title: Lingual orthodontics with orthognathic surgery in a severe class II, division 2 case.
abstract: OBJECTIVE
  To what extent are incisor protrusion, intrusion and torque feasible with orthodontic therapy in an adult? Does a lingually-fixed appliance lend itself to the controlled execution of such extensive tooth movements, and can such an appliance be used in an orthognathic surgical approach with mandibular repositioning?
  
  
  METHODS
  The treatment of a 47-year-old male patient presenting a severe Angle Class II, Division 2 with traumatic deep overbite is demonstrated in all phases of an orthodontic-surgical therapeutic approach. The preoperative harmonization of the upper and lower dental arches preceded the surgical correction via a bilateral sagittal split osteotomy in the gonial angle according to Hunsuck-Epker. Postoperative therapy included compensation for the surgical overcorrection, and the final setting of the occlusion.
  
  
  RESULTS
  Extensive tooth movements of the incisors in particular were realized with a lingually-fixed appliance. The appliance did not hamper the surgical correction in any way. Key changes in several cephalometric values were observed: the U1:NL(ANS-PNS) angle (70 degrees) changed from 106 degrees to 70 degrees, the U1:N-S (77 degrees) from 110 degrees to 76 degrees, the distance U1: NA (4 mm) from -8 mm to +3 mm, and the interincisal angle (135 degrees) from 183 degrees to 134 degrees (average values in parentheses). Standard clinical values were obtained for the upper and lower incisors, and complete leveling of the arches was achieved. The orthognathic surgical intervention changed the Wits value from +7 to 0 mm. The intended result (as laid out in the set-up) was realized.
  
  
  CONCLUSIONS
  This case report demonstrates that extensive and difficult orthodontic treatment requiring orthognathic surgery to correct a skeletal malocclusion is feasible with a fixed lingual appliance.
authors.affiliation: Private Orthodontic Practice, Baden-Baden, Germany. hjp@dr-pauls.de
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Pauls
mesh_terms: D002508:Cephalometry; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000000981:diagnostic imaging / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D016910:Orthodontic Brackets; D009971:Orthodontics, Corrective / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D011862:Radiography, Panoramic