*Ideally, this case would be treated with a surgical maxillary impaction. However, at the parents' request, a compromise (incomplete) treatment was performed.

  • Skeletal: Mesofacial pattern, skeletal Class II, severe vertical maxillary excess.
  • Dental: Bimaxillary protrusion, mild arch length
    discrepancy and crowding, mild CO-CR discrepancy.
  • Facial: Protrusive lips, excessive upper incisor exposure, gummy smile.

  1. Align, level, and coordinate dental arches.
  2. Vertical control of the upper arch (anterior and posterior) with transpalatal bars and Asher facebow.
  3. Close spaces with maximum anchorage to reduce lip protrusion. In the upper jaw, the Asher facebow was used to retract and intrude the 6 anterior teeth.
  4. Finishing and detailing.

  • Skeletal: Mesofacial pattern, severe Skeletal Class II, retruded mandible.
  • Dental: Moderate upper arch length discrepancy and
    crowding, deep overbite, severe CO-CR discrepancy.
  • Facial: Retrusive chin, lip incompetent.

Cases treated by Dr. Jorge Ayala.


  1. Align, level, and coordinate dental arches.
  2. Restrain vertical and sagital maxillary growth with transpalatal bar and hi-pull headgear.
  3. Finishing and detailing.

I didn’t just learn a technique, I learned a PHILOSOPHY and was given a new perspective…If compared to what I did 20 years ago, I do a better job and achieve much better results now. I feel that this is a dynamic philosophy that continues to evolve and is always at the forefront of orthodontics. Even though a few years have passed since I took the course, I am still in contact with the instructors and continue to learn from them. — Dr. Alfonso Meza Tell