Combined use of molar distalization and leeway space for class II division 1 malocclusion with odontoma-induced impacted maxillary right lateral incisor in the mixed dentition: a case report.

BACKGROUND: Treatment for Angle's Class II division 1 involves both extraction and non-extraction orthodontic therapy. Managing Class II division 1 malocclusion accompanied by maxillary anterior tooth impaction and anterior crowding in mixed dentition poses a therapeutic dilemma. Premolar extraction may face traction failure in the impacted tooth, resulting in excessive tooth loss, while extracting impacted teeth may compromise occlusion and anterior aesthetics, necessitating future restoration. Molar distalization as a non-extraction approach often face challenges in providing sufficient space for aligning impacted teeth and simultaneously retracting proclined anterior teeth and improving the facial profile. This study describes a non-extraction orthodontic treatment plan for Class II division 1 malocclusion accompanied by maxillary anterior tooth impaction and anterior crowding in mixed dentition.

CASE PRESENTATION: An 11-year-old girl was diagnosed with Class II division 1 malocclusion and impaction of the maxillary right lateral incisor caused by an odontoma. A non-extraction treatment plan was implemented, involving first the distalization of the maxillary molars and utilization of the leeway space to create an eruption space, followed by surgical exposure and orthodontic traction, and finally, anterior teeth retraction and mandibular advancement guided by Class II elastics. After 39 months, the impacted maxillary right lateral incisor was successfully aligned, achieving Class I molar and canine relationship with a normal overbite and overjet and an improved facial profile.

CONCLUSIONS: Molar distalization and use of the leeway space can avoid the need for tooth extraction during orthodontic treatment. Molar distalization and use of the leeway space can provide sufficient space to correct Class II molar relationship, align impacted teeth, and retract the maxillary anterior teeth. Retraction of the maxillary anterior tooth and guidance for mandibular advancement can improve the lateral facial profile.