Interdisciplinary management of a skeletal class II, hyperdivergent patient accompanied by multiple missing teeth and severe overeruption with orthodontic assisted space redistribution and implant restoration

Abstract

Long-term absence of posterior teeth often leads to significant overeruption of the antagonists, posing a substantial challenge for restorative treatment planning. This case report presents an interdisciplinary approach for a skeletal class II, hyperdivergent patient accompanied by missing maxillary second premolars (15,25), left maxillary second molar (27), mandibular first and second molars (36,37,46,47) and severe overeruption of maxillary first molars (16,17). The maxillary first molars were intruded using both buccal and palatal miniscrews while the existing maxillary spaces were closed. In the mandible, the existing spaces were strategically redistributed through the substitution of third molars for missing second molars, complemented by implant-supported restoration of the first molars. After 35 months of active treatment, well-aligned dentition, ideal intercuspation, and a notably improved facial profile were achieved, which remained stable during the 17 months follow-up. Overeruption resulting from long-standing absence of opposing teeth can be effectively managed through orthodontic intrusion with temporary anchorage devices. The strategic use of existing third molars for space redistribution offers a cost-effective, biologically conservative solution that preserves natural dentition.