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ABO > Treatment Of Class 2 Cases > Flashcards

Treatment Of Class 2 Cases Flashcards

1
Q

Class 2 division 2 patients typically exhibit an ___ maxilla, a ____ mandible, an ___ growth pattern, ___ maxillary central incisors, and a ____ chin as well as a deep bite.

A

Orthognathic

Retrognathic and short

Brachyfacial

Retroclined

Relatively prominent

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2
Q

Class 2 patients are divided into 6 separate horizontal types and 5 vertical types based on various skeletal and dentalalveolar characteristics. What are the 6 horizontal types?

A

Type A: maxillary dental protraction

Type B: Maxillary prognathism, dental protraction

Type C: Maxillary retrognathism with flared or upright incisors; mandibular severe retrognathism with flared lower incisors

Type D: Maxillary retrognathism with dental protraction; severe mandibular retrognathism

Type E: Maxillary prognathism and dental protraction + mandibular dental flaring

Type F: Mandibular retrognathism

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3
Q

Class 2 patients are divided into 6 separate horizontal types and 5 vertical types based on various skeletal and dentalalveolar characteristics. What are the five vertical class types?

A

Type 1: mandibular plane steeper than normal, steeper functional occlusal plane, palate tipped somewhat downward, anterior cranial base tipped upward

Type 2: mandibular plane, functional occlusal plane, and palatal plane are all flatter than normal and are nearly parallel

Type 3: Palatal plane tipped upward anteriorly

Type 4: mandibular plane, the functional occlusal plane, and the palatal plane are all tipped markedly downward

Type 5: palatal plane is tipped downward; cranial base tipped downward

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4
Q

True or false… in the transverse dimension, buccal segments of class 2 patients often appear normal.

A

True. However, a 3-4mm transverse discrepancy usually exists at the level of the first molar due to a narrow maxillary arch. This is readily observable if the mandible is moved into the class 1 relationship at the molar.

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5
Q

Treatment options for vertical correction in growing class 2 patients could include…

In non-growing patients, surgical correction options such as…

A

Bite blocks and various types of headgear.

LeFort 1 maxillary impaction and alveolar procedures

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6
Q

___% of skeletal class 2 discrepancies are due to ____

A

75%

Mandibular retrognathia

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7
Q

___% of the US population have an overjet of greater than ___mm. ___% have an overjet between __-___mm. And 1/3rd of the population have class 2 occlusal discrepancies

A

15%

38%

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8
Q

What is Type A horizontal class 2 type?

A

Maxillary dental protraction

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9
Q

What is Type B horizontal class 2 type?

A

Maxillary prognathism

Dental protraction

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10
Q

What is Type C horizontal class 2 type?

A

Maxillary retrognathism with flared or upright incisors

Mandibular severe retrognathism with flared lower incisors

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11
Q

What is type D horizontal class 2 type?

A

Maxillary retrognathism with dental protraction

Severe mandibular retrognathism

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12
Q

What is Type E horizontal class 2 type?

A

Maxillary prognathism and dental protraction + mandibular dental flaring

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13
Q

What is type F horizontal Class 2 type?

A

Mandibular retrognathism

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14
Q

What are the 5 treatment options for class 2 malocclusion?

A

Extra-oral traction

Distalizing appliances

Functional jaw orthopedics (FJO)

Camouflage

Surgery

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15
Q

____ can be used when class 2 problems are dentoalveolar in nature. It corrects class 2 problems by moving the ____ distally into a class 1 relationship

A

Molar distalization

Maxillary first molar

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16
Q

Name 5 distalizing appliances that are usually very effective, because they require little, if any, cooperation from the patient

A

Plates

Pendulum (pendex)

Distal jet

Jones jig

Jasper jumper

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17
Q

What is functional jaw orthopedics?

A

FJO is the utilization of appliances that work by forward positioning of the mandible. This results in altering the activity of postural muscles of the craniofacial complex, causing changes in skeletal and dental relationships.

The goal is to enhance mandibular growth by allowing the full expression of the genetic potential and encouraging remodeling at the glenoid fossa.

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18
Q

Why is repeated advancement of FJO appliances required?

A

The lateral pterygoid activation causes adaptive growth response at the condyle. However, the lateral pterygoid activity decreases after 6-8 weeks.

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19
Q

Name 6 typical result s shown from FJO therapy

A

Condylar growth during treatment: 1-3mm

Fossa displacement, growth, and adaptation 3-5mm with a dominant vertical vector

Most favorable growth direction: 0.5-1.5mm

Withholding of downward and forward maxillary growth: 1-1.5mm

Differential upward and forward eruption of lower buccal segments:1.5-2.5mm

Headgear effect: 0-0.5mm

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20
Q

Describe Type 1 vertical class 2

A

Mandibular plane steeper than normal

Steeper functional occlusal plane

Palate tipped somewhat downward

Anterior cranial base tipped upward

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21
Q

Describe Type 2 vertical class 2

A

Mandibular plane, functional occlusal plane, and palatal plane are all flatter than normal and are nearly parallel

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22
Q

Describe type 3 vertical class 2

A

Palatal plane tipped upward anteriorly

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23
Q

Describe type 4 vertical class 2

A

Mandibular plane, functional occlusal plane, and the palatal plane are all tipped markedly downward

24
Q

Describe type 5 vertical class 2

A

Palatal plane is tipped downward

Cranial base tipped downward

25
Q

What are three treatment considerations for treatment of Type A horizontal class 2

A

Extraction of upper bicuspids + orthodontic retraction and uprighting

Distalization of upper dentition into class 1

Surgery: anterior maxillary alveolar osteotomy setback and uprighting of upper centrals and lateral after extraction of upper bicuspids and orthodontic retraction of canines

26
Q

What are 2 treatment considerations for Type B horizontal class 2?

A

Headgear (growing patient)

Surgery: maxillary anterior alveolar setback (non-growing patient) with extractions of upper bicuspids

27
Q

What are 3 treatment considerations for Type C horizontal class 2

A

Complex skeletal and dentoalveolar considerations

Extraction of upper and lower bicuspids, orthodontics + functional appliance

Extraction of upper 5/lower 4s, orthodontics to close spaces and upright incisors + surgery: maxillary and mandibular differential advancement

28
Q

What are 2 treatment considerations for Type D class 2 horizontal?

A

Orthodontic + functional appliance (growing patient)

Surgery: mandibular advancement (non-growing patient)

29
Q

What are 3 treatment considerations for Type E horizontal class 2?

A

Headgear

Bimaxillary protrusion-extraction of upper and lower bicuspids

Extractions + surgery (non-growing patient)

30
Q

What are 2 treatment considerations for Type F horizontal class 2?

A

Functional appliance (growing patient)

Surgery: mandibular advancement (non-growing patient)

31
Q

When is functional appliance therapy indicated?

A

The primary indication for FJO is mandibular skeletal protrusion

Functional appliances remove abnormal and restrictive muscular activity that prevents the normal development of the maxilla and mandible as well as appropriate development of dental arches

32
Q

Greater mandibular length is obtained when functional appliance treatment is performed during…

A

The circumpubertal growth period

Ideally, functional appliance therapy should be started in the late mixed dentition or early permanent dentition followed by Phase 2 therapy to align the permanent dentition. (It may be imitated in early mixed dentition for pts who have severe problems)

33
Q

In the absence of severe dentoskeletal compensations, functional appliance therapy, when should FJO be initiated?

A

At the beginning of cervical vertebrae maturation stage CS3 to maximize the treatment effects and reduce the need for posttreatment retention

34
Q

What are the two basic types of functional appliances commonly used today?

A

Tooth born and tissue born

The only tissue born is the functional regulator - Frankel 2

All others are tooth born (herbst, twin block, bionator, MARA)

35
Q

What are some of the effects commonly seen with tooth-born functional appliances?

A

Increase in mandibular length

Maxillary molars move distally

Mandibular molars move mesially

Maxillary incisors tip lingually

Mandibular incisors procline

36
Q

Name three examples of removable functional appliances

A

Activator

Bionator

Twin block

37
Q

Name two fixed functional appliances

A

Herbst

MARA

38
Q

Name 4 situations that usually require orthodontic treatment prior to FJO

A

Severe maxillary constriction

Deep impinging bite

Maxillary incisor retroclination and mandibular incisor proclination and spacing

Moderate to severe crowding

39
Q

Why should severe maxillary constriction be treated before FJO? How is this accomplished?

A

It is often advantageous to expand the maxilla prior to class 2 correction to allow the buccal segments to appropriately interdigitate in the final class 1 position. This can be done with a rapid palatal expander prior to FJO.

40
Q

Why should a deep impinging bite be treated prior to FJO? How is this accomplished?

A

In order to allow for forward posturing of the mandible, deep impinging bites should be corrected utilizing a utility arch to intrude, tip, or reposition the incisors.

41
Q

Why should maxillary incisor retroclination and mandibular incisor proclination and spacing be treated prior to FJO? How is this accomplished?

A

Over 30% of class 2 patients present with maxillary incisors in a retroclined position. This inclination problem must be corrected to allow appropriate mandibular advancement. In addition, flaring as well as spacing of the lower incisors must be corrected to allow for maximum mandibular advancement

42
Q

Why should moderate to severe crowding be corrected prior to FJO? How is this accomplished?

A

Space supervision or serial extraction may be required depending on the severity of the upper and lower dental crowding

43
Q

Bionators are classified in three categories. What are they?

A

Bionators to open,

Maintain

Or close the bite

44
Q

True or false… in both types of Herbst appliances, a hyrax-type screw may be included to expand the maxilla as the mandible is positioned forward

A

True

45
Q

Step-by-step mandibular advancement is achieved with the Herbst appliance by adding ___ to the mandibular part of the bite jumping mechanism

A

Shims

46
Q

Describe the MARA design

A

Although modifications can be made to accommodate upper or lowe rexpansion, a trans palatal arch, a lower lingual arch, intrusion mechanics, and asymmetric cases, the basic MARA design is as follows:

Four crowns on the first molars
Arms soldered to the lower crowns
Archwire tube for upper and lower arches soldered to all crowns

Upper elbows shimmed to provide the desired advancement

Lower lingual arch soldered to crowns
Option specs includes occlusal holes to assist with crown removal

47
Q

Typically, a MARA device produces ___% skeletal change and ___% Dental change

A

47% (mainly increase in mandibular length)

53% (mainly due to distalization of maxillary molars)

48
Q

A Forsus appliance provides a mesial and intrusive force on the ___ arch and a distal and intrusive force on the ___ arch.

A

Mandibular

Maxillary

49
Q

In an untreated class 2 patient, there is about a ___% chance of a favorable change in the class 2 relationship, a ___% chance of no change, and a ___% chance the condition will worsen

A

30%

50%

15%

50
Q

Functional appliance or headgear treatment has shown a __-__% chance of producing a favorably or highly favorable result and about a __% chance of no change

A

70-80%

20%

51
Q

What is the best scenario to do class 2 camouflage treatment?

A

Pt is too old for growth modification

Mild-moderate skeletal discrepancy

Reasonably good alignment of teeth

Good vertical proportions

Reasonably good facial esthetics

Overjet that results more from maxillary protrusion than mandibular retrusion

It is most appropriately used when the patient has a mild class 2 skeletal relation with a class 2 dental malocclusion.

52
Q

What is the typical treatment for class 2 camouflage treatment?

A

Extraction of upper first bicuspids and lower second bicuspids (or only extraction of upper first bicuspids)

53
Q

Since skeletal class 2 problems are most often due to ___ or ___, surgical treatment usually consists of ___, ____, or ___.

A

Mandibular deficiencies

Clockwise rotation of the mandible due to excessive vertical growth of the maxilla

Mandibular advancement (66%)
Maxillary impaction (15%)
Or combination (20%)
54
Q

Larger than __mm of overjet in a non-growing patient usually suggests the need for surgical correction. This is especially tru if the lower incisors are ___ relative to the pogonion, the mandible is ___, or if the anterior face is too ___.

A

10mm

Protrusive

Short

Long

55
Q

If there is a significant dentofacial deformity, early orthognathic surgery may improve the health of the patient in regard to what things?

A

Speech

Airway

Anatomy

Occlusion

Esthetics

TMJ function

Masticatory function

Psycho-social factors

In the absence of a severe deformity, however, surgical mandibular advancement before the growth spurt is questionable. When the mandibular growth rate is normal, mandibular advancement can be stable due to continued normal growth of the mandible in its new position.

ABO (22 decks)

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