The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 9 ( September, 2021 ) > List of Articles


Management of Class II Hyperdivergent Mandible by Surgically Altering Occlusal Plane Pattern through Counterclockwise Rotation of Mandible

Balaguhan Balasubramanian, Neelakandan Ravanasamudram Sundaram, Srinivasan Boovaraghavan, Raja Sekar Gali, Sudhakar Venkatachalapathy, Kirthika Natarajan

Keywords : BSSO, Class II hyperdivergent mandible, Counterclockwise rotation of mandible, Occlusal plane alteration

Citation Information : Balasubramanian B, Sundaram NR, Boovaraghavan S, Gali RS, Venkatachalapathy S, Natarajan K. Management of Class II Hyperdivergent Mandible by Surgically Altering Occlusal Plane Pattern through Counterclockwise Rotation of Mandible. J Contemp Dent Pract 2021; 22 (9):1048-1054.

DOI: 10.5005/jp-journals-10024-3146

License: CC BY-NC 4.0

Published Online: 06-01-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: To evaluate the facial esthetic of class II hyperdivergent mandible by altering the high mandibular plane angle into an orthognathic mandibular plane angle by counterclockwise (CCW) rotation of the mandible. Materials and methods: Five patients with class II hyperdivergent mandible were selected for this study. Initially, preorthodontics was done by aligning the teeth. Then, surgically, bilateral sagittal split osteotomy (BSSO) advancement with CCW rotation of mandible with a posterior open bite of 4 mm was done. Eleven linear and 11 angular measurements were taken. Pre- and postsurgical values were evaluated by composite cephalometric analysis, and the changes in the occlusal plane and facial height were statistically analyzed by using paired t-test. Jarabak ratio was calculated for facial height measurements. Further finishing will be done by postsurgical orthodontic procedures to get functional occlusion. Results: Change in occlusion to class I is seen in values of Jarabak ratio and Go-Gn. Jarabak ratio shows an increase in posterior and decreases in anterior facial height. Go-Gn, which implies the CCW movement of the mandible, has reduced the anterior open bite and created a posterior open bite of 4 mm for the supraeruption of teeth. Conclusion: BSSO with CCW rotation of mandible with a posterior open bite has conservatively involved in single-jaw surgery, thereby improving the facial esthetics of all the patients taken this study. Clinical significance: This innovative method of CCW rotation of mandible with open bite mainly prevents the bi-jaw surgery, improves the stability, and gives an esthetically good appearance.

  1. Kim B-R, Oh K-M, Cevidanes LHS, et al. Analysis of 3D soft tissue changes after 1- and 2-jaw orthognathic surgery in mandibular prognathism patients. J Oral Maxillofac Surg 2013;71(1):151–261. DOI: 10.1016/j.joms.2012.02.005.
  2. Varella AM, Bhat SS, Revankar AV, et al. Orthodontic surgical approach of severe skeletal hyperdivergent Class II malocclusion treated by Le-Fort I osteotomy, BSSO and Genioplast. J Contemp Orthod 2020;4(3):9–15.
  3. Khan N, Adeni KM, Parameswaran R, et al. Surgical management of hyperdivergent Class II malocclusion with vertical maxillary excess: a 2-year follow-up. Contemp Clin Dent 2018;9(6):382. DOI: 10.4103%2Fccd.ccd_484_18.
  4. Epker BN. Discussion. J Oral Maxillofacial Surg 1993;51(7):740–741. DOI: 10.1016/S0278-2391(10)80411-2.
  5. Ardani IGAW, Wicaksono A, Hamid T. The occlusal plane inclination analysis for determining skeletal class III malocclusion diagnosis. CCIDE 2020;12:163–171. DOI: 10.2147%2FCCIDE.S248983.
  6. Burke M, Jacobson A. Vertical changes in high-angle class II, division 1 patients treated with cervical or occipital pull headgear. Am J Orthod Dentofacial Orthop 1992;102(6):501–508. DOI: 10.1016/0889-5406(92)70066-J.
  7. Ruf S, Pancherz H. The effect of Herbst appliance treatment on the mandibular plane angle: a cephalometric roentgenographic study. Am J Orthod Dentofacial Orthop 1996;110(2):225–229. DOI: 10.1016/s0889-5406(96)70113-0.
  8. Bendeus M, Hägg U, Rabie B. Growth and treatment changes in patients treated with a headgear-activator appliance. Am J Orthod Dentofacial Orthop 2002;121(4):376–384. DOI: 10.1067/mod.2002.122177.
  9. Pinho T, Figueiredo A. Orthodontic-orthognathic surgical treatment in a patient with Class II subdivision malocclusion: occlusal plane alteration. Am J Orthod Dentofacial Orthop 2011;140(5):703–712. DOI: 10.1016/j.ajodo.2010.01.037.
  10. Hasprayoon S, Liao Y-F, Hsieh Y-J. Skeletal stability after mandibular counterclockwise rotational advancement for correction of skeletal class ii deformity—a systematic review and meta-analysis. J Evid Based Dental Practice 2019;19(2):156–165. DOI: 10.1016/j. jebdp.2019.01.008.
  11. Stansbury CD, Evans CA, Miloro M, et al. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. J Oral Maxillofac Surg 2010;68(1):149–159. DOI: 10.1016/j. joms.2009.07.105.
  12. Esteves LS, Castro V, Prado R, et al. Assessment of skeletal stability after counterclockwise rotation of the maxillomandibular complex in patients with long-face pattern subjected to orthognathic surgery. J Craniofac Surg 2014;25(2):432–436. DOI: 10.1097/SCS.0000000000000395.
  13. Altay Burgaz M, Eraydin F, Diren Esener S, et al. Patient with severe skeletal class II malocclusion: double jaw surgery with multipiece Le fort I. Turk J Orthod 2018;31(3):95–102. DOI: 10.5152/TurkJOrthod.2018.17039.
  14. Hasprayoon S, Ko EWC, Chen YA. Combine the orthodontic-orthognathic surgical correction on class II division 2 malocclusion. J Orthod 2017;29(4):212–223. DOI: 10.30036/TJO.201712_29(4). 0003.
  15. Frey DR, Hatch JP, Van Sickels JE, et al. Alteration of the mandibular plane during sagittal split advancement: short- and long-term stability. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2007;104(2):160–169. DOI: 10.1016/j.tripleo.2006.12.023.
  16. Ruslin M, Hajrah Yusuf AS, Forouzanfar T, et al. One-year stability of the mandibular advancement and counterclockwise rotation for correction of the skeletal class II malocclusion and high mandibular plane angle: dental and skeletal aspect. Biomed J 2021;S2319417021000111. DOI: 10.1016/
  17. De Oliveira LB, Reis JMN, Spin-Neto R, et al. Mechanical evaluation of six techniques for stable fixation of the sagittal split osteotomy after counterclockwise mandibular advancement. Br J Oral Maxillofac Surg 2016;54(5):573–578. DOI: 10.1016/j.bjoms.2016.03.002.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.