Treatment of class II malocclusion

Question 1

What is class II occlusion?

Answer 1

Lower incisor occludes behind upper cingulum plateau

Question 2

What is the main limiting factor in class II treatments?

Answer 2

Skeletal pattern

The size of the overjet gives an idea about severity

Question 3

What is used to treat class II malocclusion in a growing patient?

Answer 3

Consider functional appliance or orthodontic camouflage

Question 4

What is used to treat class II malocclusion in non-growing patient

Answer 4

Orthodontic camouflage (if skeletal pattern isn't too severe)
Orthognathic surgery

Question 5

What are the functional appliances that can be used and when are they used?

Answer 5

Activators - mild non-crowded cases

Twin-block appliance - severe cases and crowded cases

Question 6

When can a medium opening activator be used?

Answer 6

Treatment for malocclusion
Used if have deep overbite
Space for the molars to erupt - able to correct the buccal segment

Question 7

What are twin blocks

Answer 7

2 piece functional appliance, upper and lower bite block 7-8mm inclined plate

Question 8

What is anchorage?

Answer 8

Control unwanted movement 
loss of anchorage will result in lack of occlusion in the buccal segments and residual overjet in class II case

Question 9

What are the keys to planning anchorage?

Answer 9

Think about how upper fits around lower, check for crowding and irregularity in the lower arch

Question 10

How would you treat a mild class II with no lower crowding and class one molars?

Answer 10

As long as the molars in the upper arch are class I then everything will fit in the upper arch
Need to bring back the canine and premolars to class I
This will create space to reduce the overjet 
Use headgear, functional appliance, elastics - class II elastics - fun from the front at the top to the back at the bottom - brings back uppers and moves forwards the lowers

Question 11

What anchorage will be needed when treating mild class II with no lower crowding and class one molars?

Answer 11

Need to ensure that upper molars dont move forwards

Question 12

What would be the non-extraction way of treating mild class II with no lower crowding and class one molars?

Answer 12

Headgear 12-14 hours a day
palatal arches
implants
Class II elastics

Question 13

What is the problem with treating Half-unit class II and no lower crowding?

Answer 13

upper teeth half a tooth further forwards than they should be 
because the molars are not class I there isn't enough space to correct and reduce space

Question 14

What are the 3 options for treatment Half-unit class II and no lower crowding?

Answer 14

Non-extraction distal movement - headgear for 12 hours a day
Extraction of upper 7’s and distal movement - bring all teeth back
Extraction upper premolars and then the upper 6 can move fully into class II `

Question 15

What is needed to distalise the upper buccal segemtnts?

Answer 15

Well aligned lower arch
Half-unit class II molars
Co-operative patient

Question 16

What are the appliances as an alternative to headgear?

What is the disadvantage of them?

Answer 16

Designed to alsoe push the molars back into class II
Causes overjet to increase because of the bar of metal at the front

Question 17

What are examples of non-compliance headgear?

Answer 17

Pendulum appliance - use implants to anchor 
Distal jet (premolar anchor?)

Question 18

If extrace the upper premolars to correct alf-unit class II and no lower crowding, how is it carried out?

Answer 18

Miniscrew implant - space after the premolar was removed
Molar now in class II
Now enough space to get canine into class I
Then have enough space to reduce the overjet

Question 19

How do you treat Class II no lower crowding and molars in full-unit class II?

Answer 19

Extract premolar (closer to where need the space to be)
Then retract canines and anteriors - align the anteriors
If use implant, stop the molar from moving forwards - then no pressure on the molar - equal and opposite forces on the implant

Question 20

What do you need to do if have class II incisors lower crowding and class I molars?

Answer 20

Need to extract in both arches depending on how much crowding and how much space is needed

Question 21

How do you treat half unit class II molars with lower crowding

Answer 21

Extract upper 1st and lower 2nd premolars 
Going to bring the lower molar forwards - into class I
In the uppers dont want the molar to move

Question 22

How do you treat full-unit class II molars?

Answer 22

Need to retract uppers and protract lowers
May need to extract 4 teeth in upper (molar and premolar)
in lower if need to fix crowding and bring full unit forwards, may also need to extract 4

Question 23

What do you do if have class II div II?

Answer 23

Convert to div I (procline the teeth)
Treat overbite
Comprehensive treatment: functional appliances and fixed appliances
Can procline the lower incisors, helps reduce the overjet