Class II div 1 Malocclusion

Class II div 1 Malocclusion

OR What can we do about Goofy?

Objectives

Objectives
Describe Class II div 1

Objectives
Describe Class II div 1 Describe principles of treatment

Objectives
Describe Class II div 1 Describe principles of treatment Describe treatment options

Objectives
Describe Class II div 1 Describe principles of treatment Describe treatment options Examples of treatment

Aetiology
Dento-alveolar

Aetiology

Aetiology
Dento-alveolar Skeletal

Aetiology Dento-alveolar
Incisor proclination

Aetiology Dento-alveolar
Incisor proclination

?
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Aetiology Dento-alveolar
Digit sucking?

Aetiology Dento-alveolar
Digit sucking

Aetiology Dento-alveolar
Incisor proclination Lower incisor retroclination
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Aetiology Skeletal
Mild

Aetiology Skeletal

Aetiology Skeletal
Mild Moderate

Aetiology Skeletal
Mild Moderate Severe

Aetiology Skeletal
Mild Moderate Severe High FMPA angle

Aetiology Skeletal
Mild Moderate Severe Low FMPA angle

Treatment Principles I
Ideal

Treatment Principles I

Treatment Principles I
Ideal correct skeletal discrepancy

Treatment Principles I
Ideal correct skeletal discrepancy Camouflage

Treatment Principles I
Ideal correct skeletal discrepancy Camouflage hide skeletal discrepancy

Treatment Principles I
Ideal correct skeletal discrepancy Camouflage hide skeletal discrepancy Depends on patient

Treatment Principles I
Ideal correct skeletal discrepancy Camouflage hide skeletal discrepancy Depends on patient Growing? Non-growing??

Skeletal discrepancy Growing patient

Can we make patients grow?????

Skeletal discrepancy Growing patient

Can we make patients grow????? Research studies: One patient and it works Series of patients treated and it works Randomised Clinical Trial

Skeletal discrepancy Growing patient

Can we make patients grow????? Research studies: Randomised Controlled Trails North Carolina study

Skeletal discrepancy Growing patient

North Carolina study shows:
Am J Orthod Dentofacial Orthop 1998:113:62-72

Skeletal discrepancy Growing patient

UK study shows:
OBrien et al 2004

Functional appliances produce slightly more mandibular growth Functional reduce the need for orthognathic surgery

Functional appliances produce slightly more mandibular growth Early treatment improves self image Twin blocks as effective as Herbst appliances

Manchester/UK study

Headgear reduces maxillary growth Shorter time with fixed, but longer overall treatment time

Treatment Options Conclusion

Ideal Correct skeletal discrepancy Orthognathic Surgery Functional (if growth occurs) Camouflage Accept skeletal discrepancy Reduce overjet within skeletal limits

Camouflage

Orthodontic treatment results in camouflage of skeletal discrepancies UNLESS patient grows favourably or surgery is used

Treatment principles II

Treatment principles II
1. Reduce Overbite

Treatment principles II
1. Reduce Overbite

Treatment principles II
1. Reduce Overbite 2. Create space (extraction/non extraction) ..for

Treatment principles II
1. Reduce Overbite 2. Create space (extraction/non extraction) ..for 3. Reduction of Overjet +/- relief of Crowding

Treatment options
Non extraction Extraction

Non extraction
1. Space analysis 2. DMUBS
(Distal Movement of Upper Buccal Segments)

Space analysis
Assumptions:
1. 2. 3. 4. 5. Aims of treatment is Class I occlusion Skeletal I occlusion Premolar extractions Complaint patient Skilled operator using Fixed Appliances

Space analysis
Plan lower arch
1. 2. 3. 4. 5. Lower labial segment crowding move canines to align lower incisors Add/subtract any lower centre line shift Add lower buccal segment crowding Total = space requirements

3. Functional appliances

OR

Space analysis
Plan upper arch

Space analysis
Plan upper arch
1. 2. 3. Move canines to Class I Add upper buccal segment crowding Total = space requirements

Space analysis
Which extractions?
Space less than 2mm non extraction Space 2-4mm extract 2nd premolar Space 4-6mm extract 1st premolar Space greater than 6mm anchorage

? ?

Non extraction
DMUBS Mild cases needs co-operative patient

Non extraction
Functional Growing patient Well aligned arches

Extraction
Most commonly premolars Space analysis premolar = 7mm

Extraction
Most commonly premolars Removable appliance

Extraction
Most commonly premolars Removable appliance Fixed appliance

Suitable for removable appliances?

Suitable for removable appliances?

Indications: 1. proclined incisors 2. Mesial angulation of canines 3. Acceptable lower arch

Suitable for removable appliances?

Take Cephalogram and undertake a Prognosis tracing

Suitable for removable appliances?

Trace tip upper incisor about a point from apex

Suitable for removable appliances? Extraction

Removable appliance reduction of overjet. Indications: 1. proclined incisors 2. Mesial angulation of canines 3. Acceptable lower arch
Usually a compromised result

1. Overbite reduction

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1. Overbite reduction

1. Overbite reduction
Flat Anterior Bite Plane when retracting canines and BEFORE incisor retraction

1. Overbite reduction
Flat Anterior Bite Plane - Design Design must include: 1.Height of bite plane required 2. Length of bite plane (ie Overjet)

1. Overbite reduction
Flat Anterior Bite Plane - Fitting

1. Overbite reduction
Flat Anterior Bite Plane - Fitting

1. Overbite reduction
Flat Anterior Bite Plane - USE

Molars 2mm apart

FABP may need building up/addition

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2. Overjet reduction
Design: Flat Anterior Bite Plane maintains OB reduction Incisor retraction spring e.g. Strap spring e.g.Labial Bow

2. Overjet reduction
Flat Anterior Bite Plane maintains OB reduction

2. Overjet reduction
Flat Anterior Bite Plane adjustment

Trim behind incisors to allow retraction

2. Overjet reduction
Flat Anterior Bite Plane adjustment

To be continued

Trim behind incisors to allow retraction

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