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BDS4 Orthodontics > 3 - Class 2 div 2 > Flashcards

3 - Class 2 div 2 Flashcards

1
Q

What is the BSI definition of class 2 div malocclusion?

A

The lower incisor occludes posterior to the cingulum plateau of the upper incisor, the upper incisors are retroclined, the overjet is reduced but can be increased

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2
Q

What is the incidence of class 2 div malocclusion?

A

5-18%

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3
Q

What AP skeletal pattern is class 2 div malocclusion associated with?

A
  • typically class 2 base
  • can be any
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4
Q

Describe the vertical skeletal pattern typical of class 2 div 2 malocclusion.

A
  • reduced FMPA
  • associated with forward rotational growth pattern of mandible
  • prominent chin “chin button”
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5
Q

How do soft tissues impact the aetiology of class 2 div 2 malocclusion?

A
  • high resting lower lip acts as a strap on upper incisors and increases the retroclination
  • marked labio-mental fold
  • often high masseteric forces which can cause issues with space closure
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6
Q

What causes flared and rotated laterals in class 2 div malocclusion?

A
  • clinical crown is shorter so escapes the lip strap and avoid retroclination
  • trap lower lip and rotate
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7
Q

What are classic dental features of class 2 div 2 malocclusion?

A
  • retroclination of upper centrals
  • upper laterals often crowded, may be flared and rotated
  • reduced arch length
  • lateral incisors have poor cingulum as not developed properly, deep OB
  • lower incisors traumatise palate
  • class 2 buccal segments
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8
Q

What is the effect of having a poorly developed cingulum on the upper laterals?

A
  • loss of occlusal stop
  • can increase overbite as teeth slide past
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9
Q

What are the presentations of a deep, complete overbite?

A
  • traumatised gingiva on palate
  • labial gingival stripping on lower incisors
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10
Q

What percentage of those with a class 2 div malocclusion have a developmental dental anomaly?

A

50%

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11
Q

What percentage of class 2 div malocclusion have an impacted canine and why?

A
  • 20-33%
  • altered inclination of incisors can interrupt the eruption pathway
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12
Q

Why do you treat a class 2 div 2 malocclusion?

A
  • aesthetic concerns
  • traumatic overbite, IOTN DHC 4f
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13
Q

What treatment options are there for a class 2 div malocclusion?

A
  • accept
  • growth modification
  • camouflage
  • orthognathic surgery
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14
Q

When can you accept a class 2 div malocclusion?

A
  • acceptable aesthetics
  • patient is not concerned/not suitable
  • overbite is not significant problem
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15
Q

When is the pubertal growth spurt for boys?

A

14 ± 2 years

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16
Q

When is the pubertal growth spurt for girls?

A

12 ± 2 years

17
Q

Who is suitable for growth modification in class 2 div 2 malocclusion?

A
  • mild to moderate class 2 pattern
  • not mandible growers
  • aiming to convert div 2 to div 1 by creating an overjet
18
Q

What devices can be used to procline the upper incisors?

A
  • modified twin block
  • springs or screws
  • upper sectional fixed appliance
19
Q

Describe an Elsa spring.

A
  • labial expansion spring
  • spans 2-2 or 3-3
20
Q

When can you camouflage a class 2 div 2 malocclusion?

A
  • mild to moderate class 2 pattern
  • careful extraction decision in low angle cases
  • when the patient is not compliant or not amenable to functionals
21
Q

Describe what is meant by camouflaging a class 2 div 2 malocclusion.

A

Accepting the underlying skeletal base relationship and aiming to treat to class 1 incisor relationship

22
Q

How is a class 2 div 2 malocclusion stabilised?

A

Fixed appliances used to reduce overbite and correct inter-incisal angle

23
Q

How is the inter-incisal angle corrected?

A
  • palatal torque of upper incisors (requires adequate cancellous bone)
  • proclination of lower incisors
24
Q

What risk is increased when torquing teeth?

A

Root resorption

25
Q

When is orthognathic surgery indicated for class 2 div 2 malocclusion?

A
  • too severe malocclusion for orthodontics alone
  • patient is not growing
  • profile concerns
26
Q

What orthodontics is required prior to orthognathic surgery for class 2 div 2 malocclusion?

A
  • decompensate teeth
  • correct angulation of teeth
  • create overjet
27
Q

Describe the incisor relationship following orthognathic for a class 2 div 2 malocclusion?

A
  • only contact on the incisors
  • lateral open bite
  • called a three-point landing to maintain curve of spee
28
Q

Describe the rentention required for a class 2 div 2 malocclusion.

A

Bonded retention indicated

29
Q

When is the best time to refer for a class 2 div 2 malocclusion?

A
  • deep overbite is best corrected during growth
  • orthognathic intervention is only suitable once growth has stopped
30
Q

How do you reduce a deep overbite?

A

URA with FABP

BDS4 Orthodontics (14 decks)

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