Ortho- Class II Div II

Question 1

Define class II Division 2 incisors

Answer 1

Lower incisor is contacting posterior to the cingulum plateau of the upper incisor.
The upper incisors are retroclined.
The overjet is mainly reduced. But it can be increased.

Question 2

List skeletal features of a class II Div II incisor relationship?

Answer 2

Class II skeletal bases.
Progenia (protruding chin)
Reduced FMPA

Question 3

List soft tissue features of a class II Div II Incisor relationship?

Answer 3

Soft tissue progenia
High resting lower lip line (retroclines the upper incisors)
Marked labio-mental fold.
High masseteric forces (Causes orthodontic space closure problems)
Upper 2s have a shorter clinical crown height (they escape the lower lip effect or can get trapped infront of the lower lip)

Question 4

List dental features of a class II div II incisor relationship.

Answer 4

Retroclined upper and lower incisors.
Upper 2s are often crowded (often mesiolabially rotated)
Deep overbite causing trauma- to the palate or mandibular labial region
Upper laterals are thin with a poorly developed cingulum- this allows the upper incisor to slide past the lower incisor
OJ reduced
Class II buccal segments
Increased interincisal angle
reduced arch length (exacerbating crowding)

Question 5

How can we manage Class II div II incisor relationship?

Answer 5

1. Accept
   2.Growth modification
2. Camouflage
3. Orthognathic surgery

Question 6

In what patients would we chose to accept a class II div II incisor relationship?

Answer 6

No aesthetic concerns.
No trauma from the overbite.
Patient unconcerned or not suitable.

Question 7

How can growth modification be used to manage a class II div II incisor relationship?

Answer 7

We use it for patients who are still growing. (Girls 12±2/ boys 14±2)

We use a twin block with ELSA spring to procline the upper incisors and a mid palatal screw for buccal expansion.
(convert class II div 2 to a class II div 1)

before using fixed appliances.

Question 8

How can camoflauge be used to treat manage a class II division II incisor relationship?

Answer 8

We accept the skeletal relationship & treat the class II incisal relationship.

Use a fixed appliance:
Reduce the overbite
Correct the interincisial angle (Reduction to prevent the overbite relapsing)
Through a combination of:
Palaltal root torque of the upper inciors.
Proclination of the lower incisors

Question 9

How can orthognathic surgery be used to treat a class II div II incisor relationship.

Answer 9

For patients with too severe a malocclusion from orthodontics alone or patients that are no longer growing.

There is pretreatment- Decompensation of the retroclination of the upper incisors.
Pre-surgery (we want overjet to allow space for an osteotomy)
Post surgery- ortho treatment to detail the bite.

Question 10

Discuss relapse in terms of treatment of class II Division II incisors?

Answer 10

Patients need to be informed of the high risk of relapse of rotated teeth and deep overbites..
Long term retention using a bonded retainer is required.
Compliance is important aswell.