Multipurpose miniscrew-anchored palatal appliance combined with a fixed multibracket appliance to correct a Class II Division 2 malocclusion with maxillary constriction and impacted upper canine in a 13-year-old girl: A case report

This case report describes the successful non-extraction orthodontic treatment of a 13-year-old female patient affected by a Class II Division 2 malocclusion, maxillary constriction and a unilateral impacted maxillary canine. The miniscrew-assisted palatal expansion (MAPA) system was used for precise palatal miniscrew placement, achieving bicortical engagement. A hybrid T-Rex rapid palatal expander was then employed to achieve both skeletal expansion and molar distalization without requiring patient compliance. After that, tooth 2.3 was surgically exposed and orthodontically repositioned with a miniscrew-supported extrusion cantilever on a fixed vestibular appliance and piggyback mechanics. The orthodontic treatment was completed in a total of 31 months, yielding satisfactory intraoral results. Precise digital planning for palatal miniscrew insertion was instrumental in achieving bicortical anchorage, enabling the efficient use of a single multipurpose, miniscrew-supported palatal appliance.