class 2 malocclusion

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CLASS II MALOCCLUSION By: WAQAS KHAN

DEFINITION:

DEFINITION Angle Class Classification: The mesiobuccal cusp of the upper 1st molar falls mesial to the mesiobuccal groove of the lower 1 st molar.

CLASS II MALOCCLUSION:

CLASS II MALOCCLUSION

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British Standards Institute Classification: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors. 1. Division 1: The upper central incisors are proclined or of average inclination and there is an increased in over jet. 2. Division 2: The upper central incisors are retroclined. The overjet is usually minimal or may be increased

Div 1:

Div 1 Div 2

ETIOLOGY:

ETIOLOGY Skeletal base relationships Habits, e.g. Thumb sucking Soft tissues: lip trap, short upper lip (div 1) strap like lower may retrocline upper incisors (div 2)

TREATMENT OPTIONS:

TREATMENT OPTIONS Growth modification Orthodontic camouflage Orthognathic surgery

GROWTH MODIFICATION:

GROWTH MODIFICATION Aim for Growth modification Some mandibular growth Some restraint of maxillary growth Forwards mandibular rotation

HOW TO MODIFY GROWTH:

HOW TO MODIFY GROWTH Headgears (high pull & cervical pull) Functional appliances

HEADGEARS:

HEADGEARS In class ii malocclusion, HG has 2 functions: restrain maxillary AP growth so allows mandible to catch up to control the vertical position of the maxilla and maxillary posterior teeth as downward movement of either the jaw or the teeth will project mandibular growth more vertically

SELECTION of HG TYPE:

SELECTION of HG TYPE High pull HG: superior and distal force on teeth and maixllar Cervical pull: inferior and distal force The more signs of a vertically excessive growth pattern are present, the higher the direction of pull and vice versa

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Center of resistance of the molar is in the midroot region, force vector above this point should result in distal root movement and vectors below this point should cause distal crown tipping The length and position of the outer HG bow and the form of anchorage ( head cap or neckstrap) determine the vector of force Center of resistance of maxilla is above premolar root

ORTHODONTIC CAMOUFLAGE:

ORTHODONTIC CAMOUFLAGE Aim of treatment Relieve crowding Level and align arches Decrease OB Decrease OJ

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Considerations : to reduce OB with anterior bite plane aid correction of buccal segment with EOT convert class II div 2 patients to class II div 1 Xtn 5s rather than 4s to minimize lingual movement of LLS

ORTHOGNATHIC SURGERY:

ORTHOGNATHIC SURGERY Correction of functional and aesthetic consequences of severe dentofacial deformity through combination of orthodontic, surgical and, possibly, restorative dentistry.

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Indications Orthodontic problems are so severe that neither growth modifications nor camouflage affects a solution.

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Le Fort I, II & III SARPE

STABILITY:

STABILITY Relapase mostly occurs 6-8 wks post op Proffit et al., 1996 Late relapse >1yr post op in 2.5-8% of pts depends on direction of movement, fixation, technique used. Proffit et al., 1996 Similar relapse with BSSO and VSS, approximately 10% ( Proffit et al 1996) Mandibular advancement – stable if no vert face height change

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