Correction of severe class II skeletal discrepancy with fixed twin block and high pull headgear--a case report.

This case report describes the management of a girl with a severe Class II skeletal discrepancy, Class II molar and canine relationship, a large overjet, an impinging overbite and a steep mandibular plane angle. Seemingly a surgical case, but as the patient was in CVMI stage 4, the treatment was initiated with a fixed twin block extending up to the maxillary second molars along with high pull headgear for the vertical control. This promoted the growth of the mandible, restrained maxilla in anteroposterior and vertical directions, combined with the fixed appliances for the aligning and levelling of the dentition improved the soft tissue profile. Thus severe skeletal Class II discrepancy with noncompensatory dental occlusion was successfully managed non-surgically with the combination of dentofacial orthopaedics along with comprehensive orthodontic mechanism without any extraction resulting in acceptable soft tissue changes.