MANAGEMENT OF
CLASS-II DIVISION-2
MALOCCLUSION

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INDIAN DENTAL ACADEMY
Leader in continuing dental education

www.indiandentalacademy.com

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INTRODUCTION
Many treatment approaches are currently
available to the orthodontist for altering the
occlusion relationship...
ETIOLOGY:

It is important to distinguish class II malocclusions that are
primarily of genetic origin from those of primar...
2.Abnormal perioral muscle functions.
3.Decreased Tongue size and Altered tongue posture.

Local factors:
A.Early loss of ...
Classification
According to Moyers class II can be divided into Six Horizontal
types and Five vertical types

Horizontal c...
TYPE A or DENTAL CLASS II :A Normal skeletal profile and
normal A-P position of jaws.Mandibular dentition is placed
normal...
HORIZANTAL TYPE B: Displays mid face prominence with a
mandible of normal length.Size of maxilla is increased but mandible...
HORIZANTAL TYPE D:Displays a skeletal profile which is
retrognathic because there is a smaller than normal mandible.The mi...
Vertical class II types:
There are Five vertical types of class II ,but
they are not as clearly differentiable as horizont...
Vertical type 2:
features:
1.Square face.
2.Mandibular plane, functional occlusal plane and palatal planes
are more horizo...
Vertical type 3
Features:

1.Palatal plane tipped upward
resulting in decreased upper
anterior facial height and
predispos...
Vertical type 4:
Features:
1.Rare type of vertical pattern.
2.Mandibular plane, functional occlusal plane
and palatal plan...
Vertical type 5:
Features:
1.Mandibular and functional occlusal planes
are placed normally
2.palatal plane is tipped downw...
THERAPEUTIC CLASSIFICATION.

Class II malocclusions can be classified
Therapeutically as:
1.Skeletal class II.
2.Dentoalve...
Skeletal class II
Antero posterior disproportion of jaws in size and position
result in skeletal class II.
Skeletal class ...
CEPHALOMETRIC FINDINGS INDICATING
CLASS II DUE TO
MANDIBULAR DEFICIENCY: Variant 1:

1.Downward and back ward rotation of
...
6.Increased over jet.
7.Greater positive value of wits appraisal.
8.Posterior position of point B in relation
to Na perpen...
MANDIBULAR DEFICIENCY:
Variant 2:Due to decreased Size:
features:
1.convex profile.
. 2.Normal or an increased ramus lengt...
6.Short anterior facial height.
7.Hyperactive mentalis muscle.
8.Deep anterior overbite
9.Maxillary incisors are lingually...
MANDIBULAR DEFICIENCY:
Variant 3:Due to retruded position:
Features:
1. Normal or decreased size of
mandible.
2.Cranial ba...
FUNCTIONAL CLASS II :(FORCED BITE MALOCCLUSION)

Based on different types of movement of mandible from
rest position to oc...
Why to correct class II div-2?
1.Esthetics.
2. Function.
3.Trauma.
4.TMJ problems.
5.Periodontal problems.

Function: If t...
TREATMENT PLANNING OF CLASS II:
Treatment planning of class II depends mainly on 3
criteria:
1. Nature of malocclusion.
1....
General strategies for class II correction
1.Differential restraint and control of skeletal growth
1.Extra oral traction.
...
5.Transition of parts during growth:
1.Palatal widening devices.
6.Training of muscles:
1. Functional appliances.
7.Surgic...
LIMITATIONS OF CLASS II THERAPY:
1.Occlusal plane inclinations tend to return after treatment,
this tendency diminishes as...
4.Post treatment changes primarily are the shifting of
Occlusal plane toward the original inclination and the
tendency for...
PROGNOSIS FOR CLASS II CORRECTION
Class II with Horizontal growth pattern:
In these cases prognosis is favorable for corre...
CLASSIFICATION OF CLASS II DIV-2
 Type A Maxillary four permanent incisors can
tip palatally without occerence of crowdin...
Type B- The maxillary permanent central
incisor will move palatally gradually.
The available space in maxillary dental a...
Type C- There is a marked shortage of
available space in the maxillary dental
arch.
Centals and Laterals are palatally tip...
TYPE A

TYPE B
TYPE C
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FEATURES OF CLASS II DIVISION-2
Features:
1.Mandibular molars assume a
posterior position with respect to maxillary
1st mo...
5.Maxillary arch is wider than normal in
inter canine region(U shaped arch).
6.Remarkable and constant distinguishing
feat...
8.Excessive interocclusal clearance
9.Abnormal path of closure due to
combination of lingual inclination of
maxillary inci...
Upper lip proversion
Undesirable fullness of upper lip,closer to E-Plane
line.
Imbalance is due to forward version of uppe...
Sub-labial contraction
It occurs at a lower level than the tip of the lip.
It commonly associated with thick hypertrophied...
These facial patterns usually have excessively
strong posterior vertical chain of muscles, anterior
vertical chain of musc...
There are six functions necessary in treating Class II,
Division 2 malocclusions, which are general
considerations for eva...
In most Class II, Division 2 malocclusions the
maxillary dentition is protruded and constrained
by anterior facial muscula...
At the same time Quad-Helix is unlocking the
dentition, the maxillary incisors are being
advanced with a utility arch to c...
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A. Advancement, Torque Control, and Intrusion
of the Upper Incisors
There are four basic factors in upper incisor
intrusio...
1. The direction of force
A. Tipback of 45°.
B. Distolingual rotation of 10-20°.
C. Expansion of approximately 1 cm on eac...
2. The amount of pressure.
It takes approximately double the force to
intrude the upper incisors, compared to the lower
in...
3. The stabilization of the molars.
Using .016x.022 utility arch
has adverse tipping effect on
maxillary molar.
Quad-Helix...
4.Torque control
A.It shows the normal growth pattern of maxillary
molar and incisor in class-I occlusion
B.It shows the g...
FOLLOWED BY
B.Lower incisor and canine intrusion.
C.Aligning of buccal segment and class-II
correction.
D.Consolidation of...
RICKETT’S LOWER UTILITY
ARCH
Late in the 1950's Robert Ricketts and others attempted to
counteract the tipping that occurr...
TYPICAL VARIATION IN LOWER
UTILITY ARCH

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PROTRUSION UTILITY ARCH
The protrusion utility arch is useful for proclining upper
and lower incisors. It is most commonly...
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BONDED BITE PLANES

1

2
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3

4

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5
Fixed anterior bite plane
~Acrylic component
~Wire component
~Allows extrusion of posterior
teeth
~Indicated in correction...
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-Slight accentuated curve in upper
and reverse curve in lower
-Banding of second molar in low
angle cases commonly in clas...
Side effects of using continuous arch
wire in class II div-2 cases

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BURSTONE INTRUSION ARCH

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CONNECTICUT INTRUSION ARCH

-Ravindra nanda et al,j.c.o,1998

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SIMENTANEOUS INTRUSION AND
TORQUING

-JCO,1993,JUN,RAPHAELL

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ORTHPAEDIC DEVICES USED IN
TREATMENT OF CLASS II
Extra oral force appliances(Head gears):

Indications:
1.As growth modifi...
Mechanism of action: Deliver forces to compress the
maxillary sutures,modifying the pattern of bone
apposition at these si...
Type of head gear
1.Cervical Pull head gear:
Mechanism of action: It prevents forward
growth of maxilla and and increase v...
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FUNCTIONAL APPLIANCES IN MANAGEMENT OF
CLASS II
Before instuiting myofunctional appliances the following should be
assesse...
Criteria for functional appliances selection
Indications for functional appliances:
1.Patient in growth phase.
2.Skeletal ...
Contraindications:
1.Patient in post growth phase.
2.Skeletal Class II malocclusions due to prognathic maxilla.
3.Skeletal...
Jumping the Bite
1. dentoalveolar adaptaion
2. mandibular growth
stimulation
3. TMJ adaptation

www.indiandentalacademy.co...
1.Activator:
Indication: Mild to moderate class II
malocclusions with deep bite and
horizontal growth pattern.

Contraindi...
Bionator(Balters appliance):
Indications:
1.Treatment of class II conditions to correct backward
position of tongue and it...
Mechanism of action:
1.Brings the tongue forward and correct
the disturbance in cervical viscera by bringing
them forward ...
Frankel functional regulator
Indications :

Class II cases with abnormal perioral
muscle function

Mechanism of action:
Th...
Twin block appliance:
Indications:
1.In class II malocclusion to modify
occlusal inclined plane in disto occlusion
that ha...
FIXED FUNCTIONAL APPLIANCES
Indications:
1.Indicated in correction of
class II malocclusions due to retrognathic
mandible ...
Treatment effects :
1.Stimulate mandibular growth.
2.Inhibition of maxillary growth(less
important).
3.Distal movement of ...
FORSUS(FLEXIBLE)

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FORSUS (RIGID)

UNIVERSAL BITE
JUMPER

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SUPER ELASTIC NITI WIRE
(NEOSENTALLOY)

John bednar, j.c.o ,1992

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JONES JIG

OPEN NITI SPRING

Richard jones,J.C.O,1992

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DISTAL JET APPLIANCE

Aldo carano, J.C.O,1996

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PENDULUM APPLIANCE

James.J.hilgers,J.C.O,1992

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K-LOOP MOLAR DISTALISAR

Varun kalra,J.C.O,1995

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SURGICAL CORRECTION OF CLASS II DIVISION-2

Surgical option should be choosen in following cases:
1.Severe skeletal discre...
SURGICAL CORRECTION OF SKELETAL
CLASS II DIV-2 IN ADULT:
Correction in Anterioposterior plane:
1.Mandibular deficiency:
Ma...
ClassII Division 2 malocclusions are frequently present in
brachyfacial patterns with resulting strong musculature.
They g...
Thank you
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Leader in continuing dental education

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Management of class2.div2 /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Management of class2.div2 /certified fixed orthodontic courses by Indian dental academy

  1. 1. MANAGEMENT OF CLASS-II DIVISION-2 MALOCCLUSION www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. INTRODUCTION Many treatment approaches are currently available to the orthodontist for altering the occlusion relationship typically found in classII division-2 malocclusion. These treatments include a variety of extraoral traction appliances,arch expansion appliances , extraction procedures,functional jaw orthopedic appliances,molar distilation e.t.c Depending upon experience,personal preference and success rate various www.indiandentalacademy.com modalities are selected
  4. 4. ETIOLOGY: It is important to distinguish class II malocclusions that are primarily of genetic origin from those of primarily environmental when choosing the appropriate treatment and retention. 1. Genetic causes: HERIDITY causes 2.Environmental causes: 1.Habits:A.Finger sucking habit B.Tongue thrusting habit. C.Mouth breathing habit. D.lip biting habit. E.Retained infantile swallow patterns. . www.indiandentalacademy.com
  5. 5. 2.Abnormal perioral muscle functions. 3.Decreased Tongue size and Altered tongue posture. Local factors: A.Early loss of deciduous teeth B.Generalized decrease in size of teeth(mesial migration). C.Ectopic eruption of teeth www.indiandentalacademy.com
  6. 6. Classification According to Moyers class II can be divided into Six Horizontal types and Five vertical types Horizontal class II Types NORMAL SKELETAL PATTERN:Displays normal relationship of maxilla and mandible to the cranial base and to each other. Upper and lower dentition are within their normal positions over their basal bones www.indiandentalacademy.com
  7. 7. TYPE A or DENTAL CLASS II :A Normal skeletal profile and normal A-P position of jaws.Mandibular dentition is placed normally on its base but Maxillary dentition is protracted, resulting in class II molar relationship and increased incisal overjet and overbite than normal. HORIZANTAL TYPE F:Displays mild skeletal tendency due to combination of maxillary protrusion and Mandibular retrusion with upper and lower anteriors Upright over their basal bones www.indiandentalacademy.com
  8. 8. HORIZANTAL TYPE B: Displays mid face prominence with a mandible of normal length.Size of maxilla is increased but mandible is normal Antero posteriorly HORIZANTAL TYPE C:Displays class II profile though the maxilla and mandible are further back beneath the anterior cranial base than normal the lower incisors are tipped labially,the upper incisors are eitherupright or tipped off the base labially according to the vertical category. www.indiandentalacademy.com
  9. 9. HORIZANTAL TYPE D:Displays a skeletal profile which is retrognathic because there is a smaller than normal mandible.The mid face is normal or slightly diminished.The mandibular incisors are either upright or lingually inclined,where as maxillary incisors are typically labially positioned www.indiandentalacademy.com
  10. 10. Vertical class II types: There are Five vertical types of class II ,but they are not as clearly differentiable as horizontal types.It is not necessary for a case of horizontal type to be associated with any of the described vertical class II types. 1.Vertical type 1or High angle case: Features: 1.Anterior facial height >Posterior facial height. 2.Mandibular and functional occlusal planes are steeper than normal. 3.Palatal plane may be tipped downwards while the anterior cranial base tends to be upward. www.indiandentalacademy.com
  11. 11. Vertical type 2: features: 1.Square face. 2.Mandibular plane, functional occlusal plane and palatal planes are more horizontal and often seem parallel. 3.Gonial angle is smaller than normal 4.Anterior cranial base appears horizontal. 5.Skeletal deep bite www.indiandentalacademy.com
  12. 12. Vertical type 3 Features: 1.Palatal plane tipped upward resulting in decreased upper anterior facial height and predisposition to open bite. www.indiandentalacademy.com
  13. 13. Vertical type 4: Features: 1.Rare type of vertical pattern. 2.Mandibular plane, functional occlusal plane and palatal planes are tipped downward. 3.Gonial angle is relatively obtuse. 4.Lip line high in the maxillary alveolar process. 5.Upper incisors are tipped labially and lower incisors are tipped lingually. www.indiandentalacademy.com
  14. 14. Vertical type 5: Features: 1.Mandibular and functional occlusal planes are placed normally 2.palatal plane is tipped downward 3.Gonial angle is smaller than normal. 4.Skeletal deep bite may be present 5.lower incisors are labially tipped and upper incisors are lingually tipped. www.indiandentalacademy.com
  15. 15. THERAPEUTIC CLASSIFICATION. Class II malocclusions can be classified Therapeutically as: 1.Skeletal class II. 2.Dentoalveolar class II. 3.Functional class II www.indiandentalacademy.com
  16. 16. Skeletal class II Antero posterior disproportion of jaws in size and position result in skeletal class II. Skeletal class II Pattern can result due to: 1. Increased size of Maxilla. 2. Decreased size of Mandible 3.Combination of Increased Maxilla and Decreased Mandible size www.indiandentalacademy.com
  17. 17. CEPHALOMETRIC FINDINGS INDICATING CLASS II DUE TO MANDIBULAR DEFICIENCY: Variant 1: 1.Downward and back ward rotation of mandible caused by small size of ramus and body of mandible. 2.Decreased posterior facial height. 3.Steep mandibular plane angle. 4.Increased ANB angle. 5 Increased angle of convexity. www.indiandentalacademy.com
  18. 18. 6.Increased over jet. 7.Greater positive value of wits appraisal. 8.Posterior position of point B in relation to Na perpendicular. 9. Normal position of point A in relation to Na perpendicular. 10.Dental compensation of protruded mandibular incisors www.indiandentalacademy.com
  19. 19. MANDIBULAR DEFICIENCY: Variant 2:Due to decreased Size: features: 1.convex profile. . 2.Normal or an increased ramus length. 3.Flat mandibular plane angle. 4.Normal or increased posterior facial height. 5.Excessive bony chin masking the mandibular deficiency but still have lack of support for lower lip. www.indiandentalacademy.com
  20. 20. 6.Short anterior facial height. 7.Hyperactive mentalis muscle. 8.Deep anterior overbite 9.Maxillary incisors are lingually inclined masking the anteroposterior dental discrepancy.. 10.Accentuated curve of spee. www.indiandentalacademy.com
  21. 21. MANDIBULAR DEFICIENCY: Variant 3:Due to retruded position: Features: 1. Normal or decreased size of mandible. 2.Cranial base angle is more obtuse. 3.Glenoid fossa is more posteriorly positioned. www.indiandentalacademy.com
  22. 22. FUNCTIONAL CLASS II :(FORCED BITE MALOCCLUSION) Based on different types of movement of mandible from rest position to occlusion class II malocclusions can be divided into 3 functional types. 1.Functional True class II malocclusion. 2.Functional class II with posterior sliding movement 3.Functional class II with anterior sliding movement www.indiandentalacademy.com
  23. 23. Why to correct class II div-2? 1.Esthetics. 2. Function. 3.Trauma. 4.TMJ problems. 5.Periodontal problems. Function: If there is malrelationship between maxilla and mandible making normal muscle function difficult ,an adaptive activity of muscle may occur ,so a compensatory muscle functional activity is established for demands of mastication , respiration,deglutition and speech. www.indiandentalacademy.com
  24. 24. TREATMENT PLANNING OF CLASS II: Treatment planning of class II depends mainly on 3 criteria: 1. Nature of malocclusion. 1.Skeletal. 2.Dentoalveolar. 3.Functional. 4.Combination. 2.Severity of malocclusion. 1.Mild. 2.Moderate. 3.Severe. 3.Age. 2.After growth www.indiandentalacademy.com
  25. 25. General strategies for class II correction 1.Differential restraint and control of skeletal growth 1.Extra oral traction. 2.Differential promotion of skeletal Growth: 1.Functional Jaw orthopedic appliances. 3.Guidance of eruption and alveolar development: 4.Movement of teeth and alveolar process (Camouflage treatment). 1.Extraction treatment. www.indiandentalacademy.com 2.Non Extraction treatment.
  26. 26. 5.Transition of parts during growth: 1.Palatal widening devices. 6.Training of muscles: 1. Functional appliances. 7.Surgical Translation of parts after growth in severe cases: 1.Orthognathic surgery www.indiandentalacademy.com
  27. 27. LIMITATIONS OF CLASS II THERAPY: 1.Occlusal plane inclinations tend to return after treatment, this tendency diminishes as age advances. 2.A change in mandibular plane position contributes to orthodontic result in a number of cases.This change usually comes from downward and backward mandibular rotation,but occasionally there is antero posterior shift. 3.Changes in axial inclination of the teeth tend to revert after orthodontic therapy. www.indiandentalacademy.com
  28. 28. 4.Post treatment changes primarily are the shifting of Occlusal plane toward the original inclination and the tendency for original incisal axial inclination. 5.Difficulty in correction of skeletal deep bite in class II div2 due to strong pterygo massetric sling causing relapse. 6.Success depends on correlation between growth and treatment. www.indiandentalacademy.com
  29. 29. PROGNOSIS FOR CLASS II CORRECTION Class II with Horizontal growth pattern: In these cases prognosis is favorable for correction of sagittal jaw relations but unfavorable for bite opening. Class II with vertical growth pattern : In these cases prognosis is favorable for bite opening but unfavorable for correction of sagittal jaw relationships www.indiandentalacademy.com
  30. 30. CLASSIFICATION OF CLASS II DIV-2  Type A Maxillary four permanent incisors can tip palatally without occerence of crowding  High lip line position and certain excess of external soft tissue material present in the anterior region  The lips attain a more dorsal position and a “dished in” appearance.  Space present for the correction of dentition www.indiandentalacademy.com BY-VAN DER LINDEN
  31. 31. Type B- The maxillary permanent central incisor will move palatally gradually. The available space in maxillary dental arch is limited.Thus lateral incisors are placed labially. The lower lip will become positioned inferiorly to maxillary lateral incisors and will contribute to the increase of their labial inclination. www.indiandentalacademy.com
  32. 32. Type C- There is a marked shortage of available space in the maxillary dental arch. Centals and Laterals are palatally tipped, and canines, emerges buccally and labially tipped position. www.indiandentalacademy.com
  33. 33. TYPE A TYPE B TYPE C www.indiandentalacademy.com
  34. 34. FEATURES OF CLASS II DIVISION-2 Features: 1.Mandibular molars assume a posterior position with respect to maxillary 1st molars and maxillary arch. 2.Mandibular arch may or may not show any individual irregularities but usually has exaggerated curve of spee. 3.Supraversion of mandibular incisors. 4.Mandibular labialwww.indiandentalacademy.comis often gingival tissue traumatized
  35. 35. 5.Maxillary arch is wider than normal in inter canine region(U shaped arch). 6.Remarkable and constant distinguishing feature is lingual inclination of maxillary centrals and labial inclination of lateral incisors. 7.Excess overbite (closed bite) www.indiandentalacademy.com
  36. 36. 8.Excessive interocclusal clearance 9.Abnormal path of closure due to combination of lingual inclination of maxillary incisors and infraocclusion of posteriors result in mandible to be forced into retruded tooth guidance with condylar movement posteriorly and superiorly in articular fossa creating a displacement. www.indiandentalacademy.com
  37. 37. Upper lip proversion Undesirable fullness of upper lip,closer to E-Plane line. Imbalance is due to forward version of upper lip www.indiandentalacademy.com
  38. 38. Sub-labial contraction It occurs at a lower level than the tip of the lip. It commonly associated with thick hypertrophied band of muscle crossing the midline. www.indiandentalacademy.com
  39. 39. These facial patterns usually have excessively strong posterior vertical chain of muscles, anterior vertical chain of muscles, horizontal chain of muscles, and perioral musculature www.indiandentalacademy.com
  40. 40. There are six functions necessary in treating Class II, Division 2 malocclusions, which are general considerations for evaluating the mechanics sequence: A. Advancement, torque control, and intrusion of the upper incisors. B. Intrusion of the lower incisors and cuspids. C. Alignment of the buccal segments and Class II correction. D. Consolidation of the upper incisors. E. Idealizing the arches. F. Finishing. www.indiandentalacademy.com
  41. 41. In most Class II, Division 2 malocclusions the maxillary dentition is protruded and constrained by anterior facial musculature. The upper dentition becomes constricted and, therefore, constricts the lower dentition. Arch form development of the maxillary dentition will create arch form changes reciprocally in the mandibular arch. www.indiandentalacademy.com
  42. 42. At the same time Quad-Helix is unlocking the dentition, the maxillary incisors are being advanced with a utility arch to continue the unlocking process. Essentially, after the advancement of the upper incisors www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. A. Advancement, Torque Control, and Intrusion of the Upper Incisors There are four basic factors in upper incisor intrusion: 1. The direction of force. 2. The amount of pressure. 3. The stabilization of the molars. 4. Torque control and the timing of torque control in relation to growth factors. www.indiandentalacademy.com
  45. 45. 1. The direction of force A. Tipback of 45°. B. Distolingual rotation of 10-20°. C. Expansion of approximately 1 cm on each side. www.indiandentalacademy.com
  46. 46. 2. The amount of pressure. It takes approximately double the force to intrude the upper incisors, compared to the lower incisors (125 to 160 grams). .016 × .022 blue Eligiloy or Nitinol maxillary utility arch in the initial phase of treatment. www.indiandentalacademy.com
  47. 47. 3. The stabilization of the molars. Using .016x.022 utility arch has adverse tipping effect on maxillary molar. Quad-Helix, Lingual Arch, or Tranpalatal Bar will help stabilize the maxillary molars. Stabilizing section is .016 × .016 or .016 × .022 with a tip-forward (down) bend in the www.indiandentalacademy.com molar section.
  48. 48. 4.Torque control A.It shows the normal growth pattern of maxillary molar and incisor in class-I occlusion B.It shows the growth pattern of maxillary molar and incisor in class-II division-2. www.indiandentalacademy.com
  49. 49. FOLLOWED BY B.Lower incisor and canine intrusion. C.Aligning of buccal segment and class-II correction. D.Consolidation of upper anteriors. E.Idealizing the arch. F.Finishing www.indiandentalacademy.com
  50. 50. RICKETT’S LOWER UTILITY ARCH Late in the 1950's Robert Ricketts and others attempted to counteract the tipping that occurred in the buccal segments in extraction cases by utilizing the supposedly immutable lower incisors as an anchor unit to hold the lower second bicuspids and molars upright in the retraction process. www.indiandentalacademy.com
  51. 51. TYPICAL VARIATION IN LOWER UTILITY ARCH www.indiandentalacademy.com
  52. 52. PROTRUSION UTILITY ARCH The protrusion utility arch is useful for proclining upper and lower incisors. It is most commonly used for flaring and intruding maxillary incisors in Class II div-2 www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. BONDED BITE PLANES 1 2 www.indiandentalacademy.com
  55. 55. 3 4 www.indiandentalacademy.com 5
  56. 56. Fixed anterior bite plane ~Acrylic component ~Wire component ~Allows extrusion of posterior teeth ~Indicated in correction of deep bite www.indiandentalacademy.com
  57. 57. www.indiandentalacademy.com
  58. 58. -Slight accentuated curve in upper and reverse curve in lower -Banding of second molar in low angle cases commonly in class II DIV-2 www.indiandentalacademy.com
  59. 59. Side effects of using continuous arch wire in class II div-2 cases www.indiandentalacademy.com
  60. 60. BURSTONE INTRUSION ARCH www.indiandentalacademy.com
  61. 61. CONNECTICUT INTRUSION ARCH -Ravindra nanda et al,j.c.o,1998 www.indiandentalacademy.com
  62. 62. SIMENTANEOUS INTRUSION AND TORQUING -JCO,1993,JUN,RAPHAELL www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. ORTHPAEDIC DEVICES USED IN TREATMENT OF CLASS II Extra oral force appliances(Head gears): Indications: 1.As growth modification procedure in treatment of skeletal class II with anteroposterior as well as vertical maxillary excess in growing individuals. 2.Normal mandibular skeletal and dental morphology. 3.Cases with active mandibular growth primarily displacing the mandible in forward rather than downward direction www.indiandentalacademy.com
  66. 66. Mechanism of action: Deliver forces to compress the maxillary sutures,modifying the pattern of bone apposition at these sites,these also inhibit mesial and occlusal eruption of maxillary posterior teeth. www.indiandentalacademy.com
  67. 67. Type of head gear 1.Cervical Pull head gear: Mechanism of action: It prevents forward growth of maxilla and and increase vertical dimension through extrusion of posterior teeth. www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. FUNCTIONAL APPLIANCES IN MANAGEMENT OF CLASS II Before instuiting myofunctional appliances the following should be assessed: 1.Functional criteria: A)Differentiate between true and forced bite malocclusions. B)Relationships between overjet and function of lips. C)Hyperactive,adaptive and exacerbated mentalis muscle D)Posture and function of tongue should be assessed. E)Mode of breathing (mouth breathers cannot resist all types www.indiandentalacademy.com of functional appliances in mouth)
  70. 70. Criteria for functional appliances selection Indications for functional appliances: 1.Patient in growth phase. 2.Skeletal Class II malocclusions due decreased size of mandible are good indicators for functional appliances 3.Functional forced bite class II with posterior sliding movement 4.Horizontal growth pattern. 5.Abnormal perioral function and neuromuscular dysfunction www.indiandentalacademy.com
  71. 71. Contraindications: 1.Patient in post growth phase. 2.Skeletal Class II malocclusions due to prognathic maxilla. 3.Skeletal class II due to normal sized and retrusive positioned mandible(unfavorable prognosis). 4.Gross irregularities in individual tooth positions(crowding and rotations). 5.Proclined lower anterior teeth. 6.Vertical growth pattern. www.indiandentalacademy.com
  72. 72. Jumping the Bite 1. dentoalveolar adaptaion 2. mandibular growth stimulation 3. TMJ adaptation www.indiandentalacademy.com
  73. 73. 1.Activator: Indication: Mild to moderate class II malocclusions with deep bite and horizontal growth pattern. Contraindication: 1.Crowding cases. 2.Proclined lower anteriors. 3.In vertical growers. Mechanism of action: 1. Promote or redirect the condylar growth & there by lengthening the mandible. 2. Restrict the sagittal growth of maxilla 3. It causes downward www.indiandentalacademy.com tipping of maxillary base (activator with high construction bite).
  74. 74. Bionator(Balters appliance): Indications: 1.Treatment of class II conditions to correct backward position of tongue and its consequences. 2.skeletal discrepancy not too severe. 3.Mandible in functional retrusion. Contraindications: 1.class II due to maxillary prognathism 2.Vertical growth pattern. 3.Labial tipping of lower incisors. www.indiandentalacademy.com
  75. 75. Mechanism of action: 1.Brings the tongue forward and correct the disturbance in cervical viscera by bringing them forward ,such a change will enlarge respiratory pathways and enhance reflex deglutition which will then become normal. www.indiandentalacademy.com
  76. 76. Frankel functional regulator Indications : Class II cases with abnormal perioral muscle function Mechanism of action: This appliance is used as oral gymnastic appliance to help in overcoming abnormal perioral muscle activity and rehabilitates the muscles and to establish proper lip seal. www.indiandentalacademy.com FR-2
  77. 77. Twin block appliance: Indications: 1.In class II malocclusion to modify occlusal inclined plane in disto occlusion that have a distal component of force that is unfavorable for normal forward mandibular development. 2.In patients with poor tolerance to other functional appliances Mechanism of action: Forces of occlusion are used as functional mechanism to correct malocclusion. www.indiandentalacademy.com
  78. 78. FIXED FUNCTIONAL APPLIANCES Indications: 1.Indicated in correction of class II malocclusions due to retrognathic mandible in growing patients. 2.In preadolescent patients to utilize residual growth left. 3.Can be used in Mouth breathers. 4.Uncooperative patients. www.indiandentalacademy.com
  79. 79. Treatment effects : 1.Stimulate mandibular growth. 2.Inhibition of maxillary growth(less important). 3.Distal movement of upper incisors. 4.Mesial movement of lower dentition. 5.Deep bite correction by intrusion of lower incisors and enhanced eruption of lower molars www.indiandentalacademy.com
  80. 80. FORSUS(FLEXIBLE) www.indiandentalacademy.com
  81. 81. FORSUS (RIGID) UNIVERSAL BITE JUMPER www.indiandentalacademy.com
  82. 82. www.indiandentalacademy.com
  83. 83. SUPER ELASTIC NITI WIRE (NEOSENTALLOY) John bednar, j.c.o ,1992 www.indiandentalacademy.com
  84. 84. JONES JIG OPEN NITI SPRING Richard jones,J.C.O,1992 www.indiandentalacademy.com
  85. 85. DISTAL JET APPLIANCE Aldo carano, J.C.O,1996 www.indiandentalacademy.com
  86. 86. PENDULUM APPLIANCE James.J.hilgers,J.C.O,1992 www.indiandentalacademy.com
  87. 87. www.indiandentalacademy.com
  88. 88. www.indiandentalacademy.com
  89. 89. K-LOOP MOLAR DISTALISAR Varun kalra,J.C.O,1995 www.indiandentalacademy.com
  90. 90. www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 92. SURGICAL CORRECTION OF CLASS II DIVISION-2 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. www.indiandentalacademy.com
  93. 93. SURGICAL CORRECTION OF SKELETAL CLASS II DIV-2 IN ADULT: Correction in Anterioposterior plane: 1.Mandibular deficiency: Mandibular deficiency can be corrected surgically by 1.Bilateral Saggital split osteotomy (Treatment of choice). 2.C osteotomy. 3.L osteotomy. www.indiandentalacademy.com
  94. 94. ClassII Division 2 malocclusions are frequently present in brachyfacial patterns with resulting strong musculature. They generally have moderate to minimum convexity, but occasionally do have a higher convexity with resulting orthopedic problems. The lower facial height and mandibular arc are below normal range. Management of these malocclusion depends on correct diagnosis, in depth knowledge,proper treatment Planning and regular www.indiandentalacademy.com follow up to impart perfect smile
  95. 95. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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