Orthodontic treatment with skeletal anchorage of a severe hyperdivergent retrognathic patient

Because of the skeletal complexity of the problem, hyperdivergent retrognathic patients are among the most difficult for orthodontists to treat. We present a 24-year-old woman with temporomandibular disorder and malocclusion in all three planes of space. After eliminating her temporomandibular joint symptoms with a splint, her Class II malocclusion and open bite increased. The patient refused orthognathic surgery, so we treated her malocclusion with microscrews and osseointegrated implants in different sites and used different devices supported by microscrews. The microscrews placed in the maxillary tuberosity were decisive in the success of our treatment by allowing simultaneous distalization and intrusion of posterior teeth.