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Orthodontic class 2 div 2


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Orthodontic class 2 div 2

  1. 1. Prepared by : Haval Jalal
  2. 2. CLASS II ANGLE’S CLASS II The distobuccal cusp of the upper 1st permanent molar occludes in the buccal groove of the lower 1st permanent molar. CLASS II INCISOR RELATIONSHIP The lower incisal edges lie posterior to the cingulum plateaux of the upper incisors. DIVISION 2 – The upper central incisors are retroclined ; the overjet is minimal but may be increased.
  3. 3. CLASS II, DIVISION 2 MALOCCLUSIONS 1) Occurs in about 10% of children. 2) In milder forms they may be acceptable functionally, and the facial appearance can be pleasing. 3) In severe cases the over bite is very deep, associated with periodontal trauma palatal to upper, and labial to the lower incisors. 4) Class II, Div. 2 incisor relationship is generally the result of dento-alveolar compensation for a class II skeletal pattern by retroclination of the upper central incisors.
  4. 4. FEATURES 1) Molars in disto-occlusion. 2) The classic feature of the upper incisors. 3) Deep overbite. 4) Pleasing straight profile. 5) Broad square face. 6) Backward path of closure. 7) Deep mento-labial sulcus. 8) Absence of abnormal muscle activity.
  5. 5. SKELETAL RELATIONSHIPS 1) The skeletal pattern may be Class I, but is generally mild Class II, and the chin is well developed so that the facial profile is good. 2) The lower anterior face height is often smaller than average and characteristically the maxillary-mandibular planes angle is low, with a well-developed mandibular angle
  6. 6. FACIAL GROWTH In many class II, Div.2 patients, facial growth is favourable, and there is an anterior mandibular rotation, as might be expected from the diminished anterior face height and the form of the chin.
  7. 7. SOFT TISSUES 1) The lips are almost always of adequate length to meet without strain. 2) Frequently the lip line is high relative to the upper incisor crown, and the higher the lip line the more retroclined the upper incisors are liable to be. There is often a well-developed labiomental fold.
  8. 8. MANAGEMENT OF CLASS II DIV 2 Three important factors to consider in the management are : 1. Nature of malocclusion. 1.Skeletal. 2.Dentoalveolar. 3.Functional. 4.Combination. 2. Severity of malocclusion. 1.Mild. 2.Moderate. 3.Severe 3. Age. 1.Growth left. 2.After growth
  9. 9. MANAGEMENT OF CLASS II DIV 2 Mandible is usually guided posteriorly due to premature contact from the retroclined incisors and thereby restricting its growth. The treatment sequence remains the same except that for any form of treatment modality to be instituted the retroclined teeth have to be aligned in a proper labiolingual direction.
  10. 10. 1. Mixed dentition phase – Use of functional appliances after proclining the maxillary anteriors. Results are good even after the eruption of permanent teeth. The maxillary first premolars are extracted generally to create space for aligning crowded maxillary anterior segment.
  11. 11. 2. After the cessation of growth – The need for orthognathic surgery increases with the increase in the severity of the problem. The surgical procedures are also the same but the use of presurgical orthodontics becomes imperative to achieve stable results.
  12. 12. ORTHPAEDIC DEVICES USED IN TREATMENT OF CLASS II 1. High pull H.G(parietal) 2. Medium pull H.G(occipital) 3. Low pull H.G(cervical) 4. Combee pull H.G 5. Reverse pull H.G
  13. 13. Functional Appliances Functional appliances are designed to change the patients 1) Pattern of function, 2) Alter the jaw relationships, 3) Reprogram the neuromusculature, thus altering the functional matrix of the face.
  15. 15. FIXED FUNCTIONAL APPLIANCES 1) 2) 3) 4) Herbst appliance Jasper Jumper Universal bite jumper Mandibular corrector …………………..etc
  16. 16. MOLAR DISTALIZATION 1) The Pendulum appliance 2) The K-loop appliance 3) The distal jet 4) Modified Nance Lingual appliance 5) Molar distalization with magnets 6) Use of Super elastic NiTi 7) NiTi Double Loop system
  17. 17. 1) Mild to moderate skeletal Class II Jaw Treatment of malocclusion 2) Reasonably good with underlying mild or alignment ( so that moderate jaw discrepancies, Xn spaces can be used for retraction which can achieve a good and not to relieve dental occlusion, through crowding) extraction of certain teeth, to mask skeletal problem. 3) Good vertical facial proportions, neither extreme
  18. 18. Surgical option should be choosen in following cases: 1.Severe skeletal discrepancy or extremely severe dento alveolar problem. 2.Adult patients. 3.Young patients with extremely severe or progressive deformity. 4.Good general health status of patient. DISTRACTION OSTEOGENESIS