Class II div 1 Flashcards

Question

5 management options for class II div1

Answer 1

accept attemt growth modification simple tipping of teeth camouflage orthognathic surgery

Answer 2

Mildly increased overjet Significant overjet but not unhappy treatment options be more difficult in the future * correction when stopped growing more diff – e.g. teeth harder to move and no more growth Advice re mouthguard *IOTN score low, aesthetic minimal No great pt concerns*

Answer 3

headgear functional appliance

Answer 4

Try and restrain growth of maxilla horizontally and/or vertically Not commonly used Hard to know long term effect from evidence currently Uses back of head as anchorage support, distalise upper molars can try and intrude upper molar Reduced over bite and AOB Hard to get 14+ hours wear – not going to wear out, need long time on to make effect

Answer 5

“utilize, eliminate, or guide the forces of muscle function, tooth eruption and growth to correct a malocclusion” Used mostly for class II division 1 * Can use for II div 2. Limited use for class III Posture muscle forwards Encourage mandibular condyles to grow as condyle extracted out of glenoid fossa

Answer 6

removable (pt compliant dependent) * tooth borne - twin block (most widely used globally) * soft tissue borne - Frankel fixed * Herbst

Answer 7

Twin block (most widely used globally) * Clasps onto lower teeth * Blocks hold mand forward in postured position * Edge to edge more than class I * Want good retraction to upper arch Activator/bionator

Answer 8

frankel (different types 1, 2, 3 and 4; use FRii for class ii) soft tissue sulcus shield, aims to posture mandible and expansion of maxilla, effect alveolar growth – likely sim to other devices

Answer 9

herbst most common fixed functional appliance * Silver CoCr capping on teeth, connecting rod to hold mandible forward * More likely to give efficient correction of occlusion * Prone to break

Answer 10

to produce restraint of maxillary growth and encourage mandibular growth

Answer 11

favourable growth and enthusiastic pt

Answer 12

Mostly dento-alveolar changes * Distal movement upper dentition * Mesial movement lower dentition * Retroclination of upper incisors * Proclination of lower incisors Minor degree of skeletal changes * RCT’s indicate that degree of maxillary restraint and mandibular growth is usually small (1-2mm) * Significant variation in response

Answer 13

* Distal movement upper dentition * Mesial movement lower dentition * Retroclination of upper incisors * Proclination of lower incisors

Answer 14

Should be used during growth If possible coincide with pubertal growth spurt but? Options: * Early use – about 10 years (2 phase tx) * Later use – late mixed or early permanent dentition (1 phase tx)

Answer 15

Early skeletal effects from functional appliance or headgear therapy not maintained in long term Overall treatment time increased, 2 phase treatment * Early functional appliance plus retention - *Can be hard to wear appliance after primary teeth exfoliate, but want to hold tx result until permanent dentition fully erupted* * Fixed appliances in early permanent dentition Research shows little if any difference in results between those treated early and those who waited until permanent dentition

Answer 16

Improve appearance earlier (teasing and potential psychological benefit) Reduce risk of trauma Often better compliance with appliance wear

Answer 17

well aligned arches and complele or nearly permanent dentition *Inc OB – good, forward growth rotation of mandible, bodes well for func tx*

Answer 18

limited role in the contemporary treatment of increased overjets unless * V mild class II or class I * Overjet due to proclined and space incisors * Overbite favourable * Only then after specialist assessment *e.g. occlusion not far from class I and only OJ needing correct*

Answer 19

iatrogenic class II div II created * possible too class II first place * no control on degree of OJ reduction OB increased here * Contemporary fixed appliances better tx option

Answer 20

Aim: please construct a URA to reduce OJ Active: Roberts retractor 0.5mm HSSW, 0.5mm ID tubing * Reduce OJ Retention: Adam’s clasps on 6/6 0.7mm HSSW Anchorage: good Stops: mesial to 3/3 0.6mm flattened HSSW Base plate: Flat anterior bite plane OJ+3mm * Prop bite open, progressive trim to allow UI retraction

Answer 21

older - stopped growing 15y+ fixed appliance correct incisor relationship (OJ) no attempt to fix jaw growth * No growth mod happening, OJ reduced by tipping UI and LI * Take out upper premolar to make space, retract canine and upper incisors to reduce OJ * Lower incisors proclined **Not huge change in profile – dento alveolar tx only not skeletal**

Answer 22

older pt, no longer growing * No growth mod happening, OJ reduced by tipping UI and LI * Take out upper premolar to make space, retract canine and upper incisors to reduce OJ * Lower incisors proclined *Can see recession associated with LI, due to non growing limited alveolar bone to maintain coverage of root, causing recession - warn pt *

Answer 23

carried out when growth complete severe A/P skeletal discrepancy and/or vertical discrepancy * cannot correct occlusion with ortho alone usually improve mandible surgically, sometimes maxilla too * Surgical advance mandible Class II div I -* sometimes both need moved forward* *** Assess where discrep lies before, and pt concern (largely based)** fixed appliance is always required at one or more of these times: * before * during * after

Answer 24

Inc oJ fixed appliance to align arches Shows too much upper gingival wants correct Full unit class II occlusion And inc OJ * Maxillary impaction – osteomy to reduce amount of show upper incisors and gingiva * mandible advance to bring forward After surgery more class I * Elastics to hold in place Now class I molar and incisor relationship Lower face height reduced too as maxilla move up