Treatment of an adult patient with a periodontally compromised skeletal Class II malocclusion.

This article describes the treatment of an adult female with periodontally induced bone loss, excessive gingival display when smiling, vertical maxillary excess, a convex profile, a traumatic deep overbite, and severe lip incompetence. The therapy included four steps: (1) periodontal flap surgery and root planing with regular follow-ups; (2) leveling and aligning of the maxillary and mandibular arch with closure of all spaces, the extraction of mandibular first premolars, and retraction of the mandibular incisors; (3) LeFort I two-segment osteotomy with removal of the second premolars and a 5-mm impaction to reduce the excessive gingival display and permit autorotation of the mandible to decrease the facial convexity. To close the extraction space, the posterior segment was set 4 mm anteriorly and the anterior segment 3 mm posteriorly; and (4) postsurgical orthodontics for finishing and detailing. The treatment lasted 36 months; improved facial esthetics significantly; and resulted in a normal occlusion, overjet, and overbite.