Surgical Management of Relative Chin Prominence in Class II Malocclusions.

[BACKGROUND] Relative chin prominence is commonly observed in certain Class II malocclusion morphotypes, particularly in deep bite and Class II Division 2 patterns. Despite mandibular retrusion, soft tissue volume and anterior mandibular rotation can produce a prominent chin appearance. This esthetic paradox presents a challenge for surgical planning and is currently not addressed by standardized management protocols.

[PURPOSE] To summarize the surgical approaches reported for the management of relative chin prominence in Class II malocclusions.

[STUDY SELECTION] The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Five electronic databases were searched for studies published between 1975 and 2025 using predefined keywords related to class II malocclusion, chin prominence, and orthognathic surgery. Two reviewers independently screened the records, and any disagreements were resolved by a third reviewer. No formal quality assessment was performed, in accordance with the scoping review methodology.

[RESULTS] Eleven studies including 116 patients met the inclusion criteria. Six surgical techniques were identified: total mandibular subapical osteotomy (TMSO), mandibular anterior subapical osteotomy, archwise distraction osteogenesis, mandibular advancement with clockwise rotation (MACR), clockwise bimaxillary rotation, and bilateral sagittal split osteotomy (BSSO) with setback genioplasty. Among these approaches, clockwise bimaxillary rotation was the most frequently described and was associated with favorable esthetic and functional outcomes, although the level of evidence was limited.

[CONCLUSIONS AND RELEVANCE] The available literature does not support a definitive gold standard for managing relative chin prominence in Class II malocclusions. While clockwise bimaxillary surgery appears to offer favorable outcomes in selected cases, each technique presents specific advantages and indications. Surgical planning remains individualized and requires close interdisciplinary collaboration. Further prospective studies are needed to better define indications and long-term outcomes.