Comprehensive Dentition Intrusion in Hyperdivergent Patients Using Temporary Skeletal Anchorage Devices

Hyperdivergent skeletal Class II malocclusion is largely genetically determined and poses significant challenges in orthodontic treatment, particularly due to compromised facial aesthetics, reduced bite force and airway narrowing. Traditionally, orthognathic surgery has been the standard treatment for correcting such skeletal discrepancies. However, the advent of temporary skeletal anchorage devices (TSADs) has expanded the possibilities for orthodontic camouflage by allowing effective vertical control. This narrative review outlines key diagnostic considerations-including vertical maxillary excess (VME) and its regional distribution, mandibular morphology and rotational pattern, overbite depth and occlusal plane steepness-that determine the selection of treatment targets and mechanics. Based on these factors, the treatment target may be limited to just posterior intrusion or might be expanded to total arch intrusion, involving either the maxillary arch alone or both arches. Treatment mechanics vary accordingly, with diverse TSAD placement strategies and the use of adjunctive appliances to enhance control. Clinical studies have reported successful skeletal changes such as counterclockwise mandibular rotation and improved overbite. Total arch intrusion, particularly in patients without anterior open bite, requires proportionally greater incisor intrusion and often involves dual-arch mechanics. The 'double arch intrusion' technique provides a simplified and efficient protocol using a minimal number of TSADs. Long-term outcomes of such camouflage treatments are comparable to surgical approaches, with most relapse occurring within the first year. Proper retention strategies are essential for maintaining stability.