The surgical-orthodontic correction of mandibular deficiency. Part II.

As discussed in Part I of this study, persons with mandibular deficiency and Class II malocclusions exhibit a wide spectrum of esthetic, cephalometric, and occlusal characteristics. In many such patients optimal overall results are best obtained via a combined orthodontic-surgical approach. In such patients a critical evaluation is essential to decide (1) the optimal operation and (2) the appropriate orthodontic-surgical sequencing. Our method of making these two basic decisions was presented in Part I. In this article the indications for mandibular advancement with or without genioplasty, total subapical mandibular advancement, superior repositioning of the maxilla, and inferior repositioning of the maxilla are discussed in detail. These alternatives are illustrated with representative cases, and the results are discussed. The intention of these two presentations is to illustrate an orthodontic-surgical approach to the correction of mandibular deficiency and Class II malocclusion that is predicated on a systematic evaluation of the individual patient rather than a standard approach.