There are three main patterns of tooth movement that can be used to correct a Class II malocclusion: 1) nonextraction treatment with Class II elastics, 2) retraction of the upper incisors into a premolar extraction space, and 3) distal movement of the upper teeth. Distal movement of the upper teeth is challenging but can be improved with temporary skeletal anchorage to move the molars backwards up to 6mm, correcting the molar relationship. For adolescents with Class II malocclusions, growth modification alone may not be enough and orthognathic surgery to advance the mandible may be necessary if little growth is expected.

1. CLASS II CAMOUFLAGE
Prepared by:
Dr. Kristel

2. *Orthodontic Camouflage – is the
term used to describe a treatment
procedure wherein the dental
problem is corrected therefore,
making the skeletal problem no
longer apparent.

3. The ff. 3 patterns of tooth movement
can be used to correct a Class II
malocclusion:
1. Nonextraction treatment with
Class II elastics.
2. Retraction of the upper incisors
into a premolar extraction space.
3. Distal movement of the upper
teeth.

4. Nonextraction treatment with
Class II elastics. 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

6. by the lower lip creating a treatment
relapsed.
Retraction of the upper incisors
into a premolar extraction space.
A straightforward 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

7. the lower arch, the patient would
still have a Class II molar
relationship but normal canine
relationship at the end of the
treatment. 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.

9. 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

10. problem still do exists. (1) 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. (2)
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

11. without retracting the lower incisors.
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

12. other teeth to be retracted. 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 that
molar. The difficult part is tipping
the crowns distally and bodily distal
movement. There are 2 problems

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

14. 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. From
this perspective, the most successful
way to move a maxillary 1st molar

15. 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.

16. 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. In theory, the palatal
mucosa resists displacement; in
clinical use, tissue irritation is likely.
Even with the more elaborate
appliances of this type, only about

17. 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.
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 one
with minimal growth potential, a
reasonably good jaw relationship, and
a half cusp molar relationship.

19. 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 procedure, bone anchors are
placed bilaterally in the zygomatic arch
(“keyridge”) or in the palate , and a
nickel titanium spring would be the one

20. to generate force the force needed
for distalization. Although good data
treatment outcomes still do not exist,
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

21. 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.

22. In the absence of favorable growth, treating a
Class II relationship in adolescents is difficult.
Fortunately, even though growth modification cannot be
expected to totally correct an adolescent Class II
problem, some forward movement of the mandible
relative to the maxilla does contribute to successful
treatment of the average patient. When little or no
growth can be expected, orthognathic surgery to
advance the mandible may be necessary to achieve a
satisfactory result.

23. END
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