Treatment of class II malocclusion and ectopic maxillary canines: A case report

doi:10.12998/wjcc.v13.i30.109977

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Oct 26, 2025; 13(30): 109977
Published online Oct 26, 2025. doi: 10.12998/wjcc.v13.i30.109977

Treatment of class II malocclusion and ectopic maxillary canines: A case report

Dur Alomair, Marwa R Halawani, Shahad Alsubaye, Abdulaziz A Almajed

Dur Alomair, Marwa R Halawani, Department of Preventive Dental Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia

Shahad Alsubaye, Department of Orthodontics, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia

Abdulaziz A Almajed, Department of Orthodontics, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia

Author contributions: Alomair D and Halawani MR contributed to the conception and design of the case report, as well as data acquisition and clinical management; Alsubye S. contributed to the analysis and interpretation of clinical data and assisted in drafting the manuscript; Almajed AA supervised the clinical treatment, critically revised the manuscript for important intellectual content, and approved the final version; All authors reviewed and approved the final manuscript.

Informed consent statement: The patient and his guardian gave their consent for the clinical images and findings to be posted.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Marwa R Halawani, Assistant Professor, Department of Preventive Dental Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia. mrhalawani@pnu.edu.sa

Received: May 27, 2025
Revised: June 4, 2025
Accepted: August 8, 2025
Published online: October 26, 2025
Processing time: 137 Days and 18.2 Hours

Abstract

BACKGROUND

This case report presents an innovative approach to managing a complex class II division 1 malocclusion with ectopic maxillary canines using a modified twin block (TB) appliance. The modification facilitated simultaneous skeletal correction and canine eruption, reducing treatment time and improving patient satisfaction.

CASE SUMMARY

A 14-year-old male presented with concerns about a retruded chin and spacing between teeth. Clinical and radiographic evaluation revealed a class II division 1 malocclusion on a moderate class II skeletal base, with palatally impacted maxillary canines. Treatment involved a modified Clark TB appliance designed with hooks to allow active traction of the canines, followed by comprehensive fixed orthodontics. Over 18 months, the patient achieved improved occlusion, corrected overjet and overbite, successful eruption of the impacted canines, and enhanced facial aesthetics. The final results showed significant dental and skeletal improvement without requiring surgical intervention.

CONCLUSION

A modified TB appliance can effectively manage class II malocclusion with impacted canines in growing patients. The modified approach combining functional mandibular advancement and active canine traction represents a less-documented clinical adaptation, offering a valuable, efficient alternative to traditional two-phase interventions.

Keywords: Orthodontic appliances; Functional appliance therapy; Ectopic tooth eruption; Dental traction; Skeletal malocclusion; Maxillary canine; Growth modification; Class II malocclusion; Twin block therapy; Dental esthetics; Case report

Core Tip: This case report highlights a non-surgical, dual-phase approach for treating class II division 1 malocclusion with impacted maxillary canines in an adolescent patient. A modified twin block appliance enabled simultaneous mandibular advancement and active canine traction, streamlining treatment and improving outcomes. The innovative appliance design reduced the need for additional anchorage, shortened treatment time, and enhanced facial and dental aesthetics, demonstrating a practical alternative to more invasive or prolonged treatment strategies.