Interdisciplinary management of an adult skeletal Class II patient with occlusal cant, chin deviation, and impacted canines: A case report.

Authors

Naveen K Subbaiah, Satinder Pal Singh, Vinay Kumar, Raj Kumar Verma, Vidya Rattan, Phavithrasri Kannan, Sanjeev Verma

Published in

International orthodontics. Volume 24. Issue 4. Pages 101213. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

Skeletal Class II malocclusion with facial asymmetry, occlusal cant, and multiple impacted canines presents a significant clinical challenge requiring coordinated interdisciplinary care. This report describes the management of a 20-year-old female who presented with a retruded mandible, right-sided chin deviation, soft-tissue lip cant, and a Class II Division 1 malocclusion with deep bite, increased overjet, and missing permanent canines. Radiographic evaluation revealed right condylar hypoplasia, 9% condylar asymmetry, a difficult palatal impaction of tooth 23 according to the KPG difficulty index, and mid-alveolar impactions of teeth 33 and 43. Skeletal assessment confirmed mandibular retrognathia, a hyperdivergent pattern, and a 3-mm occlusal cant. Treatment involved the extraction of over-retained deciduous canines and third molars, orthodontic alignment, and space creation, followed by surgical exposure and traction of the impacted canines. After successful eruption, pre-surgical orthodontic decompensation was performed to optimize incisor inclinations. Bimaxillary orthognathic surgery, including left maxillary impaction and asymmetric mandibular advancement, was undertaken to correct the skeletal discrepancies and facial asymmetry. Post-surgical orthodontic finishing refined occlusal relationships, and implant-supported prostheses were placed to replace missing mandibular molars. The interdisciplinary approach achieved successful canine alignment, correction of skeletal discrepancies, normalization of the occlusal plane, and improved facial symmetry. At a 36-month follow-up, the results remained stable with satisfactory function and aesthetics. This case highlights the value of coordinated orthodontic, surgical, and prosthetic care in managing complex dentofacial deformities.

PMID:
42480171
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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