2023-10-09

Treatment of Skeletal Problems

in Children 2

Dr. Fernando Inocencio

DDS, Dip. in Ortho.
Division of Orthodontics and
Paediatric Dentistry

Treatment of Class II Problems

Functional Appliances

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In functional appliance
treatment, additional
growth is supposed to
occur in response to the
movement of the
mandibular condyle out of
the fossa, mediated by
reduced pressure on the
condylar tissues or by
altered muscle tension on
the condyle

Although an acceleration of
mandibular growth often occurs, a
long-term increase in size is
difficult to demonstrate.
An effect on the maxilla, although
small, is almost always observed
along with any mandibular effects.
When the mandible is held
forward, the elasticity of the soft
tissues produces a reactive force
against the maxilla, and restraint of
maxillary growth often occurs

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Beyond the skeletal effects,

functional appliances and
headgear do differ in their effects
on the dentition. Headgear force
against the molar teeth often tips
them distally but usually has little
effect on other teeth. Removable
functional appliances, especially
the tooth-borne ones, often place
a distal force against the upper
incisors by way of the labial bow
that tends to tip them lingually.

The combination of maxillary

dental retraction and mandibular
dental protrusion that all
functional appliances create is
similar to the effect of interarch
elastics. This "Class II elastics
effect" can be quite helpful in
children who have maxillary dental
protrusion and mandibular dental
retrusion in conjunction with a
Class II skeletal problem.

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Functional appliances also can influence eruption of posterior

and anterior teeth. It is possible to level an excessive curve of
Spee in the lower arch by blocking eruption of the lower
incisors while leaving the lower posterior teeth free to erupt.

If upper posterior teeth are

prohibited from erupting and
moving forward while lower
posterior teeth are erupting up and
forward, the resulting rotation of
the occlusal plane and forward
movement of the dentition will
contribute to correction of the
Class II dental relationship..

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Fabrication of Appliances:

Constructive bite

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Class II Malocclusion
Functional Appliances

Bionator

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Class II Malocclusion
Functional Appliances

Twin Block

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Class II Malocclusion
Functional Appliances

Twin Block

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Class II Malocclusion
Functional Appliances

Frankel II

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Class II Malocclusion
Functional Appliances

Herbst

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Class II Malocclusion
Functional Appliances

Herbst

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Class II Malocclusion
Functional Appliances

Herbst

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Class II Malocclusion
Functional Appliances

Jasper Jumper

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Class II Malocclusion
Functional Appliances

Twin Force Bite Corrector

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Class II Malocclusion
Functional Appliances

Forsus

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Class II Malocclusion
Headgear

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Class II Malocclusion
Headgear

The other possible treatment for mandibular deficiency is to

restrain growth of the maxilla with extraoral force and let
the mandible continue to grow more or less normally so that
it catches up with the maxilla.

No effect on the mandible would be expected, but restraint

of mandibular growth along with restraint of maxillary
growth is never observed, and some studies have found
improvement in mandibular growth and chin prominence
during headgear treatment.

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Class II Malocclusion
Headgear

• Head cap
• Face bow

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Class II Malocclusion
Headgear

• Inner bow
• Intraoral
Anchorage

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Class II Malocclusion
Headgear

High Pull
Headgear

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Class II Malocclusion
Headgear

Cervical
Headgear

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Class II Malocclusion
Headgear

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Class II Malocclusion
Headgear

Results after approximately 2

years of headgear treatment.
Favorable downward–forward
mandibular growth with limited
change in the maxillary position.
Some posterior teeth eruption
and maxillary incisor retraction.

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