Comprehensive orthodontic management of skeletal Class II division 2 deep overbite malocclusion with severe alveolar bone defect: A case report with two-year follow-up

Background Deep overbite is a vertical developmental anomaly of the upper and lower jaws and/or dental arches, often accompanied by sagittal and horizontal abnormalities in three-dimensional space. It can lead to restricted mandibular movement, discomfort in temporomandibular joint and masticatory muscles, and, in severe case, damage to hard tissue of the teeth and periodontal structures. Case presentation This case report details the orthodontic treatment of a 27-year-old female with a severe anterior alveolar bone defect, Class II skeletal malocclusion, severe crowding, a pronounced anterior deep overbite, and posterior scissor bite. The treatment aims to alleviate the deep overbite through lingual root movement and intrusion the upper anterior teeth, combined with crown reduction, while carefully managing the intrusion and labial tipping of the lower anterior teeth. Strategic asymmetric tooth extractions and a comprehensive sequential orthodontic approach such as auxiliary intrusive arch, power arms, segmental arch-wires, and mini-screws were employed. After 29 months treatment, both deep overbite and arch width discrepancies were corrected, resulting in significantly improved facial aesthetics, harmonious tooth alignment, a balanced occlusal relationship, and enhanced stability of upper and lower anterior teeth. The treatment outcomes remained stable during a two-year follow-up. Conclusions This case demonstrates that for adult with severe deep overbite, skeletal class II division 2 malocclusion, and poor periodontal condition, a carefully tailored treatment plan with sequential and comprehensive orthodontic management— incorporating the use of auxiliary intrusive arches, mini-screws, power arms, segmental arch-wires, and crown reduction—can successfully achieve a camouflage strategy with stable and lasting results.