This document discusses Class II Division 2 malocclusion. Key points:
- Class II Division 2 is characterized by retroclined upper incisors and a retropositioned lower first molar. The overjet is usually minimal but may be increased.
- It has a prevalence of 1.5-17.7% and is highly associated with impacted canines.
- The etiology involves genetic and environmental factors like soft tissue pressures retroclining the upper incisors.
- Treatment aims to correct the skeletal and dental relationships, overbite, and achieve a functional occlusion. Options include growth modification, fixed appliances, orthognathic surgery, or a combination. Anchorage is
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.for more details please visit
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Elastics and Elastomeric are routinely used as a active component of orthodontic therapy.
Elastics have been a valuable adjunct of any orthodontic treatment for many years.
There use combined with good patient cooperation provides the clinician with the ability to correct both
Antero-posterior and vertical discrepancies. The latex elastics have become integral part of orthodontics after being first discussed by Calvin. S. case in 1893 at the Columbia dental congress but the credit goes to Henry A. Baker for the use of these elastics in clinical practice to exert a class II intermaxillary forces.
Both natural rubber and synthetic elastomers are widely used in orthodontic therapy. Naturally produced latex elastics are used in the Begg technique to provide intermaxillary traction and intramaxillary forces. Synthetic elastomeric materials in the form of chains find their greatest application with edgewise mechanics where they are used to move the teeth along the arc
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.for more details please visit
www.indiandentalacademy.com
Elastics and Elastomeric are routinely used as a active component of orthodontic therapy.
Elastics have been a valuable adjunct of any orthodontic treatment for many years.
There use combined with good patient cooperation provides the clinician with the ability to correct both
Antero-posterior and vertical discrepancies. The latex elastics have become integral part of orthodontics after being first discussed by Calvin. S. case in 1893 at the Columbia dental congress but the credit goes to Henry A. Baker for the use of these elastics in clinical practice to exert a class II intermaxillary forces.
Both natural rubber and synthetic elastomers are widely used in orthodontic therapy. Naturally produced latex elastics are used in the Begg technique to provide intermaxillary traction and intramaxillary forces. Synthetic elastomeric materials in the form of chains find their greatest application with edgewise mechanics where they are used to move the teeth along the arc
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.for more details please visit
www.indiandentalacademy.com
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. Such an approach represents a departure from the practice of adopting a "named" appliance for the treatment of a class of malocclusion
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...Indian dental academy
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,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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.for more details please visit
www.indiandentalacademy.com
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. Such an approach represents a departure from the practice of adopting a "named" appliance for the treatment of a class of malocclusion
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...Indian dental academy
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,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Arch Form in orthodontics /certified fixed orthodontic courses by Indian dent...Indian dental academy
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,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Class 2 division 2 / for orthodontists by Almuzian
1. CLASS II DIVISION 2
Definition
• Angle`s classification: based on molar relationship
Class II Division 2: The mesio-buccal cusp of the maxillary first molar occludes anterior to the midbuccal
groove of the mandibular first molar (ie the lower molar is retro-positioned relative to the upper). Hence
the alternative term – postnormal molar relationship with upper central incisors retroclined and the lateral
incisor proclined mesiolabially rotated and OB increased while the The overjet is usually minimal but
may be increased
• BSI classification: based on A-P incisor relationship
Class II Division 2: The lower incisor edges occlude or lie posterior to the cingulum plateau of the upper
central incisors with the upper central incisors are retroclined. The overjet is usually minimal but may be
increased.
Other classification also described for epidemiological point of view including
• Class II indefinite when one incisor retroclined and the other is proclined (Gravely)
• Intermediate when the incisor retroclined or upright and the OJ 5-7 mm (Stephen and William,
1993).
• Class II division 1 or division 2 sub-division is occur when MR is class 1 on one side and 2 on the
other side. (IOWA notation system)
• Super class 2 when the MR is more than full unit.
Van der Linden classified class2 division 2 into:
2. Type A: all incisor retroclined
Type B: only centrals retroclined
Type C:all incisors retroclined and overlapped by canines.
Incidences
• It has an incidence rate of 1.5% to 7% (Ingervall et al, 1972; Peck et al, 1998),
• but has also been reported as high as 17.7% (Foster and Day, 1974).
• Elevated male expression of the II/2 deep bite cases may be indicative of a sex-linked genetic
pattern of strong mandibular development. Isaacson et al. (1972).
• Highly associated with impacted canine.
Aetiology
Mainly poly-epigenetic interaction
1. Genetic and familial high heritability of class II division 2 malocclusion, complete penetrance
being reported in familial studies of monozygotic twins (100% occurrence) and dizygotic twin
10% occurrence (Peck, 1998)
2. Environmental factors
A. Soft tissue factors
B. Dental factors
C. Skeletal factors
D. Growth factors
3. a) Soft tissue factors
• A high lip line. Lapatki 2002
• Hyperactive or hypertonic lips have been implicated in the aetiology of the class II division 2
incisor relationships (Karlsen, 1994).
• Mentalis muscles, (strap-like lower lip). However Rix 1960 showed that there is no basis for this
and even the activity of the muscle are low than normal.
• Increased masticatory bite forces due to dominant short acting collagen fiber type II and
hyperatrphic master muscle. this can lead to intrusion of posterior teeth and increased OB.
NB:
• The influence of the soft tissues in class II division 2 malocclusions is usually mediated by
the skeletal pattern. If the lower facial height is reduced, the lower lip line will effectively
be higher relative to the crown of the upper incisors (more than the normal one third
coverage).
• A high lower lip line will tend to retrocline the upper incisors, and the higher the lip line,
the more severe the upper incisor retroclination will be (Houston, 1980).
• In some cases the upper lateral incisors, which have a shorter crown length, will escape
the action of the lower lip and therefore lie at an average inclination, whereas the central
incisors are retroclined.
• If there is arch length discrepancy, the laterals or canine migt be proclined and rotated to
occupy less space than normal.
b) Dental factors
• Upright incisor position,
4. • Long centrals and short lateral that escape from lip effects.
• Increased crown root angle of the upper incisor, (McIntyre and Millett, 2003).
• Overeruption of the incisors
• Thin incisors
• small trabecular or cingulum,
c) Skeletal factors
• Hopkins 1968 found in class II there is increase cranial base length and angle opposite to that of
class III
• Pancherz 1997 conclude that class 2 division 2 has the same features of class 2 division 1 in AP
wise except that upper incisors are retroclined in the former.
• Skeletal class II in 50% of cases and reduced AFH in 100%(Pancherz 1997)
d) Growth factors
• Overdevelopment of upper anterior alveolar process,
• Anterior rotation of the mandible.
Features
1. Skeletal features
2. Soft Tissues features
3. Growth features
4. Dental features
5. 5. Occlusal features
6. IOTN
In details:
A. Skeletal: Hopkins 1968
1. Increased anterior cranial base length and Obtuse cranial base angle, Hopkins 1968
2. Class II or class I and occasionaly Class III skeletal pattern
3. Decrease LAFH
4. Increase PFH
5. Decrease MMPA
6. Seven feature of anterior growth rotation of Bjork 1969
B. Soft Tissues
1. Brackycephalic faces in frontal view
2. Retrusive profile in case of bimaxillary retrognathisim
3. Obtuse NLA
4. Competent lips
5. High lower lip line
6. Thin upper lip
7. Accentuated lower lip curl due to their length relative to a reduced lower face height. This
with the prominence of the chin will lead to acute labiomental angle
8. Prominenat chin.
6. 9. Hyperactive mentalis
10. Masseter muscle hyperactivity
11. High positioned tongue causing scissor bite
12. Traumatized palate or labial gingivae secondary to deep OB
C. Growth features
The presence of seven anticlockwise rotation features described by Bjork 1969 in most of the cases
1. Anterior inclination of the Condylar Head,
2. Increased curvature of the mandibular canal,
3. Thick bone and bowed shape of the lower border of the mandible, and absence of
gonial notch
4. Forward inclination of the symphysis,
5. increased interincisal angle,
6. increased interprcmolar or intermolar angles,
7. Decreased anterior lower face height.
D. Dental:
1. Broad upper arch
2. Retroclined ULS and consequently retrocline LLS particularly if the skeletal base
relationship is class I or mild skeletal class II, as the lower incisors become trapped behind
a retroclined upper labial segment (Mills, 1973). This can result in posterior positioning of
B-point compared to pogonion (Fischer-Brandies, 1985).
7. 3. Crowding variable (crowding occur due to two problems: first LS retroclination and
secondly tooth arch length discrepancy)
4. Proclined laterals or might be retroclined if very high lower lip
5. Short upper laterals which might escape from the lip pressure and being proclined
6. Thin U1 and poor cingulum bulk. Roberston and Hilton 1965
7. Acute angle between crown and root.
8. Dental anomalies, Basdra 2000 found that there is an increased risk of impacted canine,
High risk of diminutive laterals.
E. Occlusal features
1. ↑ II angle
2. OB increased
3. Buccal-segment relationship is usually a mild class II, although it can be class I in cases of
bimaxillary retroclination. A full unit class II buccal-segment relationship is not common.
4. The overjet is normal or usually only slightly increased
5. Crossbites but mainly scissor bites.
6. In the upper arch there may be a reduced curve of Spee, while in the lower arch there is
increased and exaggerated curve of Spee
F. Mandibular function: sometime due to restricted mand movement by the deep OB, TMD
problem might arise.
G. IOTN
1. Mainly displacement 1-4D
2. Increased overbite 2-4F
3. Only in intermediate class II there is increased OJ 2-4A
8. 4. Otherwise esthetic componenet play an important role in the IOTN determination
Treatment principles & aims
According to Selwan-Barnnet 1991, the aims of the treatment are:
1. Profile improvement where required and correcting the skeletal relationship if indicated
2. Correction of the rotation specially the laterals
3. Relieve crowding (expansion, IPS, distaliation, proclination, extraction)
4. Level and align the arches (intrude anterior, extrude posterior, procline anterior)
5. Correct increased overbite
6. Correct buccal segment relationships (distalization or extraction).
7. Correction of scissor bite.
8. Achieve positive occlusal stop (centroid and II) correcting the edge to centroid relationship (lower
incisor should lie anterior to the upper root centroid) and decrease the interincisal angle
9. Correction of OJ if deviated from norms.
Treatment options
Factors to be considered:
1. Patient compliance
2. Clinician philosophy
3. Treatment mechanics
4. Patient age
9. 5. Growth potential
6. Pattern of growth skeletal II deep bite correction is facilitated by favourable facial growth.
Inherent forward mandibular growth rotation tendency (anticlockwise) aids skeletal Class II
correction but tends to increase overbite unless the interincisal angle is altered and a cingulum
stop created. In an adult, overbite reduction by incisor intrusion rather than molar extrusion is
advisable as the latter is unlikely to be stable
7. The patient’s profile little objective difference exists in lip fullness between extraction and non-
extraction treatment, but the latter is favoured, particularly with bimaxillary retroclination. For an
unfavourable profile (marked skeletal Class II and very reduced FMPA) in an adult, a combined
surgical orthodontic approach is required
8. Underlying anteroposterior and vertical skeletal discrepancy. In general, the more Class II the
skeletal pattern and the more reduced the Frankfort-mandibular planes angle (FMPA), the more
difficult to achieve optimal dentofacial correction by orthodontic means alone.
9. The presence and degree of crowding. Avoid lower arch extractions as may encourage overbite
increase by retroclination of the labial segment. Because it is often trapped lingually by the upper
incisors, proclination of the lower incisors and mild intercanine expansion is possible to relieve
crowding and may be reasonably stable
10. Local factors Impacted maxillary canines/absent or small upper lateral incisors will require
orthodontic-oral surgical, orthodontic-restorative planning as appropriate
The treatment modalities for class II division 2
1. Accept
2. Interceptive orthodontic treatment
3. Growth modification
4. Fixed appliance therapy
5. Orthognathic surgery
10. 6. Combination of the above
NB: high angle class II D2 would be treated similar to class II D1
1. Accept
• In mild cases, the occlusion may be aesthetically and functionally satisfactory and so treatment is
not indicated.
• Where the overbite is not very deep, it may be accepted and treatment directed towards alignment
of the lateral incisors if they are proclined.
2. Interceptive orthodontic treatment including the early use of HG+URA with ABP or HG and
lower lip pumper with social six fixed appliance (Nielsen, 1984)
3. Growth modification (orthopaedic/functional appliances) either:
A. It is mainly indicated in growing individuals, class II division 2 malocclusions with mild-to-
moderate skeletal class II base relationships and a class II buccal segment relationship.
B. One of the main problems of functional appliance is the lateral open bite at the end of the
functional stage. To address this, the appliance can either
• Cribbing the lower first molars can be avoided to allow buccal segment eruption,
• Cribbing the anterior teeth with clasps or acrylic coverage is recommended
• The blocks selectively trimmed
• Be worn on a part-time basis after the ap correction
• Alternative functional appliances allowing differential eruption of the posterior dentition, such as
a median opening activator can be used.
C. Conversion to class II division 1 by
• Bonding sectional FA on the ULS
11. • Using ELASSA which is beneficial if using a monobloc-type functional appliance that does not
incorporate a midline expansion screw. Further, the ELSAA appliance can also incorporate an
anterior bite plane to start the process of overbite reduction.
• Modification of the functional appliance for class II division 2 problem by incorporating a
cantilever spring or sectional screw added to the TB. This is a modification of Dyer and Sandler
2001.
• Transition from functional to FA stage better with Steep and deep. Fleming 2007
4. Fixed appliance therapy with apical control techniques. Space can be provided:
A. Non-extraction basis by proclining LS if there is mild LLS crowding (Selwan-Barrnet) and
the OJ as well as the skeletal problem are very mild
B. Preserving Lee way space
C. IPS (BOS recommendation not more than 0.25 per side per tooth)
D. Molar distalization by
• TAD for distalzation
• lip pumper,
• IO distalizer appliance
• HG with URA as En mass appliance retraction with or without exraction of second molar or
usually before eruption of second molars.
• Hg to molar bands
• HG with URA as Nudger appliance
• URA+anterior bite plane with low pull HG this is called Acrylic Cervical-Occipital (ACOA)
appliance popularized by Cetlin and Ten Hoeve (1983).
E. Class II bite corrector mechanics
12. F. Extraction of premolars or molars in the UA or both arches. However extraction might:
• Makes OB worse.
• However, Al-Mangoly 1993 found that extraction has no effects on the OB and
space closure if the correct mechanics is used.
• If only upper arch extractions are prescribed, a tooth size discrepancy will result
due to the mesiodistal dimension of the upper premolar being greater than half the
mesiodistal dimension of the lower first molar. The excess space in the upper arch should
be taken up by a slight over-rotation of the upper first molar and over-torquing the upper
labial segment or using the MBT philosophy using the contralateral second molar tube on
the first molar
• However, some authors have suggested that in borderline cases it would be a more
sound clinical approach to complete levelling, aligning and overbite reduction before a
final decision is made to extract teeth (Selwyn-Barnett, 1996).
• Stelzig 1999, compare the result of extraction of the 5 and 7s and they found
the profile flatten more in 5s extraction however it flatten in both cases. The lower 8s
erupt in a better position in the 7 cases.
In fixed appliance treatment of class II division 2 the anchorage demand is high for many reasons?
• Presence of crowding
• Canine angulation
• Incisor inclination
• Other intra and interarch problems like ML or OJ
What Are the Stages of Treatment Using the Tip Edge Appliance for this Patient?
13. i. Stage 1 of treatment involves overbite and overjet correction and correction of the molar
relationship. Initially, an appliance is placed on the upper labial segment only and a nickel–
titanium archwire placed to align the teeth, increasing the overjet as a result. Following this,
appliances are placed on the lower labial segment and upper and lower 016-inch stainless steel
by-pass arches are placed with tip-back bends mesial to the upper second and lower first molar
bands. Light class II elastics are worn on a full-time basis, which in combination with the tip-back
bends, facilitates overbite and overjet reduction.
ii. Stage 2 involves space closure. Once the overbite and overjet are fully reduced, the premolar
attachments and upper and lower 020-inch stainless steel wires are placed. Space is closed in the
maxillary arch using intra-arch elastics running from the upper second molars to circle loops on
the archwire, again supported by light class II traction.
iii. Stage 3 involves second- (angulation) and third- (torque) order correction. Once space is closed,
upper and lower 21 × 25-inch stainless steel archwires are placed with auxiliary springs
inserted into the vertical bracket slots to express the correct angulation and torque for each
bracket prescription. (Parkhouse, 1998). More recently, a horizontal slot has been introduced in
the Tip Edge-PLUS ® bracket, which is situated deep to the main bracket slot. By placing a
flexible superelastic nickel– titanium archwire in this slot, the brackets can be uprighted without
the need for an auxiliary spring or sidewinder; a rigid rectangular archwire is present in the main
bracket slot, permitting torque expression (Parkhouse, 2007). Overall, this innovation has made
stage 3 a little less complicated for the orthodontist.
iv. Finally the lower second molars were bonded and settling elastics were run to a lower braided
rectangular steel archwire.
5. Orthognathic surgery
It mainly depend on the lower anterior facial height and the prominence of the chin as well as the
presence of maxillary retrognathia. Surgical option involves:
1. Mandibular advancement with 3 point landing.
2. Bimaxillary osteotomy with clockwise rotation.
14. 3. Total subapical osteotomy of lower jaw.
4. Adjunctive procedure include:
• On occasion a reduction genioplasty may also be required to optimise the profile.
• Where the lower facial height is average or mildly increased, the overbite may be reduced by a
lower labial segment set-down at the time of surgery.
6. Combination of the above
Correcting the Overbite in class II division 2
This can be achieved by
a) Labial segment intrusion
• maxillary incisor intrusion,
• mandibular incisor intrusion,
b) Labial segment proclination
• Lower incisor proclination,
• Upper incisor proclination
This effect has been analysed by Eberhart et al (1990) who, for example, stated that 5 degrees of incisor
proclination would reduce the overbite by 1 mm on average.
c) posterior tooth extrusion
• maxillary posterior tooth extrusion,
• mandibular posterior tooth extrusion
d) surgery
15. Please refer to deep OB correction note
STABILITY
Kim 1999 found that the starting OB is the most important predictors, 50% maintained OB less than
4mm.
Canuat 1999 found II angle not related to stability and overcorrection because more relapse.
Criteria of good stability
1. Over-correction of the deep overbite to prevent vertical relapse. Leave it edge to edge.
2. Relative decrease of the lower lip cover
3. Torque of the lower incisors by positioning the lower incisal edge 0-2mm to upper centroid and
interincisal angle of 135 degree
4. Positive occlusal stop
5. Overcorrectin of rotation
6. favourable growth
7. good buccal interdigitation
8. minimal change in the LLS position
9. the use of permanent fixed retainer
Method of retentions
• Fixed retainer
16. • VFR
• Active URA with anterior bite plane
• CSF (reduced relapse by 20% Edward) (specially lateral incisors)
• Build up the cingulum plateau
Cochrane review by Millet 2007, There is no scientific evidence to establish whether orthodontic
treatment, carried out without the removal of permanent teeth, in children with Class II division 2
malocclusion is better or worse than orthodontic treatment involving extraction of permanent
teeth or no orthodontic treatment. The same is revised in 2012 with same result.