Class II Div II malocclusion

Question 1

Class II Div II malocclusion

Answer 1

The diagnosis of a Class II Div II malocclusion is based on the incisor relationship.
Lower incisor edges are palatal to the cingulum plateau of the upper incisors and the upper central incisors are retroclined. The overjet is usually average but may be increased.

Question 2

Incidence

Answer 2

5-10% of the population

Question 3

E/O features

Answer 3

Skeletal II
Reduced lower face height
Increased overbite

Question 4

I/O features

Answer 4

Retroclined upper and lower incisors
Increased inter-incisal angle
Deep overbite

Question 5

Cephalometry

Answer 5

Upper incisors retroclined: UI/Mx <105 degrees

Often class II skeletal ANB >4 degrees

Increased overbite

Reduced lower face height proportions

Question 6

Significance

Answer 6

Poor dental appearance
Traumatic overbite (lower incisors cause trauma to palate/upper incisors cause labial gingival trauma)
Reduced lower face height

Question 7

Tx aims

Answer 7

Relieve crowding and align arches
Reduce overbite
Produce a stable incisal relationship
Improve facial profile

Question 8

Tx options

Answer 8

Fixed appliances
Fixed appliance + surgery

Question 9

Fixed appliance Tx

Answer 9

Root control required to upright and retract upper incisors – ‘torqueing’

Question 10

Fixed appliance case selection

Answer 10

crowded upper arch requiring extractions
crowded lower arch requiring extractions and alignment
acceptable facial profile
only in growing pts if there is a deep overbite

Question 11

Fixed appliance tx plan

Answer 11

Anterior biteplane usually used with fixed appliances to reduce the overbite
Usually extract upper 1st premolars

Question 12

Class II Div II surgery

Answer 12

Adult patients (non-growing pts) too old for functional appliances
Poor facial profile
Deep overbite