🔎 Diagnosis

• Skeletal Class II with anterior open bite
• High mandibular plane angle (FMA ~45°)
• Large overjet, anterior open bite (~2.5 mm)
• Mesially tipped mandibular molars, posterior crossbite possible

⚖️ Biomechanics

• Maxillary microscrews: Between 2nd premolar & 1st molar →
  • Anterior retraction.
  • Posterior intrusion.
• Mandibular microscrews: Between 1st & 2nd molars →
  • Prevent mesial tipping.
  • Uprighting & forward movement of molars.
• Result: Counterclockwise mandibular rotation → improved profile.

🛠️ Treatment Progress

• Fixed pre-adjusted edgewise appliance (0.022”).
• Initial NiTi archwire (0.014”).
• Loading microscrews after 2 weeks (150 g).
• Forces Applied
  • Elastic thread from microscrews → molars for uprighting
  • Ni-Ti coil springs → anterior retraction
  • Transpalatal bar → stabilize arch, prevent buccal tipping
  • Intrusion forces applied to both arches

📌 Key Clinical Pearls

• Safe placement: 30–40° angulation, avoids root damage
• Vertical control of posterior teeth = critical in open bite management
• Microscrew implants → prevent anchorage loss, eliminate need for intermaxillary elastics (avoids molar extrusion)
• Intrusion & uprighting posterior teeth → counterclockwise mandibular rotation → improves profile