Patient overview

Age: 12 years
Main complaint: Aesthetic concerns and functional difficulties

Initial diagnosis

Skeletal Class II due to mandibular retrognathia, proclination of maxillary incisors, narrow arch creating a V-shaped arch, agenesis of 12, 31, 41, hyperdivergent facial pattern, moderate deep bite (2 mm), increased overjet (9 mm), asymmetric canine and molar Class II due to mandibular deviation to the left, maxillary midline deviation related to agenesis of 12, distal rotation of 35 and 45, and pronounced lower curve of Spee.

Functional findings:

Labial incompetence, mouth breathing, tongue dysfunction

Treatment objectives

Stimulate mandibular growth, reduce overjet, correct Class II relationships, level the curve of Spee, manage space opening for agenesis of 12, 31, and 41, recenter midlines, improve oral function.

Phase 1: Functional orthopedics

A monobloc appliance was prescribed to stimulate mandibular growth.

After 6 months:
Overjet reduced from 9 mm → 4 mm
Clear improvement in labial competence, nasal breathing, and tongue function.

Results after first Spark phase (9 months)

• Harmonized, rounded arch form
  
• Bilateral Class I canine and molar relationships
  
• Corrected incisor torque
  
• Complete leveling of the curve of Spee
• Centered dental midlines
  
• Space opening: 6 mm for 12 and 8 mm for 31–41
  
• Normalized overjet and overbite