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CLASS II MALOCCLUSION
Usman & Mehmood
DEFINITION:
The lower dental arch is posterior to the upper in one or both the lateral segments.1
The lower first molar is distal to the upper first molar.1
DIVISIONS:
Division 1
Division 2
DIVISIONS
Class II division 1:
Bilaterally distal with narrow maxillary arch with protruding upper incisors.1
DIVISIONS
Class II division 2
Bilaterally distal with normal or square shape maxillary arch, retruded maxillary central incisors, and an excessive overbite.1
TYPES OF CLASS II DIVISION 2
TYPE A: central incisors retroclined and laterals proclined
TYPE B: central and lateral incisors retroclined and canines buccally placed
TYPE C: all anterior teeth retroclined
ETIOLOGY OF MALOCCLUSION Heredity
Habits Thumb sucking Digit sucking Tongue thrust Lip thrust Lip trap Lip biting Nail biting
ETIOLOGY OF MALOCCLUSION
Speech defects Abnormal sucking habits Psychogenic problems
CHARACTERISTICS
DIV 1DIV 2
Convex Straight to mildly convex
Short
Everted
Incompetent
Normal
Normal
Competent
Deep Deep or normal
Hyperactive Normal
CHARACTERISTICS
PROFILE
LIPS
a. Upper
b. Lower
c. Competency
MENTOLABIAL SULCUS
MENTALIS MUSCLE
CHARACTERISTICS contd.
Malar processNot prominentProminent
Lower facial heightNormal or increased Decreased
Arch form V shapedSquare, U shaped
Palatal vaultDeep Normal
Incisors Proclined Central retroclined; laterals proclined
CHARACTERISTICS contd…
Overjet Increased Decreased
Crown root angulations
Normal angleAxis of crown and root bent; collum angle
Path of closureNormal Backward path of closure
Interocclusal clearance
Normal/ Increased/ Decreased
Increased
Class II division 1 malocclusion
Class II division 2 malocclusion
CEPHALOMETRIC ANALYSIS
Except for the maxillary incisor positions, no basic difference in dentoskeletal morphology exists between class II division 1 and class II division 2 malocclusions
CEPHALOMETRIC ANALYSIS Class II division 1 Upper incisor to SN
plane angle increased
Increased upper incisor-soft tissue linear measurements
CEPHALOMETRIC ANALYSIS Class II division 2: Upper incisor to SN
plane angle decreased
Decreased upper incisor-soft tissue linear measurements
MANAGEMENT
Class II Division 1
Class II Division 2
MANAGEMENT
PROBLEMS:
Skeletal Dental Combination
MANAGEMENT Class II Division 1
OBJECTIVES: Improvement of esthetics Correction of increased overjet Correction of deep bite Alignment of anterior teeth Correction of class II molar
relationship Correction of deep Curve of
Spee Correction of any individual
problems
MANAGEMENT Class II Division 1
IN DECIDUOUS DENTITION:
Habit control
Supportive aids
MANAGEMENT Class II Division 1 IN MIXED DENTITION: DENTAL DISCREPANCY: Removable appliances Molar distalization Space maintainers Space gainers Habit breaking appliances
Vestibular shields Tongue guards/cribs
Myofuntional therapy Tongue positioning excercises Lip excercises
MANAGEMENT Class II Division 1
SKELETAL DISCREPANCY:
FOR MANDIBULAR DEFICIENCY
Myofunctional appliances
FR 1
Activator
Bionator Fixed functional appliances
(late mixed dentition)
Herbst appliance
Jasper Jumper
MANAGEMENT Class II Division 1
FOR MAXILLARY PROGNATHISM
Face bow with head gear
FOR COMBINATION
Activator with head gear
MANAGEMENT Class II Division 1
IN PERMANENT DENTITION: DENTAL DISCREPANCY: EXTRACTIONa. more than 5mm discrepancy in both the
arches – extraction of all first premolars b. 5mm discrepancy in upper arch only –
extraction of upper first premolars onlyc. >5mm in upper arch, 2.5 – 5mm in lower arch
--- extraction of upper first premolars and lower second premolars
d. Extraction of first or second molars
MANAGEMENT Class II Division 1
MANAGEMENT Class II Division 1
CLASS II ELASTICS
MANAGEMENT Class II Division 1
NON EXTRACTION: Spacing ALD less than 5mm
MANAGEMENT Class II Division 1
SKELETAL DISCREPANCY: MAXILLARY PROGNATHISM:
Segmental osteotomy Lefort 1 Alveolar corticotomy
MANDIBULAR DEFICIENCY: BSSO
MANAGEMENT Class II Division 2
TREATMENT OBJECTIVES:
Improvement of esthetics
Correction of incisor relationship
Correction of closed bite realtionship
Correction of incisor inclination and gingival trauma
Correction of molar relationship
Correction of occlusal plane
Correction of any individual abnormality
MANAGEMENT Class II Division 2
IN DECIDUOUS DENTITION: Usually not diagnosed Orthodontic treatment not required
MANAGEMENT Class II Division 2
IN MIXED DENTITION: Correction of deep bite;
anterior bite plane therapy
MANAGEMENT Class II Division 2
With normal incisor pattern, aligning of anteriors followed by myofunctional appliances to correct Class II relationship
MANAGEMENT Class II Division 2
In case of mild discrepancy (2 – 3 mm) distalizing upper first permanent molars to gain space for anteriors
MANAGEMENT Class II Division 2
IN PERMANENT DENTITION: DENTAL DISCREPANCY: Extraction ---- usually not required;
managed by combination of palatal expansion and proximal stripping
Anteriors aligned by a combination of double cantilever spring and labial bow, with or without expansion screw
MANAGEMENT Class II Division 2
MANAGEMENT Class II Division 2
In case of severe crowding upper first premolars extracted
If crowding in both arches – extraction of first/second premolars in both the arches
MANAGEMENT Class II Division 2
SKELETAL DISCEPANCY: Usually not seen Mandibular segmental osteotomy
MANAGEMENT
POST TREATMENT RETENTION Temporary or permanent Removable or fixed
THANK YOU
