A basic problem facing the clinician in the treatment of the skeletal Class II malocclusion is the sagittal discrepancy between the dental bases. This may be due to a relative protrusion of the maxilla or to a retrusion of the mandible. In the treatment of a Class II malocclusion the anteroposterio discrepancy between the dental arches is importance, and in its correction some or all of the following objectives, in various combinations may be desirable : (1) inhibition of the forward growth of the maxillary complex (2) inhibition of the normal forward migration of the maxillary dentition, (3) reduction in the normal downward and forward eruption of the maxillary teeth (4) posterior translation of the entire maxillary dentition The basis of the comprehensive orthopedic approach to be described is the holding back or redirection of forward growth of the maxilla and enhancement of forward mandibular growth to the extent necessary for harmonizing the occlusion and facial esthetics A, orthopedic maxillary splint B, splint with addition of the mechanism for mandibular growth harmonization, C and D, Intraoral views of appliance. E and F, Heavy extraoral force, 1,000 to 1,500gm. per side, applied to the splint. The design allows the forces to be distributed evenly throughout the maxillary dentition. Arrows indicate direction of pull. With the comprehensive orthopedic technique the first phase usually lasts 8 to 12 months and is followed by edgewise appliance therapy to establish an optimal occlusion over a period of approximately 12 months.

1. Orthopedic coordination of dentofacial
development in skeletal Class II
malocclusion in conjunction with edgewise
therapy.
ACHIEVED BY: Dr.Maen Dawodi

2. • A basic problem facing the clinician in the treatment of the skeletal
Class II malocclusion is the sagittal discrepancy between the dental
bases.
• This may be due to a relative protrusion of the maxilla or to a
retrusion of the mandible.

3. treatment of a Class II malocclusion
• In the treatment of a Class II malocclusion the anteroposterio
discrepancy between the dental arches is importance, and in its
correction some or all of the following objectives, in various
combinations may be desirable :
• (1) inhibition of the forward growth of the maxillary complex
• (2) inhibition of the normal forward migration of the maxillary dentition,
• (3) reduction in the normal downward and forward eruption of the
maxillary teeth
• (4) posterior translation of the entire maxillary dentition

4. TREATMENTAPPROACH
• The basis of the comprehensive orthopedic approach to be
described is the holding back or redirection of forward growth of
the maxilla and enhancement of forward mandibular growth to the
extent necessary for harmonizing the occlusion and facial esthetics

5. A, orthopedic maxillary splint B, splint with
addition of the mechanism for mandibular
growth harmonization, C and D, Intraoral
views of appliance. E and F, Heavy extraoral
force, 1,000 to 1,500gm. per side, applied to
the splint.
The design allows the forces to be distributed
evenly throughout the
maxillary dentition. Arrows indicate direction
of pull.

6. • With the comprehensive orthopedic technique the first phase usually lasts 8 to
12 months and is followed by edgewise appliance therapy to establish an
optimal occlusion over a period of approximately 12 months.

7. METHODS AND MATERIALS Design of appliance
• the full appliance system
• The full orthopedic appliance system with
mandibular mechanism and soft-tissue
screens. A, Front view. B, Side view.

8. • Comprises three separate mechanisms, which can be
described as follows : The maxillary mechanism This
is the root-torqueing removable splint (Fig), used
with orthopedic
• Maxillary splint. A, Side view. B, Inferior view. Note
clasping of posterior teeth, anterior bar for retention
and incisor root torque (if required), capping of all
teeth, central screw for compensatory expansion,
tubes buccally for face-bow (lower tube allows
provision of lip bumper)

9. • force extraoral traction (1,000 to 2,000 gm. on each side).
• The mandibular mechanism for growth coordination.
• Soft-tissue screens for interaction with the buccolabial musculature

10. Patient prior to treatment at 12 years 2 months of age. Note recessive
mandible and deep overbite with trauma to labial mucosa. buccal
segments one unit , severe retroclination of maxillary central incisors, and
lack of space for maxillary lateral incisors.

11. Variant of maxillary splint allows proclination of central
incisors with spring-loaded screws. Extraoral traction is applied
to labial bow, 1,000 gm. per side.

12. Change after 8 months of maxillary growth
restraint

13. Conventional maxillary splint with torque spring. Class II traction to
mandibular utility arch to advance mandibular dentition bodily.
Extraoral traction attaches to helices of torque spring.

14. Commencement of edgewise phase to fully align the dentition and
establish an optimal occlusion. Three months into edgewise therapy.

15. CONCLUSIONS
• Restraint of maxillary growth by means of heavy extraoral forces
applied through a rigid splint to the entire maxillary dentition offers
the possibility of improving the sagittal relationships of the dental
bases as the mandible grows forward into a more satisfactory
position.

16. • At the same time, many desirable tooth movements can be carried out
effectively to assist in the correction of Class II dental relationships; these
include distal movement of the maxillary molars, reduction of eruption or
prevention of eruption of maxillary molars.
• Leveling of the mandibular curve of Spee can be carried out during the
orthopedic phase by means of an edgewise utility arch.
• Class II traction can also be carried out at the same time if advancement of the
mandibular dentition is indicated.

17. Reference
• American Journal of ORTHODONTICS
• Founded in 1915 Volume 84 Number 5 November, 1983