Skeletal anchorage for Class II correction in a growing patient.

Diagnosis A 12-year-old male in the late mixed dentition was referred by his dentist for orthodontic treatment. Initial examination revealed a skeletal and dental Class II malocclusion with a retrognathic mandible, a severe overbite, moderate overjet, and mild malalignment of both arches, including rotations and generalized spaces in the mandibular arch (Fig. 1). The facial type was hypodivergent. There was a slight Bolton discrepancy of 79% (norm = 77%), due to small maxillary lateral incisors. The anteroposterior position of the upper lip was within normal limits.1,2 The patient had a history of trauma to the maxillary left central incisor, as confirmed by the panoramic radiograph. Cephalometric analysis (Fig. 2, Table 1) revealed a Class II, division 1 skeletal malocclusion (ANB = 6°) with a low mandibular plane angle (GoGn-SN = 28°, FMA = 18°), reflecting a low-angle facial pattern and a procumbent interincisal angle (U1-L1 = 128°). The maxilla was slightly protrusive (SNA = 83°), while the mandible was retrusive (SND = 73°, ANB = 6°). Facial esthetic analysis showed 4mm of upper lip protrusion with respect to the vertical line passing through subnasale (compared with Gianelly and Dietz’s reported normal range in