Class II Div 2

Question 1

1) what skeletal pattern is class II div 2 usually associated with?

2) describe vertical skeletal pattern of it?

Answer 1

1) Usually associated with a mild or moderate Sk 2 base
- Can also be Sk 1 or Sk 3

2) Typically reduced
- Reduced FMPA

Often associated with a forward rotational pattern of growth of the mandible

Prominent chin
- “progenia”

Question 2

2) describe vertical skeletal pattern of it?

Answer 2

2)
- Reduced FMPA

Often associated with a forward rotational pattern of growth of the mandible

Prominent chin
- “progenia”

Question 3

1) describe soft tissue features of class II div 2?

Answer 3

High resting lower lip line
- Secondary to lower face height
- Retrocline upper incisors

Marked labio-mental fold

High masseteric forces
- Orthodontic space closure problems

Upper 2’s shorter clinical crown
- Escape the effect of the lower lip
- Trap lower lip

Question 4

1) describe dental features of class 2 div 2?

Answer 4

 Retroclined upper and lower incisors
 Deep OB
 OJ usually reduced
 Class II buccal segments
 increased inter-incisal angle
 Upper laterals thin with poorly developed cingulum

Question 5

1) why treat class 2 div 2 and dental health component number?

Answer 5

1)  Aesthetic concerns
 Dental health concerns
- Traumatic overbite
- IOTN DHC 4f

Question 6

2) what do treatment options depend on?

Answer 6

2) Severity of malocclusion
Age and motivation of patient
Dental health
Patients concerns

Question 7

when is accept an option for class 2 div 2?

Answer 7

Acceptable aesthetics
Patient not concerned / not suitable
Overbite not a significant problem

Question 8

when do you do growth modification for class 2 div 2?

Answer 8

Growing patient
- Adolescent growth spurt
- Boys 14 ± 2 years
- Girls 12 ± 2 years

Mild to moderate skeletal 2 pattern

Convert Class II div 2 into Class II div 1

Detail occlusion with fixed appliances

Question 9

what do functional appliances do for class 2 div 2 and what types?

Answer 9

Proclination of upper incisors
- Modified Twin block
- Springs or screw
- Upper sectional fixed appliance

Question 10

what is this?

Answer 10

modified twin block

Question 11

what is this design of?

Answer 11

modified twin block

Question 12

when to use camouflage as treatment option for class 2 div 2?

Answer 12

accept skeletal - goal make class 1 incisor

Mild to moderate Class II skeletal pattern

Question 13

what does fixed appliances do in class 2 div 2?

Answer 13

• Stable correction of class II div 2 needs
  *Overbite reduction
  *Correction of inter- incisal angle (reduction)
• Overbite will relapse if not corrected

Question 14

how is inter-incisal angle corrected?

Answer 14

• Inter-incisal angle corrected by a combination of
  *Palatal root torque upper incisors
  *Proclination of lower incisors

Question 15

when upper incisor torqueing what do you need and what is there risk of?

Answer 15

• Needs adequate cancellous bone palatal to upper incisors
• Risk of root resorption

Question 16

when do you use orthognathic surgery for class 2 div 2?

Answer 16

Too severe a malocclusion for orthodontics alone *AP
*Vertical

Non growing patients

Profile concerns

Question 17

when to refer class 2 div 2?

Answer 17

 Deep overbites best corrected when patient is growing
*Growth modification with functional appliance if AP discrepancy
*URA with FABP

 Orthognathic/Orthodontics if significant skeletal component
*After growth completed

 Remember link with other dental anomalies

Question 18

how is stability and retention in class 2 div 2?

Answer 18

 Difficult to treat
 Future facial growth can affect stability
 Rotated laterals and deep overbite can relapse
 Long term bonded retention usually required

Question 19

what is definition of class II div 2

Answer 19

The lower incisor occludes posterior to the cingulum plateau of the upper incisor

The upper incisors are retroclined

The overjet is reduced but can also be increased

Question 20

tx options for class II div 2

Answer 20

• accept - pt unconcerned, acceptable aesthetics, overbit no problem
• growth modification - growing, mild moderate skeletal 2, make div 2 to div 1
• camouflage - accepet skeletal base make class 1 incisor - mild moderate pattern
• orthognathic tx - too severe for ortho alone, non growing