Camouflage treatment guided by facial improvement in hyperdivergent skeletal class II malocclusion

BACKGROUND: To detect parameters associated with the craniomaxillofacial system that could be altered during hyperdivergent skeletal class II malocclusion camouflage treatment for better profile improvement. METHODS: Forty-two subjects with hyperdivergent skeletal class II malocclusion who had finished their orthodontic treatments and achieved good soft tissue responses were included in this study. Cephalometric analyses of these patients were taken before (T1) and after (T2) treatment. Measurements were made at each treatment stage and analyzed within and between groups. RESULTS: No obvious decrease in the cant of occlusal plane (OP) (the line of point L1 and point L7) and mandibular plane (MP) was observed. However, an obvious decrease in the cant of the posterior occlusal plane (POP) and the angle of plane NA and plane NB (ANB) and a significant increase in the distance from the condylar center (Dc) to OP (DPO) were observed in the subjects (P<0.05). CONCLUSIONS: Decreased POP canting and increased DPO values play a vital role in profile improvement. Sagittal discrepancies might be considerably alleviated by a decreasing ANB angle [especially the sella nasion A point (SNA) angle]. Therefore, to attain a successful camouflage treatment of hyperdivergent skeletal class II malocclusion, treatment should be targeted towards finding an alternative to control POP canting, including reducing crowding in the posterior arch, as well as modifying and intruding molars to an upright and lower position.