Class II Division 1 Flashcards

1
Q

What is the BSI definition of Class II Division 1 Malocclusion?

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
There is an increased overjet
The upper central incisors are proclined or of average inclination

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2
Q

Why do you treat Class II div 1 malocclusions?

A

Aesthetic concerns
Dental health concerns (risk of trauma especially with incompetent lips)

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3
Q

What skeletal pattern (A/P) is typical of a Class II div 1 malocclusion?

A

Class II skeletal pattern
Commonly due to a retrognathic mandible (rather than a maxillary prognathism)

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4
Q

What is the FMPA typically for this malocclusion?

A

A reduced FMPA

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5
Q

What habit can be associated with this malocclusion?

A

A sucking habit of things such as a thumb, fingers, a blanket, a lip or a combination of things.
Effect depends on duration and intensity

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6
Q

What are the occlusal features of a sucking habit?

A

Proclination of upper anteriors
Retroclination of lower anteriors
Localised AOB or incomplete OB (to have a skeletal effect, needs to be a bad habit)
A narrow upper arch

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7
Q

What are the habit treatment principles?

A

Stop the habit
Allow spontaneous improvement of malocclusion
Treat residual malocclusion if required

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8
Q

How can you stop a habit of sucking?

A

Reinforcement- requires patient co-operation
Removable appliance habit breaker - requires patient co-operation
Fixed appliance habit breaker- last resort

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9
Q

What are the management options for a Class II div 1 malocclusion?

A

Accept- aware of risk of trauma
Attempt growth modification- has to be at the right age
Simple tipping of the teeth (URA)
Camouflage
Orthognathic surgery

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10
Q

What are functional appliances used for?

A

Functional appliances utilise, eliminate, or guide the forces of muscle function, tooth eruption and growth to correct a malocclusion
Used mostly for Class II div 1

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11
Q

What are the different types of functional appliance?

A

Removable
Fixed

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12
Q

What are the removable types of functional appliance?

A

Tooth borne - twin-block, activator
Soft tissue borne- Frankel (FR II)

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13
Q

How are functional appliances used in growth modification?

A

They aim to produce restraint of maxillary growth & encourage mandibular growth
Success depends on favourable growth & an enthusiastic patient

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14
Q

What are the therapeutic effects of functional appliances?

A

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

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15
Q

When should you use a functional appliance?

A

It should be used during growth
If possible it should coincide with pubertal growth spurt
Early use- about 10 years old (2 phase treatment)
Later use- late mixed or early permanent dentition (1 phase treatment)
—ideally during period of maximal growth
—Females 11-13
—Males 13-15

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16
Q

What can early use of twin block create?

A

Early use can create gaps

17
Q

What are the potential disadvantages of early treatment?

A

Early skeletal effects from functional appliance or headgear therapy not maintained in long term
Overall treatment time is increased, 2 phase treatment
–early functional appliance plus retention
–fixed appliances in early permanent dentition

18
Q

What are the potential benefits of early treatment?

A

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

19
Q

When are URA’s appropriate for treatment?

A

Very mild Class II
There is an overjet due to proclined and spaced incisors
Overbite favourable

20
Q

What URA can you design to retrocline the anterior teeth? (reduce the overjet)

A

Active: Roberts retractor 0.5mm in ID tubing
Retention: Adams clasps 16,26 0.7mm HSSW
Anchorage: mesial stops 13,23
Baseplate: flat anterior bite plane

21
Q

What does camouflage treatment involve?

A

Fixed appliances
—If the goal is to reduce the overjet may need upper arch extractions to give space (for distal movement)

22
Q

When is orthognathic surgery carried out?

A

Carried out when growth is complete
Skeletal discrepancy is severe in A/P & or vertical direction
Usually involves mandibular surgery, but may also involve maxillary surgery
Fixed appliances required
–Before surgery
–During surgery
–After surgery