Nonsurgical treatment of an adult Class II division 1 right-subdivision malocclusion with reduced periodontal support using third-molar extraction and palatal miniscrew-assisted distalization: A case report.

Adult Class II patients with protrusive maxillary incisors, a constricted maxillary arch, deep overbite, and reduced periodontal support are challenging to manage when orthognathic surgery is refused and preservation of the soft-tissue profile is a major concern. This case report describes the nonsurgical treatment of an adult patient with an Angle Class II division 1 right-subdivision malocclusion using maxillary third-molar extraction, self-ligating appliances, and miniscrew-assisted maxillary distalization, with successful transfer of anchorage from failed buccal miniscrews to palatal miniscrews. A 30-year-old man presented with maxillary anterior spacing, a constricted maxillary arch, excessive overjet, traumatic deep overbite, mild mandibular crowding, and generalized reduced periodontal support. Treatment was performed without premolar extraction using bite turbos, sequential archwires, intermaxillary elastics, maxillary third-molar extraction, and en masse maxillary distalization supported initially by buccal miniscrews and subsequently by palatal miniscrews after buccal screw failure. After 16 months of active treatment, facial and smile aesthetics were improved, with full maxillary incisor display and reduced buccal corridors. Bilateral Class I canine and molar relationships, coincident dental midlines, normal overjet and overbite, and good intercuspation were achieved. Periodontal re-evaluation showed a clinically stable periodontium. Successful nonsurgical correction of this adult Class II division 1 right-subdivision malocclusion was achieved without premolar extraction. Transfer of anchorage from failed buccal miniscrews to stable palatal miniscrews was a key factor in completing treatment and obtaining favourable occlusal, dentoalveolar, periodontal, and aesthetic outcomes.