MANAGEMENT OF A COMPLEX PRESENTATION OF ANGLE’S CLASS II SUBDIVISION LEFT MALOCCLUSION WITH CROWDED-OUT UPPER LEFT CANINE

Abstract

BACKGROUND: Angle’s Class II subdivision, which often leaves malocclusion, especially when combined with a buccally displaced
canine, an edge-to-edge incisor relationship, and a midline diastema, presents both aesthetic and functional challenges. This case report highlights the clinical decision-making process, treatment strategies, and successful outcomes associated with managing such a complex presentation using a fixed appliance therapy with extractions.
CASE PRESENTATION: A 14-year-old female presented with a buccally displaced upper left canine, midline diastema, low maxillary
labial frenal attachment, and Angle’s Class II subdivision left molar relationship with an edge-to-edge incisor relationship. Treatment
involved extraction of all first premolars, followed by fixed appliance therapy, canine traction, en-masse incisor retraction, and frenectomy. Active treatment lasted 20 months. Post-treatment results showed well-aligned arches, Class I molar and canine relationships, and
corrected midlines.
CONCLUSION: This case demonstrates that extraction-based fixed appliance therapy can effectively address severe crowding, dental
midline deviation, and edge-to-edge incisor relationships without compromising facial aesthetics. Careful treatment planning and
anchorage management were key to achieving optimal results. The case underscores the importance of individualized orthodontic
approaches for complex Class II subdivision malocclusions