© Dr Biju Krishnan 2013. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, copied, photocopied, translated or converted to any electronic or machine - readable form without the prior written consent of Dr Biju Krishnan and Cfast UK Ltd. You must not circulate this work in any form and you must impose this same condition on any acquirer. Whilst great care has been taken to ensure the accuracy, Cfast Ltd makes no claims that this document is entirely error - free and reserves the right to alter or delete anything stated or implied in them. Help Sheets Treatment of Class 2 Division 2 Cases Patients presenting with a class2/2 incisor relationship need to be managed with particular caution. Here quite often, as shown below, the case present as a crowded arch: We can see in the above picture that the classic appearance of class2/2 incisor relationships – the centrals are very retroclined and the laterals are proclined and mesially rotated. It appears crowded but one has to proceed very cautiously here. The full impact of just how powerful the rounding out effect, as discussed earlier, can be is demonstrated quite dramatically in such cases. After just one month of wearing the appliance and with no IPR the following result was achieved: What started off looking crowded now presents as a spaced case that requires a completely different approach to treat. Hence it is very important in all such cases never to do IPR in the first month or two to allow the arch wire to express itself fully and allow the rounding out to take effect. Class2/2 cases also bring with them the greatest amount of controversy. As the incisors, particularly the centrals, come forward there can be a significant increase in the overjet. This may have an impact on the anterior occlusion, especially anterior guidance, creation of an incomplete or open bite, changes in lip resting position and, albeit transient, effect on speech. As such very good informed consent is required and it is strongly advised in all these cases to carry out some diagnostic 3D imaging with printed models prior to commencing patient so both patient and dentist can see where the incisors will end up and base treatment accordingly. In summary important points to remember with all Class 2/2 cases: - Usually quite dramatic changes - Will get a significant increase in overjet so we need to advise patient of this - NEVER do IPR on first visit – allow arch to round out - Problem with these cases tend to be excess spacing not crowding – as it may present - As always – discuss in advance potential outcomes with patient and likely end point of treatment - Advisable to do 3D imaging +/- printed models - Advise patient of different sensation of new tooth position against lip which patient will adapt to in time. - May be slight speech changes which again is transient. Some languages will be affected more than others.

Treatment of Class 2 Clinical Photographs Division 2 Cases · Clinical Photographs Clinical photography is an important prerequisite for any cosmetic procedure. ... Treatment of Class

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Help Sheets

Clinical Photographs

Clinical photography is an important prerequisite for any cosmetic procedure. There are many views that can be taken but the minimum ones required for CFO are:

o Facial view with patient smiling so teeth are visible ideally want to se e the high smile line

o Close up of smile from nose to chin o Retracted facial view of teeth in ICP o Retracted facial view with teeth apart so incisal edges of upper and lower canine to

canine are visible o Retracted oblique left and right lateral views - so the overjet can be seen o Upper and lower occlusal views – ideally taken with occlusal mirror

No part of this publication may be reproduced, stored in a retrieval system, copied, photocopied, translated or converted to any

electronic or machine - readable form without the prior written consent of Dr Biju Krishnan and Cfast UK Ltd.

You must not circulate this work in any form and you must impose this same condition on any acquirer. Whilst great care has been taken to ensure the accuracy, Cfast Ltd makes no claims that this document is entirely error - free and reserves

the right to alter or delete anything stated or implied in them.

Help Sheets

Treatment of Class 2 Division 2 Cases

Patients presenting with a class2/2 incisor relationship need to be managed with particular caution. Here quite often, as shown below, the case present as a crowded arch: We can see in the above picture that the classic appearance of class2/2 incisor relationships – the centrals are very retroclined and the laterals are proclined and mesially rotated. It appears crowded but one has to proceed very cautiously here. The full impact of just how powerful the rounding out effect, as discussed earlier, can be is demonstrated quite dramatically in such cases. After just one month of wearing the appliance and with no IPR the following result was achieved:

What started off looking crowded now presents as a spaced case that requires a completely different approach to treat. Hence it is very important in all such cases never to do IPR in the first month or two to allow the arch wire to express itself fully and allow the rounding out to take effect.Class2/2 cases also bring with them the greatest amount of controversy. As the incisors, particularly the centrals, come forward there can be a significant increase in the overjet. This may have an impact on the anterior occlusion, especially anterior guidance, creation of an incomplete or open bite, changes in lip resting position and, albeit transient, effect on speech.As such very good informed consent is required and it is strongly advised in all these cases to carry out some diagnostic 3D imaging with printed models prior to commencing patient so both patient and dentist can see

where the incisors will end up and base treatment accordingly.

In summary important points to remember with all Class 2/2 cases:- Usually quite dramatic changes- Will get a significant increase in overjet so we need to advise patient of this- NEVER do IPR on first visit – allow arch to round out- Problem with these cases tend to be excess spacing not crowding – as it may present- As always – discuss in advance potential outcomes with patient and likely end point of treatment- Advisable to do 3D imaging +/- printed models- Advise patient of different sensation of new tooth position against lip which patient will adapt to in time.- May be slight speech changes which again is transient. Some languages will be affected more than others.