Class 2 division 2 malocclusion /certified fixed orthodontic courses by Indian dental academy

ANGLE’S CLASS II, DIVISION
2
MALOCLLUSION


It is important for every orthodontist to have an adequate
and correct understanding of the various types of
Class II Malocclusions before instituting a treatment plan.



There is no universal method of managing the condition.



It is essential to have an adequate knowledge of normal

growth pattern and various cephalometric analysis for a
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Angle’s Class II div 2 malocclusion is
characterized by Class II Molar relation.
The classic feature of this malocclusion is
the presence of lingually inclined upper
central incisors and labially inclined
upper lateral incisors overlapping the
central incisors.
Incidence : 5 – 10 %
Variations in this form exist.

INCISAL INTER ARCH
RELATIONSHIP
Anteroposterior incisor relatioships
The British Standard Classification of incisor relationships
has been widely adopted.
• CLASS I INCISOR RELATIONSHIP
The lower incisal edges occlude with
or lie immediately below the cingulum
plateaux (middle part of the palatal
surfaces) of the upper central incisors.

CLASS II INCISOR RELATIONSHIP
The lower incisal edges lie posterior to the cingulum
plateaux of the upper incisors.
DIVISION 1 – The upper central
incisors are proclined or of average
inclination and there is an increase in
overjet.
DIVISION 2 – The upper central
incisors are retroclined ; the overjet is
minimal but may be increased.


• CLASS III INCISOR RELATIONSHIP
The lower incisal edges lie anterior to the cingulum plateaux
of the upper incisors ; the overjet is reduced or reversed.


Van der Linden classification of Class II Div 2
depending on the spatial conditions in the maxillary
dental arch.
Type A- The upper central and lateral
incisors are retroclined.
It is of less severe in nature.

Type B- The central incisors are
retroclined and overlapped by the
lateral incisors.

Type C- The central and lateral
incisors are retroclined and
overlapped by the canines.

FEATURES OF CLASS II DIV 2
• Molars in disto-occlusion.
• The classic feature of the upper incisors.
• Deep overbite.
• Pleasing straight profile.
• Broad square face.
• Backward path of closure.
• Deep mento-labial sulcus.
• Absence of abnormal muscle activity.


CLINICAL FEATURES OF CLASS II
DIV 2
EXTRAORAL

• Squarish face (Brachycephalic).
• Upper lip is invariably short and
positioned high with respect to
the upper anteriors.

• Lower lip is thick flabby covering
the upper incisors and exhibiting


• Usually straight to mildly convex
profile because of less skeletal
discrepancy and the retroclined
incisors.
• Usually straight face.
• Deep mentolabial sulcus.


INTRAORAL CHARACTERISTICS
• Class II molar relation indicating
distal relation of mandible to the
maxilla.
• Decreased overjet, an increased
overbite.
• Deep bite usually traumatic.

• The upper arch is usually broad, ‘U’
shaped.
• The palatal vault is usually deep.

• An exaggerated curve of spee.

Aetiological considerations for class II div 2

Class II molar relationship
1. Dentoalveolar factors – Loss or absence of mesial
teeth in maxilla.
2. Skeletal factors – Class II skeletal pattern.


Class II div 2 incisor realtionship
1. Dentoalveolar factors – Underdeveloped incisal cingulae.
Lid Effect.
2. Skeletal factors – Class II skeletal pattern (often mild) ;
Decreased lower facial height.
3. Neuromuscular factors – High lower lip line ;
Over closure and under eruption
of posterior teeth related to lack
of inter incisal contact.


MANAGEMENT OF CLASS II DIV 2
Three important factors to consider in the management are :
1. The AGE at which the patient is seen.
2. The NATURE AND SEVEARITY of the problem.
3. The UNDERLYING ETIOLOGIC FACTORS as seen
from the diagnostic aids and clinical and functional
examination.


Mandible is usually guided posteriorly due to premature
contact from the retroclined incisors and thereby restricting
its growth.
The treatment sequence remains the same except that for
any form of treatment modality to be instituted the retroclined
teeth have to be aligned in a proper labiolingual direction.


1. Mixed dentition phase – Use of functional appliances
after proclining the maxillary anteriors.
Results are good even after the eruption of permanent
teeth. The maxillary first premolars are extracted
generally to create space for aligning crowded maxillary
anterior segment.

2. After the cessation of growth – The need for
orthognathic surgery increases with the increase in
the severity of the problem.
The surgical procedures are also the same but the use
of presurgical orthodontics becomes imperative to
achieve stable results.
Overall the treatment results are better after the resolution of
class II div 2 malocclusion as compared to class II div 1
malocclusion.

DEEP BITE
DEFINITION – GRABER has defined deep bite as a
condition of excessive overbite, where the vertical
measurement between the maxillary and mandibular
incisal margins is excessive when the mandible is
brought into habitual or centric occlusion.

Deep over bite can be of two types :
Incomplete over bite – Its an incisor relationship in
which the lower incisors fail to occlude with either the
upper incisors or the mucosa of the palate when the
teeth are occluded.
Complete over bite – Its an incisor relationship where
the lower incisors contact the palatal surface of the upper
incisors or the palatal tissue when the teeth are in centric
occlusion. This kind of deep bite often results in truama.

Classification –
Deep bite can be broadly classified into two types .
1. Skeletal deep bite
2. Dental deep bite

Skeletal deep bite
- Usually of Genetic origin.
- Caused by upward and forward rotation of mandible.
- Worsened in cases of forward inclination of maxilla.
- Characterized by the presence of following features :
• Horizontal growth pattern.
• Reduced anterior facial height.
• Reduced inter-occlusal clearance.
• Mandibular plane, FH plane, SN plane etc. parallel to
each other.


Dental deep bite
Dental deep bite occur due to over – eruption of
anteriors or infra – occlusion of molars.
Deep bite due to over - eruption of anteriors :
• Due to over-eruption of lower incisors usually seen class II
malocclusions.
• Patient exhibits an excessive curve of spee.
• Inter- occlusal clearance is usually normal as the molars are
fully erupted.


Deep bite due to infra-occlusion of molars :
• Presence of lateral tongue posture or lateral tongue
thrust may prevent the molars from erupting to their
normal occlusal level.
• Characterized by the presence of partially erupted molars
(i,e reduced crown height ) and large inter- occlusal
clearance.


Diagnosis

Routine Diagnostic aids ,
1. Clinical Examination
2. Study Models
3. Lateral Cephalogram – Helps to differentiate skeletal
deep bite from dental deep bite. The patients with
skeletal deep bite show a reduced mandibular plane
angle as well as www.indiandentalacademy.com
reduced anterior facial height.

Factors to consider in treatment of deep bite
Deep bites are usually corrected by intrusion of anterior
teeth or by extrusion of posterior teeth. There are certain
factors that help an orthodontist to decide which of the
two modalities is indicated for a given patient.
• Lip relationship.
• Consideration of vertical facial relationship.
• Consideration of inter-occlusal space.

Treatment
Deep bites can be treated by using Removable, Fixed
or myofunctional appliances.
Romovable
appliances
• Anterior bite plane

Myofunctional Fixed appliance therapy
appliances
• Activator

• Use of anchorage bends

• Bionator

• Use of archwires with
reverse curve of spee
• Use of utility arches


OPEN BITE
Malocclusions can occur in three planes i,e.
sagittal, transverse and in the vertical plane.
Open bite is a malocclusion in the vertical
plane, characterized by lack of vertical
overlap between the maxillary and
mandibular dentition.
It may be an anterior or a posterior open bite.

Classification
OPEN BITE

POSTERIOR

ANTERIO
R
SKELETA
L

DENTAL

SKELETAL


DENTAL

Anterior open bite –
Is a condition where there is no
vertical overlap between the upper and
lower incisors.

Posterior open bite –
Is a condition characterized by lack of contact
Between the posteriors when the teeth are in
centric occlusion.


Etiology

The etiology is multifactorial.
No single factor can account for most open bites.
Can occur due to a variety of hereditary and non-hereditary
factors.


Etiologic considerations of open bite
Some of the etiologic factors responsible for anterior

open bite :
1. Prolonged Thumb-sucking.
2. Tongue thrusting.
3. Nasopharyngeal airway obstruction and associated
mouth breathing.
4. Inherited factors such as increased tongue size, and
abnormal skeletal growth pattern of the maxilla and
mandible.


Posterior open bites are very rare.
The etiologic factors responsible for posterior

open bite :
1. Mechanical interferences with the tooth eruption, either
before or after the tooth emerges from the alveolar bone.
2. Failure of the eruptive mechanism of the tooth so that the
expected amount of eruption does not occur.

Features of skeletal anterior open
bite :
• Increased lower anterior facial height.
• Decreased upper anterior facial height.
• Increased anterior and decreased
posterior facial height.
• A steep mandibular plane angle.
• Small mandibular body and ramus.

• The patient may have a short
upper lip with excessive maxillary
incisor exposure.
• The patient often has a long and
narrow face.
• Divergent cephalometric planes.
• Steep anterior cranial base.
• Downward and forward rotation of
mandible.


Features of dental anterior open
bite :
• Proclined upper anterior teeth.
• Upper and lower anteriors fail to
fail to overlap resulting in a space.
• Patient may have a narrow maxillary
arch due to lowered tongue posture
due to a habit.


Treatment
Anterior open bite

Posterior open bite

• Removal of cause

• Removal of cause

Removable or fixed type

Lateral tongue spikes for

habit breaking appliance.

lateral tongue thrust.

• Myofunctional appliances
Skeletal anterior open bite –
F.R.IV or a modified activator
• Fixed Orthodontic therapy
• Surgical correction

• If due to infra occlusion
of ankylosed teeth, it is
best treated by crowns.


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Class 2 division 2 malocclusion /certified fixed orthodontic courses by Indian dental academy

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