The current era of orthodontics has evolved from regular dental corrections to achieve the most needed harmony between functional stability and esthetics enhancement of craniofacial structures. The “desire” for attaining this harmony led to the birth of orthognathic surgeries. The orthognathic approach has undergone a paradigm shift through the years, from correcting the skeletal component to addressing the soft tissues, thus optimizing esthetic outcome. This present case report is of a patient with skeletal Class II malocclusions with vertical maxillary excess (VME), managed by multidisciplinary treatment approach. The treatment progressed through presurgical orthodontics with premolar extraction followed by bi-jaw surgery. The outcome resulted in a phenomenal change in the profile by establishing a Class I skeletal base with a stable occlusion.

Aim: The main objective of the study is to assess and compare the skeletal and dental changes obtained before and after treatment using centrographic analysis in patients with class II skeletal base using three different treatment modalities-Functional, Fixed Functional and Surgical (BSSO advancement). Materials and methods: A sample of 240 retrospectively collected pre-and post-treatment lateral cephalograms of class II malocclusion treated by orthodontics or orthodontic-surgical combined approach are included. The samples are grouped as Group I-Functional appliances (Twin Block appliance), Group II-Fixed functional appliances (AdvnSync II) and Group III-Surgical (BSSO advancement). The lateral cephalograms are traced and analysed using Centro-graphic analysis on FACAD 3.10 (Ilexis AB, Sweden). The post-treatment cephalograms are analysed to compare the treatment outcomes amongst the groups. Results: The results show high statistical significance in post-treatment class II skeletal correction among the three groupsalso, a sharp reduction in the prognathic maxilla in the fixed functional group. The post-treatment mandibular prognathism was observed in the functional and surgical group. In terms of vertical component, the most significant neutral position of FC was found to be in the fixed functional group. Conclusion: This study primarily establishes a non-numerical method of evidence of highly significant mandibular changes were observed across the three groups. The most effectively treated subjects were found to be of the BSSO advancement group followed by functional and fixed functional groups, respectively.

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Background: Tooth size-arch length discrepancy (TSALD) is a consequence of disharmony between the size of the teeth and the space available to accommodate them in the dental arches, they are manifested in the form of either crowding or spacing. Crowding is the deviation in tooth position such as rotation, overlapping, tooth emergence inside or outside the dental arch and impaction due to the lack of space. Crowding may occur due to different reasons, for example, growth, maturation, aging of dentition, mesial drift, soft tissue pressures, and tooth morphology. The correction of severe mandibular crowding could be carried out by extraction, distalization, surgical and non-surgical expansion of the mandible. Aim:The aim of this case report is to describe a novel method of non-surgical mandibular expan-sion.Case report: This case report demonstrates a non-surgical dentoalveolar expansion by the use of a translingual force mandibular expander appliance ('TORKO' Leone rapid micro expander screw) for the correction of severe mandibular crowding with posterior bilateral scissor bite in an adolescent patient with reduced inter canine and premolar width. This is a case report first of its kind which demonstrates a severe crowding case treated by an expansion device and outlines the challenges faced in achieving well stable results. Conclusion:The overall active orthodontic treatment lasted for 16 months, an expansion of 6 mm of inter-canine width is achieved. The one year follow up showed a stable mandibular arch following the treatment using TORKO appliance. Clinical significance:In this case report we have discussed the concept of increasing mandibular inter-canine width in an adolescent patient presenting severe lower anterior crowding and the factors affecting its stability.