This document discusses the classification, causes, and treatment options for Class II and Class III malocclusions. It begins with an overview of Class II malocclusions, including the dental and skeletal classifications. Common causes are discussed, such as heredity and environmental factors. Treatment options for Class II malocclusions include camouflage with orthodontics alone, extraction of premolars with orthodontics, and distalization of maxillary molars with appliances or temporary skeletal anchorage. Class III malocclusions are also briefly covered, discussing etiology, classification, and treatment including camouflage or surgical options.

1. 1

2. 2
PRESENTER :Dr.Ankur Dhuria
3rd year MDS

3.  Introduction
 Class II maloclusion classification and causes
 Indication and contraindication of camouflage
 In class II extraction
 nonextreaction
 molar distalization
 expansion
 Class III maloclusion
 etiology
 classification
 treatment
 Surgical camouflage
3

4. Malocclusions in human populations and attempt to treat these
conditions have been evident since early civilization
Although orthodontists historically have appreciated the
relationship between facial morphology and malocclusion ,
cephalometrics provided a more comprehensive awareness of the
underlying skeletal features that affect occlusion
Angle’s original dental classification was extended by the next
generation of orthodontists to describe the anteroposterior skeletal
discrepancies between the maxilla and the mandible
4

5. Skeletal class I malocclusion
Skeletal class II malocclusion
Skeletal class III malocclusion
These patterns often correspond with the Angle’s
classification but
not necessarily all the time
5

6. CLASSIFICATION
D
E
N
T
A
L
Class II malocclusions are characterised as
having a distal relationship of the mandibular
teeth relative to the maxillary teeth of more
than one-half the width of the cusp
6

7. D
E
N
T
A
L
CLASS II DIVISION 1
CLASS II DIVISION 2
7

8. 8

9. 9

10. HEREDITY CONGENITAL
DRUG
S
PRENATAL
ABNORMAL FOETAL POSTURE INFECTIONS
POSTNATAL
FORCEPS DELIVERY CONDYLAR FRACTURES10

11. LIP
BITING
HABIT
S
THUMB
SUCKING
TONGUE
THRUSTING
MOUTH
BREATHING
POSTUR
E
TREACHER COLLINS
HEMIFACIAL
MICROSOMIA
ACHONDROPLASIA
MOBIUS SYNDROME
ENDOCRINE
DISORDERS
11

12. CLINICAL
•Profile
•Divergence
•Lip competency
•Nasolabial angle
•Chin prominence
•Molar relation
•Overjet
•Overbite
•Constricted maxillary arch
•Tapered arch form
•Hyperactive mentalis activity
12

13. CEPHALOMETRICALLY
•SNA
•SNB
•Witts appraisal
•Gonial angle
•Saddle angle
•Extent of maxillary and mandibular
bases
•Basal plane angle
•Angle of inclination
13

14. Envelope of Discrepancy 7
The inner circle indicates the limits to
orthodontic tooth movement
(Camouflage) alone. the middle circle,
tooth movement combined with growth
modification the outer circle, surgical
correction
14

15. ORTHODONTIC CAMOUFLAGE
15

16. 1. Distal movement of maxillary molars, and eventually
entire upper dental arch
2. Retraction of maxillary incisors into a premolar
extraction space
3. A combination of retraction of the upper teeth and
forward movement of the lower teeth
16

17. INDICATIONS
•Too old for successful growth
modification
•Mild to moderate skeletal
discrepancy
•Good facial aesthetics
•Good vertical facial proportions,
neither extreme short face nor
long face
CONTRAINDICATIONS
•Severe skeletal discrepancies
•Adolescents with good growth
•Better long-term results with surgery
•Periodontally compromised patients
17

18. IDEAL TREATMENT MODALITIES
1. Repositioning the teeth through
orthodontic tooth movement.
2. Redirection of facial growth through
functional alteration of jaw growth (e.g.
bite-jumping appliances)
3. Redirection of facial growth through
dentofacial orthopedics
4. Surgical-orthodontic treatment
18

19. NON EXTRACTION TREATMENT
CLASS II ELASTICS
•Modest retraction of the upper arch, major forward displacement
of the lower arch(prominent lower lip)
•Elongate maxillary incisors(gummy smile) and mandibular
molars(Tipping down of occlusal plane)
•If molars extrude more than ramus growth mandible will rotate
downwards(hence contraindicated in non growing patients)
Janson G, Sathler R, FernandesTM, Branco NC, Freitas MR. Correction of Class
II malocclusion with Class II elastics: a systematic review. Am J Orthod
Dentofacial Orthop. 2013 Mar;143(3):383-92 19

20. Class II malocclusion can be corrected with the use
of intermaxillary elastics by means of forward
movement of the mandibular teeth relative to the
mandible and retraction of the upper teeth.
However, in a patient with a skeletal Class II due to
mandibular deficiency, the result is both
unesthetic.and unstable due to the pressure exerted
by the lower lip creating a treatment relapsed.
20

21. 21

22. •Result is likely to be neither stable nor esthetically acceptable
•After treatment lip pressure tends to move the lower incisors
lingually leading to crowding ,return of overjet and overbite
CLASS II ELASTICS MAY PRODUCE OCCLUSAL
RELATIONSHIPS THAT LOOK GOOD ON DENTAL
CASTS BUT ARE LESS SATISFACTORY WHEN
SKELETAL RELATIONSHIPS AND FACIAL
AESTHETICS ARE CONSIDERED
22

23. PREMOLAR EXTRACTION
UNIARCH EXTRACTION
Retracting the upper incisors into the extraction space
Anchorage reinforced-HG ,TPA ,Nance palatal button , Skeletal
anchorage devices
Class II elastics are contraindicated
Maintaining the class II molar relationship
UPPER 4 LOWER 5
Extraction protocal of choice
Lower molars moved forward and upper incisors retracted
Ending in a class I molar relationship
23

24. Janson G, Dainesi EA, Henriques JF, de Freitas MR, de Lima KJ. Class II
subdivision treatment success rate with symmetric and asymmetric extraction
protocols. Am J Orthod Dentofacial Orthop. 2003 Sep;124(3):257-64
ASYMMETRIC EXTRACTION
 Class II subdivision cases
 Extraction both the upper first premolars and lower first premolar
on the class II side
 Ending in a class II subdivision with class I canine relation bilateral
coincident midlines
 Cheney and Wertz suggested extracting the second premolar on th
Class II side(greater elastic use and difficult midline control)
28 subjects(4 premolar)
23 subjects(3 premolar)
There is a tendency for a slightly better treatment success rate
when Class II subdivision patients are treated with asymmetric
extraction of 3 premolars,
compared with extraction of 4 premolars
Fink and Smith-Treatment time is increased by 0.9 months for
each extracted premolar
24

25. •Group 1- 49 patients with 2 premolar extractions(14.35yrs)
•Group 2 -48 patients with 4 premolar extractions(13.03yrs)
•Treatment time will be shorter and the occlusal results more
predictable with a 2-premolar-extraction protocol compared
with 4 premolar extractions
Janson G, Busato MC, Henriques JF, de Freitas MR, de Freitas LM. Alignment
stability in Class II malocclusion treated with 2- and 4-premolar extraction
protocols. Am J Orthod Dentofacial Orthop. 2006 Aug;130(2):189-95
Janson G, Leon-SalazarV, Leon-Salazar R, Janson M, de Freitas MR. Long-
term stability of Class II malocclusion treated with 2- and 4-premolar
extraction protocols. Am J Orthod Dentofacial Orthop. 2009
Aug;136(2):154.e1-10
Treatment of complete Class II malocclusions with 2 maxillary
premolar extractions or 4 premolar extractions had similar long-
term post treatment stability
25

26. Retraction of the upper incisors into a
premolar extraction space:
A straight forward way to correct excessive
overjet is to retract the protruding incisors
into the extraction space created by the
extraction of maxillary 1st premolars.
Without extractions on the lower arch, the
patient would still have a ClassII molar
relationship but normal canine relationship
at the end of the treatment.
26

27. In cases wherein the mandibular 1st or 2nd
premolars are also extracted, Class II elastics are
used to bring the molars forward and retract the
upper incisors, correcting both the molar
relationship and the overjet.
On the other hand, although premolar extraction
can produce an excellent occlusion and an
acceptable dentofacial appearance, potential
problem still do exists.
27

28. If the patient’s Class II malocclusion is
due to mandibular deficiency, retracting
the maxillary incisors just to go with the
mandibular would create a facial
deformity.
Extractions in the lower arch allow the
molars to come forward into a Class I
relationship, but it would be important to
close the lower space without retracting
the lower incisors.
28

29. If elastics are used, the upper incisors are
elongated as well as retracted, which can
produce a “gummy smile”.
Distal movement of the upper teeth. If the
upper molars could be moved posteriorly, this
would correct a Class II molar relationship and
would also provide space for the other teeth to
be retracted.
29

30. If maxillary molars are rotated
mesiolingually, as they often are
when Class II molar relationship
exists, correcting the rotation by
moving the buccal posteriorly would
create a small space mesial to
thatmolar.
The difficult part is tipping the
crowns distally and bodily distal
movement.
30

31. “ Mesiolingual rotation of the
Maxillary 1st molar”
31

32. There are 2 problems that exists: (1)
It is difficult to maintain the 1st
molar in a distal position while the
premolars and anterior teeth are
moved back, so it must be moved
back into a considerable distance.
(2) the farther it must be moved, the
more the 2nd and 3rd molars are in
the way.
32

33. From this perspective, the most successful
way to move a maxillary 1st molar distally
is to extract the 2nd molar, which would
create a space for the tooth movement.
Also, until quiet recently, the anchorage
created by a transpalatal lingual arch was
accepted as the best way to undertake
distalization of the maxillary dentition.
This type of treatment is time consuming
and requires excellent patient
cooperation.
33

34. Palatal anchorage for the molar
movement can be created by
splinting the maxillary premolars and
including an acrylic pad in the splint
so that it contacts the palatal mucosa.
34

35. In theory, the palatal mucosa resists
displacement; in clinical use, tissue
irritation is likely.
Even with the more elaborate appliances
only about two-thirds of the space that
opens between the molars and premolars is
from distal movement of the molars, even
if the molars are tipped distally.
35

36. They tend to come forward again
when the other maxillary teeth are
retracted, so more than half-cusp
molar correction cannot be expected.
The ideal patient for this approach is
onewith minimal growth potential, a
reasonably good jaw relationship, and
a half cusp molar relationship.
36

37. Using temporary skeletal anchorage
greatly improves the amount of true distal
movement of the maxillary dentition that
can be achieved, and makes it possible to
distalized both 1st and 2nd molars but
still, it is necessary to create some space
in the tuberosity region so removal of the
3rd molars is a typical procedur.
37

38. Bone anchors are placed bilaterally in the
zygomatic arch (“keyridge”) or in the
palate , and a nickel titanium spring
would be the one to generate force the
force needed for distalization.
38

39. In some patients, it has been possible to
produce up to 6mm of distal movement of
the 1st and 2nd molars. In addition, the
premolars migrate distally due to the
supercrestal fiber network making
retraction less complicated and no reaction
force against the incisors to move them
facially. This approach is compatible if a
Class II malocclusion is due to maxillary
dental protrusion with normal mandibular
growth.
39

40. 40

41. • Lack of space for eruption of premolars due to mesial
migration of permanent first molars
• End on molar relationship with mild to moderate space
requirement
• Cases with less than a full cusp class II molar
relationship
• Good soft tissue profile
• Borderline cases
• Mild to moderate space discrepancy with missing 3rd
molars or 2nd molars not yet erupted
MOLAR DISTALISATION
41

42. 42

43. CONSIDERATIONS OF ERUPTION STATUS
OF SECOND AND THIRD MOLARS
Joseph et al-Successfully achieved regardless
of the status of second molar calcification or age
Ghosh and Nanda-Patients who have erupted second molars
achieve correction as quickly as those who do not
Worms et al-Second molar in contact with the first molars provide
a resistance to the distal movement
Bondemark et al-Second molars impact the tipping and
distal movement of first molars
Hilgers-Most opportune time for distalisation of first molars is before
the eruption of second molars 43

44. Kinzinger GS, Fritz UB, Sander FG, Diedrich PR. Efficiency of a pendulum
appliance for molar distalization related to second and third molar eruption
stage. Am J Orthod Dentofacial Orthop. 2004 Jan;125(1):8-23
PG 1 (18 patients), eruption of the second molars had either not
yet taken place or was not complete
PG 2 (15 patients), the second molars had already developed as
far as the occlusal plane, with the third molars at the budding
stage
PG 3 (3 patients), germectomy of the wisdom teeth had been
carried out, and the first and second molars on both sides had
completely erupted
For young patients, the best time to start therapy with a
pendulum appliance is before the eruption of the second
molars
However, if distalization of the first and second molars is to
be carried out simultaneously (in which case the banded first
molars are pushing the second molars along during
distalization), prior germectomy of the third molar is
strongly recommended
However, greater loss of anchorage and vestibular drift of
the second molar must be accepted
44

45.  KELES SLIDER
 PENGUIN PENDULUM
 DISTAL JET
 INTRAORAL MAGNETS
45

46. Temporary skeletal anchorage is very useful
when maximum incisor retraction is desired
or if the maxillary molars have little
anchorage value because of bone loss.
46

47. A limiting factor in orthodontic class II treatment is the
extent to which the lower teeth can be moved forward
relative to the mandible. Moving the lower incisors
forward more than 2 mm is highly unstable unless they
were severely tipped lingually, but this is likely to occur
during camouflage treatment when class II elastics are
used unless lower premolars were extracted
47

48. The advent ofTADs or skeletal anchorage devices has led many
orthodontists to get good results without surgery
There are four main areas of their use
• Positioning individual teeth when no other satisfactory
anchorage is available
• Retraction of severely proclined incisors
•Distal or mesial movement of the molars
•Intrusion of posterior teeth to close an anterior open bite or of
anterior teeth to open a deep bite
48

49. MINIPLATES
MINISCREWS
49

50. SMALL SIZE
SIMPLE TO USE
INEXPENSIVE
PATIENT COMFORT
PROVIDE RESULTS EQUIVALENT
OR SUPERIOR WHEN COMPARED
TO CONVENTIONAL SYSTEMS
NOT OSSEO-INTEGRATED
BIOCOMPATIBLE
DIFFERENT INSERTION SITES
ROTATIONAL INSTABILITY
MOBILITY OF SCREW
FRACTURE AFTER REMOVAL
IRRITATION OF MUCOUS
MEMBRANE
INJURY TO ROOTS OR
NEUROVASCULAR BUNDLES
50

51. DESIGN FACTORS
Pitch-Tight or loose
Length-6-10mm
Diameter-1.3-2mm
Shape-Conical or cylindrical
Form of tip-Thread forming or thread cutting
Surface-Machined or roughened
51

52. Need for a pilot hole.....Self drilling screws
Need for a soft tissue punch.....unattached gingiva
Insertion torque and devices.....moderate
Number of screws…….3(2 is less and 4
does not increase retention)
Age…….After 11 years for adequate bone
maturity
52

53. Reduction in force to fail was 30-3
Keep heads as close as possible to the
cortical bone
53

54. Reduction in force to fail was 25%
54

55.  2.2 mm with repelling magnets
 2.16 mm with the Wilson rapid molar distalizer
 3.2 mm with the nickel-titanium coil spring
 4.8 mm with a distal jet
 2.51 mm with a Jones jig
 5.7 mm with a pendulum appliance
 Seldom evaluated true amount after retraction of
anteriors and premolars
Sugawara J, Kanzaki R,Takahashi I, Nagasaka H, Nanda R. Distal movement of
maxillary molars in nongrowing patients with the skeletal anchorage system.
Am J Orthod Dentofacial Orthop. 2006 Jun;129(6):723-33
 Distalisation of the maxillary first molars was 3.78 mm at
the crown level and 3.20 mm at the root level
 Twenty-five nongrowing patients (22 females, 3 males)
55

56. MAXILLARY EXPANSION
56

57. Traditionally, clinicians have viewed a Class II malocclusion
as primarily a sagittal and vertical problem
Class II malocclusions have a strong transverse component
Expansion of the maxilla disrupts the occlusion and patient
becomes more inclined to posture his or her jaw slightly
forward, thus eliminating the tendency toward a buccal
crossbite and at the same time improving the sagittal
occlusal relationship
Presumably, subsequent mandibular growth makes this
initial postural change permanent
57

58. With increasing age the midpalatal suture becomes more
interdigitated; however in most individuals it remains
possible to obtain significant increments in maxillary width
upto the end of adolescent growth spurt
This requires placing a relatively heavy force across the
suture
(15 years…….Proffit)
But a correct assessment of the midpalatal suture
ossification is imperative
Occlusal radiographs
CBCT(more reliable)
58

59. Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA
Jr. Midpalatal suture maturation: classification method for individual
assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop.
2013 Nov;144(5):759-69
A) Midpalatal suture is almost a
straight high-density sutural line with
no or little interdigitation
B) Irregular shape and appears as a scalloped high-density line
C) 2 parallel, scalloped, high-
density lines that are close to each
other, separated by small low-
density spaces in the maxillary and
palatine bones
D)Fusion of the midpalatal suture
has occurred in the palatine bone
E)Fusion of the midpalatal suture
has occurred in the maxilla. The
actual suture is not visible in at
least a portion of the maxilla
59

60. Maxillary arch width deficiency (associated or not with
posterior crossbite)
Correction of unilateral or bilateral crossbite
Cleft lip and palate patients with collapsed maxilla
Gain arch length in patients with moderate maxillary
crowding
Reducing nasal resistance to provide a normal
breathing pattern
Mobilization of the maxillary sutures to facilitate correction
of a Class II or Class III malocclusion
Orthodontic and orthopedic treatment in mixed dentition-
James.A.McNamara,
William.L.Brudon 60

61. Single tooth crossbite
Post ossification of midpalatal sutures
Severe skeletal asymmetries of the maxilla and the
mandible
Periodontally weak dentition
61

62. TOOTH AND TISSUE BORNE
• Derichsweiler type
• Hass type
TOOTH BORNE
• Issacson
• Hyrax
62

63. Downward and forward movement of maxilla.Midpalatal suture
opens
in a non parallel pyramidal manner
Lateral bending of the alveolar process
Diastema between central incisors
Buccal tipping and extrusion of maxillary posteriors
Downward and backward rotation of mandible
Increase in width of nasal cavity particularly at the floor of nose
adjacent to midpalatal suture(decreased nasal resistance)
All craniofacial bones directly articulating with the maxilla were
displaced (except the sphenoid bone)
63

64. POOR RESULTS
1. Average or short facial
pattern
2. Mild antero-posterior jaw
discrepancy
3. Crowding<4-6mm
4. Normal soft tissue
features(lip, nose,chin)
5. No transverse skeletal
problem
1. Long vertical facial
pattern
2. Moderate or severe
antero-posterior jaw
discrepancy
3. Crowding > 4-6mm
4. Exaggerated features
5. Transverse skeletal
component of problem
ACCEPTABLE
RESULTS
65

65. Class III skeletal
discrepancy
66

66.  “Class III malocclusion occurred when the
lower teeth occluded mesial to their normal
relationship the width of one premolar or
even more in extreme cases”.
Classification of Malocclusion-Edward angle -Dental cosmos 41;3 March
1899, pp. 248-264 67

67. 1.HEREDITY
2.TERATOGENS:
• Cleft lip and palate result in maxillary deficiency in
most occasions a class III malocclusion is established
• Vitamin D excess causes premature closure of sutures
and might lead to class III malocclusion
3. ACROMEGALY AND HEMI MANDIBULAR HYPERTROPHY:
Litton SR, Ackerman LV, Isaacson Rl, Shapiro B. A genetic study of Class III
malocclusion. Am J Orthod 58:565-577, 1970. 68

68. 4.ENVIRONMENTAL INFLUENCES:
• Mouth Breathing
• Large tongue
69

69. 7. Abnormal Incisal guidance (Pseudo class III)
8. Premature loss of deciduous molars leading to
autorotation of the mandible
9. Lack of eruption in maxillary buccal segments
leading to autorotation of the mandible.
70

70. Tweed CH. Clinical Orthodontics, Vol. 2. The C. V. Mosby Company, St. Louis, 1966.
1. TWEED (1966)
CLASS III MALOCCLUSION
PSEUDO CLASS III
Normal Mandible
Underdeveloped Maxillae
SKELETAL CLASS III
Large Mandible
Underdeveloped or Normal
Maxillae
72

71. Skeletal Pseudo class III
Maxilla retrusion More Less when compared
with skeletal
Mandibular
prognathism
Increased SNB Less
Incisor interference -ve +Ve
Compensatory
mechanism
Proclined maxillary
incisors and retroclined
mandibular incisors
Retroclined maxillary
incisors and/or
proclined mandibular
incisors
Facial profile The soft tissues tend to
camouflage the
underlying
discrepancy, and the
patient often displays a
concave facial profile
Pseudo-class III
profile appears
normal in centric
relation and slightly
concave in centric
occlusion.
Gonial angle Obtuse Same as class I
Cephalometric characteristics of Pseudo-class III and skeletal class III
patients GU YAN et al[jco2000] 73

72.  The goals of camouflage, are to obtain satisfactory dental and
facial esthetics, along with acceptable dental occlusion and
function.
 The problem is that most Class III patients already have some
dental compensation that developed during growth.
 Typically, the upper incisors are at least somewhat proclined
and protrusive relative to the maxilla, whereas the lower
incisors are upright and retrusive relative to the chin
74

73.  Extraction of two lower first premolars,
corrects the malocclusion, but it almost always
produces an esthetically undesirable result.
 Extraction of mandibular second premolars is
a way to reduce the amount of lower incisor
retraction that would occur.
75

74. Mandibular incisor extraction
 The incisor extraction decision is supported by
a large intercanine width, relatively minor
crowding, some mandibular anterior tooth size
excess, and normal rather than triangular
incisor shape
76

75. PROCESS FOR CLASS III CASES
Stage 1 – Setting a PIP for the upper incisors
The first stage in Class III treatment planning concerns upper
incisor position. It is necessary to determine an ideal position
and then decide whether it can be achieved. If not, a modified
position may be appropriate, which is less than ideal, but
acceptable. In this way a ‘planned incisor position’, or PIP, is
determined.
77

76.  The second stage of treatment planning involves
positioning of the lower incisors. This is frequently a
key concern in Class III cases with mandibular excess
78

77. It is beneficial to evaluate the remaining upper teeth at stage 3.
 If upper premolar extractions are necessary (usually second
premolars) then it is normally logical to extract lower first
premolar, in a Class III case.
 However, if the upper arch can be treated without extractions,
then a range of lower arch options needs to be considered.
 This stage involves deciding how to position the rest of the teeth
to fit the PIP of upper incisors.
Stage 3 – The remaining upper teeth
79

78.  Lower premolar extractions assist in the retraction of lower
incisors, and are helpful to Class III treatment mechanics in
many cases.
 The dental VTO can be used to reach a correct decision. In
some Class III marginal extractions cases, second molars
may be considered
Stage 4 – The remaining lower teeth
80

79. If a Class III case requires mesial movement of upper
incisors, it can be achieved in two ways:
1. By proclination and mesial movement of upper
incisors within the available bone When upper
incisors are proclined forwards, each 2.5° of
proclination creates approximately 1mm of space per
side, or 2mm in total.
2. By mesial movement of the maxillary bone as a result
of normal growth or orthodontic procedures
UPPER INCISOR MOVEMENT IN CLASS III TREATMENT
81

80. 1. Excessive proclination.. As a general rule, proclination of the
upper incisors beyond 120° to the maxillary plane should be
avoided, although there is individual variation .
2. Failure to fully achieve a positive overjet. This can be due to
the forward position of the lower incisors, or other reasons, and
the resulting bite can be difficult to manage
Limits to mesial movement of upper incisors
82

81. • Distal movement of the lower incisors can be achieved by
distal movement of the teeth within the mandibular bone,
or by distal movement of the mandible itself, when there
is a displacement.
• Unfavorable mesial movement of the lower incisors can
occur because of mandibular growth
83

82.  In most non-surgical Class III treatments, it is helpful
to retract and retrocline the lower incisors
 Retraction and retroclination beyond a figure of
approximately 80° to the mandibular plane is
undesirable, because of the risk of dehiscence and
lack of bone support
84

83.  Inter-maxillary Class III elastics are most helpful in
orthodontic (non-surgical) correction of Class III cases.
 They tend to produce lower incisor retroclination, upper
incisor proclination, and A/P correction of the molar
relationship.
 All components of the Class III elastic force can therefore be
helpful in reaching treatment goals in average or low angle
cases.
85

84.  1. Genioplasty
 2. Rhinoplasty
 3. Malar augmentation
 4. Stripping of gonial angle
86

85.  In many cases, jaw discrepancy is not so great, so as
to warrant a full fledged surgical approach. In these
patients the dental relation is compensated for the
skeletal discrepancy
 Bimaxillary Class II Malocclusion
 Borderline extraction patient with a good nasolabial
angle,protruding lower incisors and a deficient chin
Obtains a better result from non-extraction orthodontic
treatment followed by Genioplasty.
87

86.  Genioplasty as an adjunct to orthodontic
treatment allows the orthodontist to
overcome problems of facial esthetics and
stability.
88

87.  MALAR AUGMENTATION
 It is a boney defect or deficiencies in the maxilla
may occur as a part of a congenital or
developmental problem loss of bone substance
due to trauma Complication of the surgery
Maxilla contour deficiencies are seen commonly
Paranasal Infraorbital Zygomatic prominence
area (malar)
 Augmentation in these anatomic regions can
significantly enhance soft-tissue contours and
improve facial balance and function.
89

88.  RINOPLASTY
 Patients with orthodontic problems often
have a nasal deformity. Alterations in the
nose can benefit a significant minority of
those who seek orthodontic corrections.
 In mild to sever class II cases accompanies
the nasal prominence and elevation of the
nasal bridge. With out changes in the
nose, just by retracting protruding
maxillary incisors makes the nose even
prominence.
90

89.  Camouflage treatment in Post- adolescent
Class II Patients The boundary between
orthodontic and surgical treatment is
particularly troublesome for teenagers with
class II problems. Because of the following
points:
 1. The risk of camouflage failure
 2. The greater cost and morbidity of
orthodontic surgery
91

90.  If you select camouflage then… what do you
do with the rather mature 14 years old with a
full cusp Class II malocclusion with : 10mm
overjet mandibular deficiency
 1st choice: Maxillary premolar extraction to
provide space to retract the upper incisors
Achieve proper over jet End up in class II
molar relation4extrn- Upper 1st premolar
extraction Upper 1st premolar extraction
92

91.  2nd choice Extract upper 4|4 & lower 5|5 .
Retract upper incisor & protract lower
posteriors. End up in Class I molar relation
93

92.  3rd choice If spacing is present in the
upper arch Then we have the 3rd option
- which rather should be the 1st option
whenever there is sufficient anterior
space.
 Non-Extraction
94

93.  Factors to be consider in the decision making The
possible role of augmentation genioplasty as an adjunct
to class II camouflage. The risk of root resorption with
camouflage treatment.
 What causes the roots to contact the lingual cortical
plates Touring the upper incisors back during class II
camouflage. Tipping the upper incisors facially in class
III camouflage. Relationship between root resorption and
camouflage treatment also should be kept in mind. Class
II ElasticsBut, what is the problem ? Retention &
stability is only big mark.
95

94.  Camouflage treatment in Post-adolescent Class III
Patients
 Camouflage also can be used in patients with mild
skeletal Class III problems.
96

95.  Adjustment of incisor position can achieve acceptable
occlusion and reasonable facial esthetics In even
moderately to severe skeletal Class III problems,
camouflage in much less successful.
 Extraction of lower premolars combined with Class III
elastics and extra oral force can improve the dental
occlusion for many class III patients
 Extraction provide space to displace the remaining
teeth only in the anteroposterior plane of space
97

96. Contemporary Orthodontics.Proffit,Fields,Sarver.5th edition
Textbook of orthodontics.Samie E Bishara
Orthodontic and orthopedic treatment in mixed dentition-
James.A.McNamara,
William.L.Brudon
Orthodontic treatment of Class II non compliant patient:Current
principles and techniques-Moschos A Papadopoulous
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98. Janson G, Sathler R, FernandesTM, Branco NC, Freitas MR. Correction of
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