Ortho- Class II Div 1 Treatment.

Question 1

Define Class II div1 incisor relationship

Answer 1

Lower incisor edges are located posterior to the cingulum of UI
Increased overjet
Upper central incisors are proclined or average angulation.

Question 2

How does class II div 1 incisor relationship affect a patient’s dental health?

Answer 2

Patient is at risk of trauma.
Overjet >9mm 2x more likely to suffer from trauma.

Question 3

Discuss the skeletal pattern associated with class II div 1 incisors?

Answer 3

Normally class II skeletal base. More likely retrognathic mandible (instead of maxillary protrusion)
Sometimes class I.

Question 4

What can cause an overjet?

Answer 4

Tooth inclination
Skeletal pattern.
Combination.

Question 5

Discuss the soft tissues normally associated with class II div 1 incsior relationship?

Answer 5

Patient normally has an incompetent lip due to incisor proclination or underlying skeletal pattern

Question 6

How does a patient with incompetent lips achieve an anterior oral seal.

Answer 6

Mentalis muscle overactivity and protrusion of the maxilla. or
Lower lip drawn behind upper incisors and tongue placed forward between incisors to the lower lip.

Question 7

List some dental factors assoicated with class II div 1 incisor relationship?

Answer 7

Overjet
Varied overbite

Question 8

How can habitally parted lips affect the gingviae?

Answer 8

Gingivae are exposed to air so can dry up.
This also exacerbates any pre-existing gingivitis.

Question 9

At what age would we be concerned about a patient’s sucking habits?

Answer 9

Age 9

Question 10

How can we treat sucking habits?

Answer 10

Reinforcement
Removable habit breaker
Fixed habit breaker

Question 11

List the treatment options for a Class II div 1 incisor relationship.

Answer 11

Accept
Growth modification
Tipping teeth
Camoflauge
Orthognathic surgery.

Question 12

What should be highlighted to any patients selecting to accept their class II div 1 relationship?

Answer 12

Treatment may be more difficult to complete in the future

Question 13

What is growth modification?

Answer 13

This is trying to change the underlying skeletal base using functional appliances with the force of muscles correcting the malocclusion.
Maxillary growth is restrained and mandibular growth is encouraged.

Question 14

Explain the dento-alveolar effects of growth modulation?

Answer 14

Distal movement of upper dentition
Mesial movement of lower dentition.
Upper incisors are retroclined.
Lower incisors are proclined.

Question 15

List some growth modification options for Class II div 1 treatment

Answer 15

Headgear (uncommon)
Removable appliance (Twin block)
Fixed appliance (Herbst)

Question 16

When would we use a functional appliance?

Answer 16

during growth.
either in primary dentition (age 10) or in mixed/ permanent dentition.

Question 17

Compare early and late treatment with a functional appliance.

Answer 17

There is no difference in the treatment outcome.
Early treatment- earlier aesthetic improvement. Reduced risk of trauma. But will require further treatment later.
Late treatment- only requires one set of treatment.

Question 18

In what situations could an URA be used to treat increased overjets?

Answer 18

Class I
Very mild class II
Overjet caused by proclined and spaced incisors.
Overbite.

Question 19

What is camoflauge and when is it used?

Answer 19

This is when the skeletal relationship is not bad enough for orthognathic surgery so we use a fixed appliance to correct the incisor relationpship (we do not change the jaws)

Question 20

What is orthognathic surgery?

Answer 20

This is treatment for severe skeletal discrepancy in the A/P or vertical direction which includes mandibular surgery but sometimes surgery to the maxilla.
Fixed appliances are also required before, during and after treatment.

Question 21

When do we provide orthognathic surgery?

Answer 21

When patient is at least 18/19/20

Question 22

How do we treat a class II div I patient using camoflauge?

Answer 22

We use a fixed appliance to reduce the overjet.
But we may need extractions to give space to facilitate the distal movements of incisors or mesial movement of the molars.