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Treatment of super Class II with wide overjet: functional, aesthetic and psychological harmonization.

This is a 13 years old female patient.


  • Thumb sucking
  • Class II subdivision
  • Super overjet of 10 mm with aesthetic and psychological disfavor.
  • Agenesis of 45

Protocol of treatment:

  1. Stop thumb sucking: the patient was motivated and stopped few days later
  2. 4D Harmonization by PUL appliance containing expansion screw and anterior elastic on the upper splint. It is worn 22H/24H.
  3. 9 months after, we have a simple Class 1. It is the beginning of 2nd phase: self-ligating low friction system.

Photos 12 to 17 show the comparison between before and after the action of PUL concept.

  1. What do you think about this case?
  2. And the psychological effect of the first phase?
  3. What are the other options of treatment?

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