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SEMINAR PRESENTATION
MANAGEMENT OF CLASS II MALOCCLUSION
SUBMITTED BY:
FATHIMA SHAMIN
FINAL YEAR PART I
180021889
CONTENTS
Introduction
Definition
Treatment objectives
Management
Conclusion
Reference
INTRODUCTION
Orthodontic specialty deals with various malocclusions.
Many treatment approaches are currently available to the orthodontists for altering the
occlusal relationship typically found in class II malocclusion.
These treatments include a variety of extraoral retraction appliances, arch expansion,
extraction procedure, functional jaw orthopedic appliance, molar distalisation etc
DEFINITION OF CLASS II
According to Angle’s classification: it is when the distobuccal cusp of the maxillary first
molar occludes in mesiobuccal groove of mandibular first molar
Class II is subdivided into
Class II Division 1
Class II Division 2
TREATMENT OBJECTIVES
Reduction of overjet
Reduction of overbite
Correction of crowding and local irregularities
Correction of unstable molar relationship
Correction of posterior crossbite
Normalizing the musculature
TREATMENT
There are three basic approaches to the treatment of class II malocclusion
They are:
1. Growth modification
2. Camouflage
3. Surgical correction
GROWTH MODIFICATION
Growth modification can be achieved by;
orthopedic appliances like head gear
functional appliances like activator, bionator, twin block, frankel appliance
fixed functional appliance (herbst, jasper jumper, twin block)
HEADGEAR
For a patient of either gender who is beyond the mixed dentition period but still in the
adolescent growth spurt, there is no reason to wait for alignment and leveling to be completed
before beginning treatment with a headgear or a fixed functional appliance.
Headgear used for growth modification apply a posterior and superior force on the maxilla
using maxillary first molars as handles to deliver forces
Two types of headgears used are cervical headgear and occipital headgear
CERVIAL HEADGEARS
A cervical headgear takes anchorage from the neck and therefore has a posterior and inferior
force direction. This produces distal and an extrusive force on maxillary molars
Extrusion of molars cause further clockwise rotation of mandible and worsens skeletal class
II. Therefore, cervical headgears are indicated only in patients who exhibit horizontal growth
pattern
OCCIPITAL HEADGEARS
Occipital headgears take anchorage from the head and have higher point of attachment.
Direction of force is posterior and superior. Therefore, it helps in antero-posterior skeletal
problems as well as vertical maxillary excess.
Lighter continuous forces are capable of efficient tooth movement
400-600gm force per side is required for 12-14hours
FUNCTIONAL APPLIANCE
By definition, a functional appliance is one that changes the posture of mandible, holding it
open or open and forward. Pressure created by stretch of the muscles and soft tissues are
transmitted to the dental and skeletal structures, moving teeth and modifying growth
Both removable and fixed functional appliances can be used
When the mandible is held forward, the elastic stretch of soft tissues produces a reactive
effect on appliances. If the appliance contacts the teeth, this reactive force produces an effect
like that of class II elastics, moving the lower teeth forward and the upper teeth back, and
rotating of the occlusal plane.
Even if contact with the teeth is minimized, soft tissue elasticity can create a restraining force
on forward growth of maxilla, so that a headgear effect is observed
HERBST APPLIANCE
Herbst created in 1900s and reported on it in 1930s
This appliance forces patient to maintain an advanced mandibular position. It is
recommended for early permanent dentition but not for mixed dentition.
Because this appliance can produce maxillary posterior dental intrusion, it provides better
result when used in patients with normal or slightly long anterior face height.
The major disadvantage of this appliance is breakage.
MARA
Mandibular anterior repositioning appliance
It is less bulky and an alternative to Herbst appliance with the same fixed properties and
anterior bite guidance.
It has less effect on mandible compared to Twin-block and Herbst. It tips the teeth and has
dentoalveolar effects. The amount of tipping depends on which anterior or posterior teeth are
included in anchorage units.
CAMOUFLAGE
In patients who have reasonable jaw relationship, the underlying skeletal discrepancy can be
camouflaged by orthodontic teeth movement.
This is acceptable treatment, only if the patient’s facial appearance as well as dental
alignment and occlusion are satisfactory.
There are 3 major ways to correct class II malocclusions with tooth movement.
1. Non extraction correction (distal movement of upper molars)
2. Differential anterio-posterior tooth movement using extraction spaces.
3. Non extraction correction- consists primarily of forward movement of lower arch
using inter arch elastics
A patient with both class II problems and crowding is a difficult problem because the same
space cannot be used for both purposes.
The more extraction space is required for alignment, the less is available for differential
movement in camouflage and vice versa
SURGICAL CORRECTION
In patients exhibiting severe skeletal malrelationsip, surgery maybe the ideal treatment
modality. Based on the underlying skeletal pattern a maxillary set back or a mandibular
advancement is undertaken after completion of growth.
MANDIBULAR SURGERY
Sagittal split osteotomy is done and the mandible can be moved forward. This procedure is
quite compatible with the use of rigid intraoralfixation (RIF) so that immobilization of the
jaws during healing is not required.
Excellent bone to bone contact after the osteotomy means that the problem with healing are
minimized and postsurgical stability is good.
MAXILLARY SURGERY
Le fort I osteotomy/ maxillary segmental (anterior) setback is done. Vertical excess of the
maxilla can be aptly treated by Le Fort osteotomy of the maxilla and taking a slice of the
bone beyond root apices at the nasal septum and walls of sinus lateral to the pyriform
aperture.
The maxilla is moved upward in a favorable rotation (more upward in the posterior region, if
so required) thereby resulting in an anticlockwise rotation of mandible, improvement in face
profile and of class II relation to some extent.
CONCLUSION
Class II malocclusion have several forms of presentation. It can be identified with specific
skeletal and dental features. The treatment varies for growing and non growing patients.
Growth modification, camouflage and orthognathic surgeries are main three treatment
approaches for class II correction.
REFERENCE
Contemporary Orthodontics: Profitt
Orthodontics, Diagnosis and Management of Malocclusion and Dentofacial
deformities: Om P Kharbanda
Orthodontics- The art and science: S I Balajhi