA 7mm shows upper incisor lip,L1-NB° 34°,L1-NB 13 mm,U1-L1° 112° shows lower incisor lip,FMA 37°shows high angle.According to the examination of this patient,we chose to remove four first premolars and four third molar and we decided to use straight archwire technique.Alignment and leveling maxillary and mandibular tooth,TPA control molar,with J-hook to retraction canine and to retraction anteriors to finish space close.Adjust tooth aix,molar relationship,and remove appliance.Vacuum-formed retainer was made both for upper and lower teeth.Finally,we compare and analysis the cephalometrics of pretreatment and postreatment,and to investigate the treatment result.Result: The treatment ocurse lasted for 30 months.Class I molar relationship on left and class I to Ⅱ molar relationship on right.Medlines are in the middle,overbite and overjet is normal.Profile esthetics.By analysis the cephalometrics,there are no obvious resorption in the root area.Cephalometrics comparision show :(1)SNA°,SNB° no change,ANB° decreased 1°,wits decreased 4.5 shows maxillary and mandibular coordinated.(2)U1-SN° decreased 10°,L1-NB decreased 5mm upper incisor and lower incisor axis vertical.(3)FMA decreased 2°,Mp-SN° decreased2°shows the mandibular plane don,t clockwise rotate.(4)U1-PP decreased 2mm shows good upper incisor vertical height controled well.(5)Z angle increase 10°,H angle decrease 5°,lip relationship becomes harmonious and beautiful.Conclusion: During the treatment adult patients of skeletal class Ⅱ with high angle,SWA technology,extract four first premolar and four third molar,TPA control molar,J hook headgear adduct incisor to finish space close.profile esthetics and harmonious and can control the tooth three-dimensional direction,and get good response.