Orthodontic Treatment Of A Skeletal Class II Subdivision Malocclusion With Severe Maxillary Crowding And Midline Discrepancy Using A Straight-Wire Appliance: A Case Report

Abstract

Abstract

Background: Skeletal Class II subdivision malocclusion is a challenging asymmetric malocclusion, often associated with severe crowding, dental midline discrepancy, and dentoalveolar and soft-tissue imbalance. Achieving optimal occlusion and facial harmony requires careful management of both space and asymmetry. Objective: To report the diagnosis, treatment protocol, and outcomes of straight-wire fixed appliance therapy in a 24-year-old female with skeletal Class II subdivision malocclusion, severe maxillary crowding, and dental midline discrepancy. Case Report: A 24-year-old female presented to the Orthodontic Clinic of the Hasanuddin University Dental and Oral Hospital with protrusive and crowded teeth. Clinical examination showed dental midline deviation (maxillary 1 mm left; mandibular 0.5 mm right), overjet 3.5 mm, and overbite 2.5 mm, with a Class II subdivision canine relationship. Model analysis demonstrated a 9-mm maxillary space deficiency. Cephalometric findings indicated skeletal Class II (Class II subdivision) with incisor proclination/protrusion. Treatment was performed using straight-wire fixed appliances (Roth prescription, 0.022-inch slot) with selective extractions and staged mechanotherapy, including leveling and alignment, anterior retraction with T-loops, finishing, and fixed retainer retention. Active treatment lasted from 5 May 2023 to 19 December 2025 (approximately 32 months). Outcomes included improved facial profile, correction of crowding and midline discrepancy, and reduction of overjet to 3.0 mm.