Class II Division 2 malocclusion

Question 1

What is the definition of a class II division 2 malocclusion?

Answer 1

Lower incisal edge occludes posteriorly to the cingulum plateau of the upper incisors.

Upper incisors are retroclined.

Overjet is reduced but can also be increased.

Question 2

What are the Skeletal features seen in a class 2 division 2?

Answer 2

Mild or moderate class 2 skeletal base.
Reduced FMPA
Reduced lower face height.
Prominent chin- progenia

Question 3

What are the soft tissue features seen in a class 2 division 2?

Answer 3

High resting lower lip line
Marked labio-mental fold

Question 4

What are the dental features seen in a class 2 division 2?

Answer 4

Upper centrals are retroclined and upper laterals are proclined.
- Caused by the fact the laterals have a smaller crown and so that are able to get above the the lower lip and become proclined.
- The crown of the centrals is much larger and gets trapped behind the lower lip, and so becomes retroclined.

Poor cingulum on the upper incisors
Arch length is shorter- exacerbates crowding
Upper laterals often crowded.
Deep overbite
Increased inter-incisal angle
Class 2 buccal segments
Overjet usually reduced.

Question 5

Why might you want to treat a class 2 division 2 patient?

Answer 5

Aesthetics
Dental health concerns- traumatic overbite.

Question 6

What factors influence treatment options?

Answer 6

Severity of malocclusion
Motivation of patient and parent
Age of patient
Dental health

Question 7

What are the management options for a class 2 division 2 malocclusion?

Answer 7

Accept and monitor
Growth modification
Camouflage
Orthognathic surgery

Question 8

Under what circumstances might you want to accept the underlying class 2 division2 malocclusion?

Answer 8

Acceptable aesthetics
Patient not concerned
Overbote not a significant problem- no palatal or gingival trauma

Question 9

Under what circumstances might you use growth modification for a class 2 division 2 malocclusion?

Answer 9

Mild to moderate skeletal class 2
During the patient’s pubertal growth spurt

Question 10

What is the aim of a functional appliance with regards to a class 2 division 2 malocclusion?

Answer 10

Convert the malocclusion to a class 2 division 1 and then correct with fixed appliances.

Proclines the upper incisors.

Question 11

What Functional appliances may be employed in this case?

Answer 11

Modified twin block
Springs or screw
Upper sectional fixed appliance

Question 12

What modifications are made to the twin block to treat a class 2 division 2 malocclusion?

Answer 12

ELSA spring added to twin block to help procline the upper labial segment.
Transpalatal screw to widen the maxilla.

Question 13

Why might you opt to undertake camouflage treatment for a patient with a class 2 division 2 malocclusion?

Answer 13

Patient may have stopped growing
Patient may not be able to cope with functional appliance treatment.

Question 14

What is camouflage treatment with regards to class 2 division 2 malocclusion?

Answer 14

Accept the underlying skeletal discrepancy and aim for class 1 incisor relationship.

Question 15

What appliance would you use for camouflage treatment?

Answer 15

Fixed appliance.

Question 16

What features of a class 2 division 2 need to be corrected using fixed appliances?

Answer 16

Overbite reduced
Inter-incisal angle reduced.

Question 17

How is the inter-incisal angle corrected?

Answer 17

Root torque of upper incisors
Proclination of lower incisors.

Must have adequate cancellous bone palatal to upper incisors.

Question 18

Why might you opt for orthognathic surgery in a class 2 division 2 case?

Answer 18

Too severe a malocclusion for orthodontics alone
Non-growing patients
Profile concerns

Question 19

What pre-treatment is required for orthognathic surgery?

Answer 19

Fixed appliances to convert class 2 div 2 to class 2 div 1.

Then surgery for mandibular advancement.

Question 20

What are the common features to relapse?

Answer 20

Rotations and deep overbites.

Question 21

When do you refer a patient with a class 2 division 2 malocclusion?

Answer 21

Deep overbites are best treated with a functional appliance if there is an Ap discrepancy- refer when patient is still growing.

Orthognathic surgery if the patient has a severe A-P discrepancy or if they have stopped growing.