The patient, a 13-year-old Caucasian guy, presented with a Class II, Division 1 malocclusion on a Class II skeletal base. The upper incisors were proclined, with space loss in the upper left central incisor region caused by the loss of the central incisor following an avulsion trauma at the age of eight. The overjet was extended by 7 mm, but the overbite was average and unfinished to the palate. The buccal segment measured a full unit Class II on the right and one-half unit Class II on the left [Figure 1]. Canines were class II on both sides. The gingivae was inflamed, particularly around the lower incisors, confirming the presence of gingivitis.

The orthopantograph (OPG) revealed that all permanent tooth roots looked to be normal in size, shape, and growth stage. The unerupted upper second premolars, right second molars, and third molars were at a healthy developing stage. Pneumatization of the maxillary sinus was observed around the upper molars. The upper left central incisor was identified as lacking [Figure 2].

The cephalometric radiograph and analysis [Figure 3] revealed an ANB value of 6°, indicating that the patient had a Class II skeletal pattern. This was confirmed by the Wits study (+3 mm). The proportion of lower to total anterior facial height was typical. The maxillary-mandibular plane angle (MMPA) was at the upper end of the normal range, indicating a small reduction in posterior face height. The top incisors were proclined at 124°, whereas the lower incisors were at the lower end of the normal range at 88°, owing to the impact of the lower lip. The lower lip was located on the Ricketts E-plane, presumably due to the high tip of the snout [Table 1]. The patient was in cervical vertebral maturation stage II; phases II to III are ideal for growth modification.

Summary

13-Year-Old Caucasian Patient with Class II Malocclusion

• Patient presents with a Class II, Division 1 malocclusion on a Class II skeletal base.
• Upper incisors proclined, space loss in upper left central incisor region due to avulsion trauma at age eight.
• Overjet extended by 7mm, overbite average and unfinished to the palate.
• Buccal segment measured full unit Class II on right and half unit Class II on left.
• Canines were class II on both sides.
• Gingivae inflamed, particularly around lower incisors, confirming gingivitis.
• Orthopantograph (OPG) revealed all permanent tooth roots normal in size, shape, and growth stage.
• Upper left central incisor identified as lacking.
• Cephalometric radiograph and analysis confirmed Class II skeletal pattern.
• Top incisors proclined at 124°, lower incisors at 88° due to impact of lower lip.
• Patient in cervical vertebral maturation stage II, ideal for growth modification.