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Introduction This study aimed to compare the skeletodental and soft tissue changes with total arch distalization using a modified C‐palatal plate (MCPP) and maxillary first premolar extraction treatment in Class II malocclusion patients with severe overjet. Setting and sample population The sample consisted of 46 adult patients who had Class II Division 1 malocclusion with severe overjet; 25 of them received non‐extraction treatment with MCPPs (age, 22.5 ± 7.2 years), and 21 received maxillary first premolar extraction treatment (age 23.4 ± 6.5 years). Method A total of 26 variables were measured on pre‐ and post‐treatment lateral cephalograms. To evaluate the differences between pretreatment and post‐treatment in each group, t tests and Wilcoxon rank‐sum tests were used. To compare the amount of change between the two groups, MANOVA test was used. Results The overjet was significantly reduced in the MCPP and extraction groups by 4.8 mm and 5.4 mm, respectively. However, the two groups had no significant difference in the sagittal, vertical and angular changes of the maxillary incisors. In addition, regarding soft tissue changes, the MCPP and extraction groups showed an increased nasolabial angle of 7.5° and 9.4°, decreased upper lip to the true vertical line of 1.8 mm and 2.2 mm, respectively (P < .001). Conclusions There was no significant difference in the skeletal changes between the MCPP and extraction groups, and the reduction in overjet was similar in the groups. These results suggest that MCPP might be a viable treatment option for total arch distalization in Class II malocclusion patients with severe overjet.

This case report presents surgically assisted orthodontic treatment for an adult patient due to labial exostosis, prominent malar, and unesthetic chin. Her treatment was total arch distalization with modified C-palatal plate for maxillary arch and miniscrews for mandibular arch. In addition, she was treated with alveoloplasty, malarplasty, and genioplasty to improve the consistency of her profile. The total treatment duration was 28 months.