Case Report Table 1. Pretreatment Cephalometric Measurements Cephalometric Measurement SNA (°) SNB (°) ANB (°) Figure 3. Pretreatment panoramic radiograph (left) and lateral cephalogram (right) Wits (mm) U1-NA (mm) U1-SN (°) L1-NB (mm) Norm Pretreatment 82.0 80.2 80.0 72.6 2.0 0.0 FMA (FH-MP) (°) 25.0 SN-MP (°) 4.0 4.0 7.6 6.1 21.0 32.0 36.0 3.6 104.0 98.2 8.0 IMPA (L1-MP) (°) 90.0 103.9 Upper Lip-E Line (mm) −4.0 Lower Lip-E Line (mm) −2.0 1.7 2.5 Radiographic Findings A panoramic radiograph at pretreatment showed normal condyles of good cortication without beaking. All four third molars were present but were not yet erupted. Based on her cephalometric analysis, the patient had a skeletal Class II pattern (ANB, 7.6°) with orthognathic maxilla (SNA, 80.2°) and retrognathic mandible (SNB, 72.6°). A Wits appraisal of 6.1 mm also indicated a skeletal Class II pattern. The patient presented a normovergent skeletal type (SN-MP, 36.0°). While the positions of her slightly upright maxillary incisors were still within normal limit, her mandibular incisors were largely proclined (L1-NB, 8.0 mm; IMPA, 103.9°). Both of her upper and lower lips were protrusive to the E-line: the upper lip by 1.7 mm and the lower lip by 2.5 mm (Figure 3; Table 1). The American Board of Orthodontics (ABO) Discrepancy Index score of this case was 27 (Figure 4). Figure 4. ABO Discrepancy Index score Fall 2021 PCSO Bulletin 35