CLASS 2 DIVISION 2 MALOCCLUSION

Prepared by : Haval Jalal

CLASS II

ANGLE’S CLASS II The distobuccal cusp of the upper 1st permanent molar occludes in the buccal groove of the lower 1st permanent molar.

CLASS II INCISOR RELATIONSHIP

The lower incisal edges lie posterior to the cingulum plateaux of the upper incisors.

DIVISION 2 – The upper central incisors are

retroclined ; the overjet is minimal but may be

increased.

CLASS II, DIVISION 2 MALOCCLUSIONS1) Occurs in about 10% of children.

2) In milder forms they may be

acceptable functionally, and the

facial appearance can be pleasing.

3) In severe cases the over bite is very deep, associated with periodontal trauma palatal to upper, and labial to the lower incisors.

4) Class II, Div. 2 incisor relationship is generally the result of dento-alveolar compensation for a class II skeletal pattern  by retroclination  of the upper central incisors.

FEATURES

1) Molars in disto-occlusion.

2) The classic feature of the upper incisors.

3) Deep overbite.

4) Pleasing straight profile.

5) Broad square face.

6) Backward path of closure.

7) Deep mento-labial sulcus.

8) Absence of abnormal muscle activity.

Occlusal Features

SKELETAL RELATIONSHIPS

1) The skeletal pattern may be Class I, but is generally mild Class II, and the chin is well developed so that the facial profile is good.

2) The lower anterior face height is often smaller than average and characteristically the maxillary-mandibular planes angle is low, with a well-developed mandibular angle

FACIAL GROWTH

In many class II, Div.2 patients, facial growth is favourable, and there is an anterior mandibular rotation, as might be expected from the diminished anterior face height and the form of the chin.

SOFT TISSUES

1) The lips are almost always of adequate length to meet without strain.

2) Frequently the lip line is high relative to the upper incisor crown, and the higher the lip line the more retroclined the upper incisors are liable to be.  There is often a well-developed labiomental fold.

MANAGEMENT OF CLASS II DIV 2

Three important factors to consider in the management are : 1. Nature of malocclusion. 1.Skeletal. 2.Dentoalveolar. 3.Functional. 4.Combination.

2. Severity of malocclusion. 1.Mild. 2.Moderate. 3.Severe 3. Age.

1.Growth left. 2.After growth

MANAGEMENT OF CLASS II DIV 2

Mandible is usually guided posteriorly due to premature

contact from the retroclined incisors and thereby

restricting its growth.

The treatment sequence remains the same except that for any

form of treatment modality to be instituted the retroclined

teeth have to be aligned in a proper labiolingual direction.

1. Mixed dentition phase – Use of functional

appliances after proclining the maxillary anteriors.

Results are good even after the eruption of

permanent teeth. The maxillary first premolars are

extracted generally to create space for aligning

crowded maxillary anterior segment.

2. After the cessation of growth – The need for

orthognathic surgery increases with the increase

in the severity of the problem.

The surgical procedures are also the same but

the use of presurgical orthodontics becomes

imperative to achieve stable results.

ORTHPAEDIC DEVICES USED IN TREATMENT OF CLASS II

1. High pull H.G(parietal)

2. Medium pull H.G(occipital)

3. Low pull H.G(cervical)

4. Combee pull H.G

5. Reverse pull H.G

Functional Appliances

Functional appliances are designed to change the patients

1) Pattern of function,

2) Alter the jaw relationships,

3) Reprogram the neuromusculature,

thus altering the functional matrix of the face.

TWIN BLOCK APPLIANCE

ACTIVATOR BIONATOR

FIXED FUNCTIONAL APPLIANCES

1) Herbst appliance 2) Jasper Jumper3) Universal bite

jumper4) Mandibular

corrector

…………………..etc

MOLAR DISTALIZATION

1) The Pendulum appliance

2) The K-loop appliance

3) The distal jet

4) Modified Nance Lingual

appliance

5) Molar distalization with magnets

6) Use of Super elastic NiTi

7) NiTi Double Loop system

CAMOUFLAGE

Treatment of malocclusion

with underlying mild or

moderate jaw discrepancies,

which can achieve a good

dental occlusion, through

extraction of certain teeth, to

mask skeletal problem.

1) Mild to moderate skeletal Class II Jaw

2) Reasonably good alignment ( so that Xn spaces can be used for retraction and not to relieve crowding)

3) Good vertical facial

proportions, neither

extreme short face

(skeletal deep bite) or long

face (skeletal open bite)

4) Too old for growth modification.

SURGICAL CORRECTION

Surgical option should be choosen in following cases:

1.Severe skeletal discrepancy or extremely severe dento alveolar problem.

2.Adult patients.

3.Young patients with extremely severe or progressive deformity.

4.Good general health status of patient.

DISTRACTION OSTEOGENESIS