Class II Malocclusion Treatment with the Distal Active Concept Technique

Aims: The aim of this case report is to evaluate the skeletal and dental effects of the Distal Active Concept (DAC) technique in an adolescent female patient.

Presentation of Case: The patient is a 14-year-old female who presented with a skeletal class II malocclusion, class II division 1 dental relationship, and protrusion of upper and lower incisors. She was treated using the DAC technique which relies mainly on the use of double class II elastics to correct the Class II malocclusion and is indicated for treating young patients presenting a skeletal class II division 1 malocclusion caused by a retrognathic mandible without extraction of premolars. During the distalization phase of the DAC technique, open coil springs are inserted in compression against the maxillary first molars and are associated with double class II elastics on each side to correct the molar et canine class II relationship. Bite turbos made of glass ionomer cement are placed on the occlusal surfaces of the lower first molars to facilitate the forward movement of the mandible.

Results: The upper lip protrusion was reduced after retraction of maxillary incisors so that the facial profile became more balanced. The patient’s occlusion was finished with a bilateral molar and canine class I relationship. No skeletal changes were obtained. The class II malocclusion was corrected mainly by dentoalveolar compensation. The maxillary incisors were retracted by 2 mm and the mandibular ones were protruded and intruded by 2 mm. Consequently, the overjet decreased from 6 to 2 mm, and the overbite from 4 to 2 mm. The upper first molar tipped slightly distally whereas the lower first molar moved mesially by 2 mm.

Conclusion: Orthopedic growth modification with the Distal Active Concept therapy can be attained, provided that the patient’s remaining pubertal growth is adequate. Otherwise, the skeletal discrepancy will remain the same, and the class II malocclusion will be corrected only by dental camouflage.