orthodontic class 2 div 2
TRANSCRIPT
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