The Use of the Surgical Guide for Placing Miniscrew in Treatment of Class II Subdivision: A Case Report With 2-Year Follow-Up.

Treatment of Class II subdivision can present a challenge for the clinician because of its asymmetry and possible midline deviation. This case report documents the use of a computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guide for miniscrew placement in a Class II subdivision treatment. A 17-year and 1-month-old female presented with a skeletal Class I relationship, but mild mandibular skeletal and dental midline shift to the right relative to the facial midline. A full-step Class II molar relationship on the right side and slight Class III molar relationship on the left side and a 4.0 mm deficiency of space in the maxillary were noticed. Using CAD/CAM technology, a surgical guide was designed virtually and 3D printed for predrilling. With the surgical guide, one ø1.3 mm twist drill was chosen to prepare a 4-5 mm deep hole in the alveolar process distobuccal to the maxillary right second premolar. A 1.4  × 8.0  miniscrew was inserted into the prepared hole. With this miniscrew, the unilateral Class II relationship was corrected successfully by distalization of the unilateral maxillary dentition on the Class II side after 13 months of treatment. Application of CAD/CAM surgical guide is very helpful for placement of the miniscrew. Class II subdivision may be treated by distalizing unilateral maxillary dentition on the Class II side using the miniscrew.