DOI: 10.36347/sjds.2021.v08i05.003

Pages: 131-139

The following case report shows management of class I bimaxillary protrusion malocclusion with facial asymmetry in a hyperdivergent case with extraction of all first premolars. The effective management of space without losing anchorage is itself a big challenge. The results produced a pleasant facial profile with attainment of good occlusion. The case required extraction of 1st premolars for correction of the proclined, forwardly placed and crowded upper and lower anterior teeth. The patient presented with an occlusal cant on clinical evaluation and presence of a facial asymmetry on PA cephalogram. Lateral cephalometric evaluation revealed a Class I skeletal pattern and clinical examination revealed presence of facial asymmetry with chin deviation towards the patients left side, an orthognathic facial profile, a vertical growth pattern, increased overjet and average overbite, crowding in maxillary and mandibular anterior region, potentially incompetent lips, increased lip fullness and lip strain with an unaesthetic smile arc and a decreased nasolabial angle. Following fixed orthodontic treatment by removal of all 1st premolars and with retraction of anterior segment, a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life. Facial asymmetry was corrected non-surgically, simply by application of appropriate biomechanics with the help of temporary anchorage devices (TADs).