title: Treatment of an adult patient with a periodontally compromised skeletal Class II malocclusion.
abstract: This article describes the treatment of an adult female with periodontally induced bone loss, excessive gingival display when smiling, vertical maxillary excess, a convex profile, a traumatic deep overbite, and severe lip incompetence. The therapy included four steps: (1) periodontal flap surgery and root planing with regular follow-ups; (2) leveling and aligning of the maxillary and mandibular arch with closure of all spaces, the extraction of mandibular first premolars, and retraction of the mandibular incisors; (3) LeFort I two-segment osteotomy with removal of the second premolars and a 5-mm impaction to reduce the excessive gingival display and permit autorotation of the mandible to decrease the facial convexity. To close the extraction space, the posterior segment was set 4 mm anteriorly and the anterior segment 3 mm posteriorly; and (4) postsurgical orthodontics for finishing and detailing. The treatment lasted 36 months; improved facial esthetics significantly; and resulted in a normal occlusion, overjet, and overbite.
authors.affiliation: Ragas Dental College and Hospitals, Uthandi, Chennai, India. bdsgowri@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Gowri
authors.forename: V Shiva
authors.initials: VS
authors.lastname: Sankar
authors.forename: S
authors.initials: S
authors.lastname: Venkateswaran
authors.forename: N R
authors.initials: NR
authors.lastname: Krishnaswamy
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000628:therapy; D001641:Bicuspid / Q000601:surgery; D002508:Cephalometry / Q000379:methods; D003724:Dental Arch / Q000473:pathology; D003766:Dental Occlusion; D005260:Female; D005881:Gingiva / Q000473:pathology; D006801:Humans; D007180:Incisor / Q000473:pathology; D008046:Lip / Q000473:pathology; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D018704:Orthodontic Retainers; D019516:Orthodontic Space Closure / Q000295:instrumentation / Q000379:methods; D009969:Orthodontic Wires; D019340:Osteotomy, Le Fort / Q000379:methods; D057887:Overbite / Q000473:pathology / Q000628:therapy; D010347:Patient Care Planning; D010510:Periodontal Diseases / Q000628:therapy*; D010514:Periodontal Pocket / Q000601:surgery; D016745:Root Planing; D012399:Rotation; D013524:Surgical Flaps; D014081:Tooth Extraction