Treatment of an adult skeletal class II patient with a modified surgery-first approach.

This case report presents an 18-year-old female patient who had skeletal Class II relationship due to a mandibular retrognathia, decreased lower anterior facial height and proclined incisors with increased overjet and overbite. Her main complaints were protruding upper incisors and decreased distance between the tip of the nose and chin. A modified surgery-first approach was performed with two months of presurgical orthodontics to achieve 8mm mandibular advancement. The total treatment time was 11 months. Improved aesthetics, a balanced facial profile and a stable and functional occlusion were obtained in less treatment time due to accelerated tooth movement.