Orthodontics, malocclusion,class 2

1. ANUSHA SREEDHARAN
SRM KATTANKULATHUR DENTAL
COLLEGE

2. CONTENTS:
 Introduction
 Etiology
 Clinical features
 Class II division 1 malocclusion
 Class II division 2 malocclusion
 Diagnosis
 Management
 Growth modification
 Camouflage
 Surgery

3. INTRODUCTION
It was based on the mesio
distal relation of the teeth,
dental arches and the jaws. The
maxillary first permanent molar
is the key to occlusion.
Edward Angle in 1899

4. ETIOLOGY
SKELETAL PATTERN:
Prognathic maxilla or retrognathic mandible or combination of both.
PRENATAL
FACTORS:
Hereditary
Teratogenesis
Irradiation
Intra uterine fetal
posture
POST NATAL
FACTORS:
Trauma to mandible
Long term irradiation therapy
Infections
Habits like mouth breathing,
thumb sucking that prevents
normal muscle activity
NATAL
FACTORS:
During forceps
delivery, trauma in the
condylar region can
cause under developed
mandible
DENTAL PATTERN:
Max dental
protrusion with
no underlying
skeletal
component.
Max 1st molar
moved mesially due
to absence or early
loss of max. 2nd
primary molar.
Tooth size
discrepancy due to
smaller/ congenitally
absent max. teeth
can cause mesial
movement of max.
molars.
Impaction/
ectopic
eruptionof
certain max.
teethcauses
mesial drift of
max. molar.

5. CLASS II DIVISION 1
EXTRA ORALLY
Convex profile Deep mento labial sulcus
Hypotonic upper lip
Hyperactive mentalis
Lip trap

6. CLASS II DIVISION 1
INTRAORALLY
Class II molar relation Excessive curve of spee &
flared incisors
Due to unrestrained buccinator activity, Increased overjet & deep bite
narrowed V- shaper upper arch

7. CLASS II DIVISION 2
EXTRA ORALLY
Straight profile Hypotonic upper lip

8. CLASS II DIVISION 2
INTRA ORALLY
Class II molar relation Lingually inclined upper C.I &
labially tipped L.I overlapping C.I
Deep overbite & minimal Square shaped arch &
over jet traumatising retroclined lower anteriors
the gingiva

9. DIAGNOSIS
 History
 Intra oral & extra oral examinatiion
 Study models
 Photographs
 Radiographs
 Cephalometrics
 Orthopantomogram
 Hand wrist radiograph

10. MANAGEMENT
3 basic approaches:
Growth modification
Camouflage
Surgical correction

11. GROWTH MODIFICATION
a). Maxillary prognathism - Headgears
Occipital head gear Cervical head gear Combination head gear
Anchorage from head Anchorage from neck Anchorage from head & neck
Direction of force- Direction of force- Direction of force-
Force of 400- 600gms per side applied for 12- 16 hrs.
Neck strap or head cap and a facebow is attached intraorally t
maxillary molar on either side.

12. GROWTH MODIFICATION
b). MANDIBULAR RETROGNATHISM - Myofunctional appliance
Removable:
Activator Bionator
Frankels appliance Twin block

13. GROWTH MODIFICATION
b).MANDIBULAR RETROGNATHISM -Myofunctional appliance
Fixed:
Herbst appliance Jasper Jumper

14. CAMOUFLAGE
a). With extraction of teeth.
To obtain correct molar & incisor relationship despite
uncorrected skeletal decrepancy.
On upper arch alone:
On both arches:
Retraction of upper anteriors
Class II molar relation
Class I canine relation
Normal overjet
Retraction of upper anteriors &
protraction of lower molars
Class I molar relation
Class I canine relation
Normal overjet

15. CAMOUFLAGE
b. Without extraction of teeth.
 Utlization of spaces present in the arch.
Distalization of maxillary molars.
Done prior to eruption of 2nd molar or after
extraction of 2nd or 3rd molar.

16. CAMOUFLAGE
c). Class II Elastics
Stretches between the maxillary canine & mandibular
1stmolar.
It delivers anterior force on mandibular teeth & a
posterior force on posterior teeth; protracting mandibular
teeth & retracting maxillary teeth.

17. CLASS II DIVISION 2
 Here the treatment objective is to:
 Obtain class I molar relation- By camouflage or
growth modification.
 Reduce incisal overbite-
Anterior bite plane Anchor bends
 Alteration of incisal inclination-
Torquing springs to move upper
incisor roots lingually &
crowns bucally

18. SURGERY
In maxillary prognathism,
Maxillary segmental (anterior) set back.

19. SURGERY
In mandibular retrognathism,
Sagittal split osteotomy Sliding chin genioplasty
With mandibular advanvement

20. REFERENCES
 Contemporary orthodontics by
William. R. Profitt (5th edition)
 Orthodontics- The art &
science by S.I.Balajhi