## 4 Discussion  
[PERSON] [8] emphasized the importance of the position of mandibular incisors in determining esthetics after orthodontic treatment. However, despite being rooted in hard tissue analysis of the teeth and alveolar bone, [PERSON]'s diagnostic approach has been overshadowed by modern soft tissue-focused diagnostics [12; 13]. The present study emphasizes the importance of mandibular incisor position and inclination in patients' satisfaction with facial esthetics and occlusion after orthodontic correction of Class II malocclusion, particularly after ASO and NASO treatments resulting in ANB normalization. The study revealed that the ASO group exhibited significantly greater IMPA values than did the NASO group both before and after treatment. Additionally, mandibular incisor movement and IMPA changes were smaller in the ASO group than in the NASO group, suggesting that mandibular incisor inclination, camouflaged by severe skeletal disharmony pretreatment, persisted post-treatment, despite surgical intervention. However, unlike two-jaw surgeries, ASO preserves basal bone integrity, limiting the dentition's camouflaging potential, as observed in this study. Table 3 demonstrates that the pretreatment FMIA values were 45.68\({}^{\circ}\) for the ASO group and 51.84\({}^{\circ}\) for the NASO group. After treatment, while the FMIA was 51.87\({}^{\circ}\) (\(\Delta\)6.19\({}^{\circ}\)) in the ASO group, in the NASO group, it was 63\({}^{\circ}\) (\(\Delta\)11.16\({}^{\circ}\)). This suggests that if mandibular incisor inclination falls within the range where normal FMIA values can be achieved through tooth movement and inclination adjustments with extraction orthodontics, NASO may yield esthetically pleasing and stable treatment outcomes, obviating the need for ASO. When comparing VTO/STO, achieving 5\({}^{\circ}\) more of incisor uprighting with orthodontic teeth movement may only suffice for nonsurgical treatment, given that the changes in FMIA were 4.98\({}^{\circ}\) greater in the NASO group than in the ASO group (\(p\) < 0.05); this serves as a clinical benchmark for deciding between ASO and NASO. Consequently, reevaluating the importance of the mandibular incisor inclination improvement in patients with Class II skeletal malocclusion while considering [PERSON]'s diagnostic method underscores the significance of both initial mandibular incisor inclination and achievable movement of the mandibular incisors. In a comparative study by [PERSON] and [PERSON] [3], orthodontic treatment was found to be more effective than ASO, especially in cases where the maxillary teeth were inclinedforward, the occlusal plane was less steep, the interlabial gap was large, and the lower nasolabial angle was acute. Conversely, [PERSON] et al. [5] recommended ASO for cases with normal-range maxillary incisor inclination, relatively deficient chin growth, and a gummy smile. They also suggested that orthodontic treatment was preferable to ASO in patients with a skeletal Class I relationship and proclined upper and lower incisors. These recommendations were based on the assumption that orthodontic treatment with extraction is preferable for cases with maxillary or bimaxillary incisal proclination, whereas ASO is suitable for cases with skeletal issues or normal-range maxillary incisor inclination. However, this study found no significant difference in maxillary incisor inclination between the ASO and NASO groups before treatment. Specifically, it was noted that during orthodontic treatment, more controlled maxillary incisor movement can be achieved within the alveolar bone compared to that of the mandibular incisors due to the thicker medullary space of the palatal bone. Furthermore, advancements in orthodontic devices, such as TADs, have increased the scope of tooth movement in contemporary orthodontics.