Severe Crowding Management in Class II Subdivision Without Extraction

Abstract

Background: Severe dental crowding presents a major orthodontic challenge, often requiring a decision between extraction and non-extraction approaches. This condition may be complicated by Class II subdivision malocclusion, labial ectopic canines, and anterior crossbite. This case report aims to describe non-extraction orthodontic management in a patient with such complex features.  Case Report and Case Treatment: A 22-year-old female presented with labial eruption of the mandibular left canine, severe crowding in both arches, and anterior crossbite of the maxillary right lateral incisor. Treatment was performed using a fixed appliance with a pre-adjusted edgewise system, Roth prescription, 0.022-inch slot. The non-extraction approach included molar distalization with Class II elastics, arch coordination, and selective interproximal reduction of 0.3 mm per side on teeth 32–35. Conclusion: A 12-month post-treatment evaluation demonstrated optimal correction of the malocclusion. The patient’s facial profile remained harmonious, the buccal corridor had increased (16.92%), and the smile curve was ideal. Post-treatment cephalometric analysis showed that the upper incisors exhibited 3° proclination (<U1-NA = 28°) and the lower incisors exhibited 6° proclination (<L1-MP = 103°) as a form of stable dental compensation. The relationship of the right permanent first molar was successfully corrected from Class II subdivision to a stable Class I with good interdigitation.