MESSAGE BOARD 1 Asymmetric Dental Class II A Townie gets backup from seasoned docs on a tricky case OrthoErin 13.5-year-old male. Skeletal Class I. Full step Class II on the right side. Short anterior facial height. Minimal incisor display upon smiling. Hypodivergent. Minimal overjet. Midlines not coincident. Small lateral incisors. Sorry for the wonky ceph (new assistant). Treating this type of case is kind of my weakness and I have only been in practice for about two years, so still a lot to learn. How would you all treat? n Post: 1 of 15 3/21/2019 dhmjdds Post: 2 of 15 3/21/2019 For me, it would be Herbst appliance with brackets on U4-4 to start, using high torque brackets U2-2. Overcorrect the midline as you shim the appliance. Open spaces around the U2s (especially UR2) and then bond temporary veneers of appropriate size when there's enough space. Once the Class II and midline are overcorrected by a couple of millimeters (generally a year), remove Herbst, bond lower arch and U7, 6, 5 and it will take 12 months of braces U/L to finish. Plan for porcelain veneers U2s once he's an adult. n emac Post: 3 of 15 3/21/2019 A couple of quick things. Which midline is correct? If the upper is on with midline, then you have an asymmetric lower arch. Combine that with small laterals and it may be very hard to get a Class I on both sides. Those are in fact very hard because of skeletal asymmetry. Be very careful of focusing on getting Class I cuspids when the lower is not symmetric. You may not make it textbook-perfect. n JANUARY/FEBRUARY 2023 | 24 | ORTHOTOWN.COMhttp://www.ORTHOTOWN.COM