Aetiology Skeletal:

Genetic component: Prognathic maxilla Retrognathic mandible Combination of both

AetiologySoft tissues:Incompetent lips

Proclined upper incisorLower lip trap behind upper incisors

Proclination of upper incisorsRetroclination of lower incisors

Tongue thrust

AetiologyHabits:Digit sucking habit

Proclination of upper incisors Retroclination of lower incisorsAOB or in less severe forms incomplete OBCross biteIncresed LFH

Features of Class II div 1Skeletal features:

Usually class II relation ranging from mild to sever (Large ANB angle)

Open bite, normal or deep (MM angle)

Features of Class II div 1

Features of Class II div 1Dental features:

Class II molar, canine and incisor relations

Proclined maxillary incisors or normally inclined

Increased overjetOpen bite, normal overbite

or deep bite

Treatment modalitiesTreatment modalitiesGrowth modification: Head gear (High pull, low pull, medium Head gear (High pull, low pull, medium

pull)pull)Functional appliancesFunctional appliances

Fixed appliances (with Class II elastics)

Removable appliances

Surgery

Functional appliancesFunctional appliances

For growth modification in

a growing patients:

1- Mild to moderate Class II div. 11- Mild to moderate Class II div. 1

2- Proclined upper incisors2- Proclined upper incisors

3- 3- NNo lower and upper arch crowdingo lower and upper arch crowding

4- Deep overbite4- Deep overbite

5- Average or reduced LFH.5- Average or reduced LFH.

Effect of functional appliances

Class II division I malocclusionClass II division I malocclusion

Removable appliancesRobert retractors

-Proclined upper incisors-Spaced upper incisor-Normal or reduced

overbite

Fixed appliancesFixed appliances

Used for most complicated tooth movements which involve bodily tooth movement, intrusion, extrusion.

Treatment modalities Non growing patients:

Removable appliances:e.g Robert’s retractor

Fixed appliances

Surgery

Patient’s assessment and RX planningRx depends on:

Patient’s age (Grower or not) Growth modification with or with out fixed

appliancesThe severity of malocclusionPatients facial profile

Retention and stabilityFor OJ reduction to be stable, anterior lip

seal should be achievedLower lip contact the upper incisors

Retention

ORTHOGNATHIC SURGERY

FIXED APPLIANCES

GROWTH MODIFICATION