CLASS II\2 MALOCCLUSION

:PRESENTED TO
Dr.MAZEN SBEH
Dr.MOUHNAD AL-EQER &
:PREPARED BY
‘MOHAMMAD SALAH QREA
2008\2007
 Definition
• Class 2 div. 2 includes
those malocclusions where
the upper incisors are
retroclined, the lower are
also retroclined,and the
overjet is usually minimal.
 Abstract
• The orthodontic literature does
not agree on the skeletal
characteristics of this
malocclusion.
• But some studies agree the
skeletal rule in this
malocclusion.
 Aetiology
• Skeletal pattern.
• Soft tissue.
• Dentoalveolar rule.
 Skeletal pattern
• May associated with class II, I, or even class III
dental base relationship.
• The vertical dimension is also important and
typically is reduced, leading to increase
overbite.
• The forward rotational pattern leads to make
the mandible more prognathic, while this
growth is helpful for reducing the severity of the
class II, it is also increase the overbite unless
there is an occluzal stop.
 Soft tissues
• The influence of the soft tissues is usually
mediated by the skeletal pattern. If the
facial height is reduced the lower lip line
will be high causing retroclination of the
upper incisors.
 Dental factor
• Crowding
• Lack of the occluzal stop to eruption of the
lower incisors leading to increase the
overbite, this may be due to class II
skeletal pattern or retroclination of the
upper incisors due to other factors.
 Management
• Two goals:
• Reduction of the overbite.
• Reduction of the inter-incisal angle.
 Inter-incisal angle
• Reduced by:
• 1-) torquing the incisal roots lingually with
fixed appliance.
• 2-) proclination of the anterior lower
segment.
• 3-) proclination of the upper labial
segment followed by a functional
appliance to reduce the resultant overjet.
• 4-) OR combination of the above.
 The Options
• The treatment approach chosen for a
particular patient will depend on the:
• Aetiology of malocclusion.
• The degree of the crowding.
• The patient's profile.
• And the patient's compliance.
• After the decision is made we must decide
whether extractions are required or not.
Mild crowding
Moderate Severe
 Mostly without
• The treatment of the class II\2 are
managed more frequently on a non-
extraction basis, particularly in the lower
arch.
• Dished in profile.
 !!?But why in lower
• If we decide to extract in the lower we
must prevent and watch the lingual
movement of the labial segment causing
worsening the overbite, indeed we may
prefer some degree of the crowding rather
than this risk.
 Overbite reduction
• 1-) incisors intrusion.
• 2-) molars eruption.
• 3-) extrusion of molars.
• 4-) proclination of lower incisors.
• 5-) or surgery.
 intrusion of the incisors )-1
• It is easier to extrude the molars than to
intrude incisors.
• High pull headgear can be hooked onto
the anterior segment by fixed appliance.
• Increasing the anchorage area will reduce
the extrusion of the molars and aiding the
intrusion of the incisors.
 High pull headgear

Intrusion force system consists of anterior intrusive force,

.posterior extrusive force, and pos­terior tipback moment
 eruption of the molars )-2
• In a growing child we can use removable
upper appliance with anterior bite plan
causing to free the occlusion of the buccal
segment, this lead to eruption of the
molars and limiting the occluzal movement
of the incisors, thus reducing the overbite
and increasing the vertical dimension.
 extrusion of the molars )-3
• This method is important in increasing the
vertical dimension, but the overbite
reduction that must be achieved in this
way is to be stable.
proclination of the lower incisors )-4
• This method should only be carried out by
experienced orthodontist.
• In a few cases where the lower anterior
segment is trapped behind the upper by
increased overbite, fitting of an upper bite-
plan appliance may cause spontaneous
proclination of the lower incisors.
 surgery )-5
• In adults with increased overbite and with
underlying skeletal class II pattern, a
combination of both surgery and
orthodontics is required.
 Practical management
• We can accept or treat the incisor
relationship.
• The extraction may in some cases worsen
the problem.
• The degree of the overbite mostly
determines the treatment plan.
 The incisor relation is to be
.accepted
• 1-) in mild cases where the lower incisors
occlude on the tooth structure.
• 2-) in mild to moderate lower arch
crowding where the extraction may cause
lingual movement of the Incisors
worsening the overbite.
• 3-) where the extraction run the risk of
tilting of the incisors that cause trauma to
palatal gingiva.
 The incisor relation is to be
.corrected
• When the incisors bite on the palatal
gingiva.
• Corrected by using:
• 1-) fixed appliance.
• 2-) functional appliance.
• 3-) surgery.
 Fixed appliance
• Used to reduce the inter incisal angle by
tourquing the roots or by proclination of
the lower incisors.
• Torquing of the apices depends on the
palatal\lingual bone.
• This type of movement is more commonly
associated with roots resorption than other
movements.
• The mild crowding can be managed by
forward movement.
• In marked crowding the extraction is
required with fixed appliance.
• The headgear if to be used must be low
pull )cervical pull) that is indicated in class
II\Dv2
• The retention should be continued until the
growth is complete
 Functional appliance
• Used in mild to moderate class II skeletal
pattern, with class II\dv 2, and a relatively
well-aligned lower arch in a growing child.
• Reduction of the inter incisal angle is
achieved by the proclination of the lower
anterior segment.
• activator type or twin-back functional
appliances.
• If we decide to use activator type, we must
procline any retroclined incisors and to
expand upper arch, this design called
ELSAA.
• If a twin-block is used, then a spring to
procline the incisors can be incorporated
into the upper appliance.
ELSSA
TWIN­BLOCK
 Surgery
• In patients with an unfavourable skeletal
pattern anteroposteriorly and\or vertically,
particularly if the growth is completed.
 DEGREESº =? Initial Final Norm
SNA ?77.6 ?78.3 ?82.0
SNB ?76.5 ?76.0 ?80.0
ANB ?1.1 ?2.3 ?2.0
Mx 1 ­ NA mm 3.4 mm 5.8 mm 4.0
Mx 1 ­ NA Angle ?5.7 ?24.9 ?22.0
Md 1 ­ NB mm 2.2 mm 5.2 mm 4.0
Md 1 ­ NB Angle ?15.9 ?24.2 ?25.0
PO ­ NB mm 8.6 mm 7.2 mm 1.0
Occlusal Plane ­SN ?23.4 ?22.2 ?14.0
GO ­GN ­ SN ?28.8 ?31.3 ?32.0
Interincisal Angle ?157.2 ?128.6 ?130
FMA ?17.0 ?21.9 ?25.0
FMIA ?72.3 ?61.3 ?65.0
IMPA ?90.6 ?96.9 ?90.0
Maxillary Convexity mm 3.3­ mm 1.2­ mm 0.9
Thanks