Post-burn facial and neck contractures pose significant challenges to craniofacial growth, dentoalveolar development, and orthodontic biomechanics due to altered soft-tissue dynamics and reduced elasticity. This report describes a biomechanical adaptation of orthodontic treatment in a 16-year-old female with a history of extensive childhood facial and neck burns who presented with a skeletal Class II pattern, vertical growth tendency, anterior open bite, bimaxillary dentoalveolar protrusion, and severe lower facial and neck contractures. Given the elevated surgical risk and the potential for unpredictable scar response, a non-extraction orthodontic camouflage approach was selected. Treatment emphasised modification of conventional force systems through carefully controlled biomechanics, staged appliance placement, and vertical control to accommodate reduced soft tissue compliance and altered equilibrium, while minimizing adverse soft tissue effects. Favorable outcomes were achieved, including improved incisor inclination, reduction of anterior open bite, enhanced lip competence, and establishment of functional occlusion without exacerbation of soft tissue restrictions. This case illustrates that orthodontic camouflage, when guided by individualised controlled fixed orthodontic mechanotherapy and interdisciplinary planning, may be a feasible treatment alternative in high-risk patients with severe post-burn contractures where surgical intervention carries high risk.
