MANAGEMENT OF CLASS II MALOCCLUSION

Dr Gazanafer Roshan

Department of Orthodontics, MES Dental College

Contents

• Introduction

​

• Classification Angles Class 2 malocclusion

​

• Angles Class 2 Division 1 malocclusion

​

• Angles Class 2 Division 2 malocclusion

​

​

Angle’s Class II malocclusion

​

Disto-buccal cusp of the first permanent molar occludes in the buccal groove of the lower first permanent molar.

​

CLASSIFICATION OF CLASS II MALOCCLUTION

​

Class II division 1 Class II division 2

Class II division 1 Class II division 2

subdivision subdivision

ANGLE’S CLASS II DIVISION 1 MALOCCLUSION

​

• Molar relation:

class 2

• Canine relation:

class 2

Features

1. Proclined maxillary incisors- Increased overjet

​

• Convex profile

​

• Lower incisor fails to make contact with palatal surface of upper incisor erupts freely increased overbite exaggerated curve of spee

​

• Short hypotonic upper lip, lower lip against palatal surface of upper incisor (Lip Trap) both leads to upper anteriors to procline

5. Lacks anterior lip seal due to short upper lip- incompetant lips

​

6. Abnormal muscle activity

Abnormal buccinator- constricted, narrow upper arch

posterior crossbite

Hyperactive mentalis activity

​

7. Sometimes proclined lower anteriors- natures compensation to reduce overjet

​

​

• Skeletal features

​

• Maxillary protrusion

​

• Mandibular retrusion

​

• Maxillary protrusion & mandibular retrusion

Etiology

​

• Prenatal factors

​

• Natal factors

​

• Post natal factors

• Prenatal factors
• Hereditary
• Teratogens

Eg: Aspirine,cigasret smoke,Thalidomide

• Irradiation
• Intra-uterine fetal posture

Eg:intra-uterine moulding

• Natal factors
• Birth trauma

​

• Forceps delivery- trauma to condyle ankylosed or fibrosed underdevelopment of mandible

• Postnatal factors

​

• Trauma to mandible & TMJ

​

• Longterm irradiation therapy of skeletal craniofacial region

​

• Infections- rheumatoid arthritis

​

• Abnormal functions

​

• Oral respiration
• Abnormal swallowing
• Oral habits

MANAGEMENT

TREATMENT OBJECTIVES

• Reduction of overjet

​

• Reduction of overbite

​

• Correction of crowding and local irregularities

​

• Correction of unstable molar relationship

​

• Correction of posterior cross bites

​

• Normalizing the musculature.

​

Growing Pt

Skeletal class II

Dental class II

Dental class II

Skeletal class II

​

Max Prognathism & Mand retrognathism

​

Mild to mod class II

Severe class II

Mand retrognathism

Max Prognathism

Max Prog

Max setback

Camouflage

Headgear & Myofunctional

Myofunctional Appliance

Headgear

Mand Retro

Non growing Pt

Mand advancement

Ortho Rx

TREATMENT OF CLASS II MALOCCLUSION

• Growing patient

Correction of skeletal class II malocclusion

growth modulation.

​

1.PROGNATHIC MAXILLA

• Restrict maxillary growth & distalize – HEADGEAR

​

• 12-14 hrs/day, force 400-450 gm / side

2.RETROGNATHIC MANDIBLE

• functional appliances.

​

• Acts by placing mandible in anterior position & also by eliminating functional retrusion

​

​

• Activator, Frankel ,TWIN BLOCK and Bionator.

​

• End of growth period- Fixed functional appliances like Herbst, Jasper jumpers are used.

Twin

block

VTO

3.PROGNATHIC MAXILLA & RETROGNATHIC MANDIBLE

• Headgear + Functional appliances.
• Activator with headgear commonly used.

Correction of dental class II malocclusion

• Crowding - distalization of molar or extraction.

​

• Deep bite- anterior bite planes in low angle cases.

​

• high angle cases, incisor intrusion using utility arches.

​

• Retraction of incisors is achieved by using labial bows or with fixed appliance mechanotherapy.

​

• Posterior crossbites- expansion screws

• Non growing patient

Correction of skeletal class II malocclusion

1. ORTHODONTIC CAMOUFLAGE

​

• Indications;
• Patients too old for growth modulation
• Mild or moderate skeletal class II
• Good alignment of teeth
• Good vertical propotions

​

• Extraction of upper 4’s alone – in well aligned lower arch with good intercuspation

​

​

• Extraction of all 4’s- in lower arch with endon molars, crowding, rotation, proclination correction

​

​

• Minimum anchorage cases- upper 4’s +lower 5’s

• Correction using distalization of molars

• Orthodontic camouflage is achieved through fixed appliance.

​

• Camouflage is best performed in adolescents but it is also done in adults.

2. SURGERY

Severe class II skeletal malocclusion

​

• Prognathic maxilla
• Le Fort I osteotomy
• Anterior maxillary osteotomy

• Retrognathic mandible

BSSO advancement

​

• Combination

Bijaw surgery with genioplasty,if required

ANGLE’S CLASS II DIVISION 2 MALOCCLUSION

• Molar relation:

class 2

• Canine relation:

class 2

• Incisor relation

>The central incisors are retroclined.

Other features

1. Lingual inclination of upper central incisors alone or central and lateral incisors together.
2. Canine overlaps the retroclined incisors
3. Square shaped arch
4. Deep overbite
5. Straight profile
6. Deep mentolabial sulcus
7. Absence of abnormal muscle activity

​

CLASS II DIV 2 MALOCCLUSION

Treatment objectives;

• Relief of gingival trauma
• Correction of incisor relationship
• Relief of crowding and local irregularities
• Correction of buccal segment relationship

1.FUNCTIONAL APPLIANCES

• Functional appliances with modification for division 2 malocclusion are used
• Usually incisors are aligned before giving functional appliances.

2. REMOVABLE APPLIANCES

• Hawley’s appliance with anterior bite plane.
• Hawley’s appliance with double cantilever spring.

3.FIXED APPLIANCE

• UPPER ARCH

​

• Fixed appliance in upper arch alone is indicated, when the overbite and incisor inclination is acceptable.

​

• UPPER ARCH AND LOWER ARCH

​

• Extraction and correction of crowding
• Overbite correction by active intrusion
• Achieve proper interincisal angle

5. RETENTION

• Prolonged retention should be planed.
• Pericision is done for the incisors.

4. ORTHOGNATHIC SURGERY

In severe form of class II division malocclusion, combination of orthodontics and jaw surgery is done.

​

• Mandibular advancement