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Bimaxillary Osteotomy Using a Physiological Positioning Strategy for Skeletal Class II with Anterior Open Bite and Gummy Smile: Case Reports and Review of the Literature

Seigo Ohba*,Hitoshi Yoshimura,Takiko Matsuura,Izumi Asahina,Kazuo Sano

The treatment of skeletal class II cases has long been a great challenge because of the tendency for relapse. This is particularly true in skeletal class II patient with an anterior open bite and gummy smile, owing to the anterior movement and counter-clockwise rotation of the mandible. This movement of the mandible sometimes induces relapse and temporomandibular disorders. To avoid these complications, we have advocated a new treatment strategy, the ‘physiological positioning strategy’, for mandibular osteotomy in patients with jaw deformity. Few disadvantages were observed after surgery when using this strategy, and good outcomes were seen in skeletal class III patients who underwent bimaxillary osteotomy or mandibular osteotomy solely. Two skeletal class II patients with anterior open bite and a gummy smile were treated using this method. The long-term outcomes were good in both cases. The proximal segments moved anteriorly after surgery. This new treatment strategy may provide a reliable outcome for not only class III but also class II cases, even when concomitant anterior open bite and a gummy smile are present.