Download - Class II Div 1 Maloccusion 2005a
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Class II div 1 Malocclusion Class II div 1 Malocclusion
OR
What can we do about Goofy?
Objectives
Objectives
Describe Class II div 1
Objectives
Describe Class II div 1
Describe principles of treatment
Objectives
Describe Class II div 1
Describe principles of treatment Describe treatment options
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Objectives
Describe Class II div 1
Describe principles of treatment
Describe treatment options
Examples of treatment
Aetiology Aetiology
Dento-alveolar
Aetiology
Dento-alveolar
Skeletal
Aetiology Dento-alveolar
Incisor proclination
27
82
79
125
93
Aetiology Dento-alveolar
Incisor proclination
?
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Aetiology Dento-alveolar
Digit sucking?
Aetiology Dento-alveolar
Digit sucking
Aetiology Dento-alveolar
Incisor proclination
Lower incisor
retroclination
27
82
79
125
87
Aetiology Skeletal Aetiology Skeletal
Mild
Aetiology Skeletal
Mild
Moderate
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Aetiology Skeletal
Mild
Moderate
Severe
Aetiology Skeletal
Mild
Moderate
Severe
High FMPA angle
Aetiology Skeletal
Mild
Moderate
Severe
Low FMPA angle
Treatment Principles I Treatment Principles I
Ideal
Treatment Principles I
Ideal correct skeletal discrepancy
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Treatment Principles I
Ideal correct skeletal discrepancy
Camouflage
Treatment Principles I
Ideal correct skeletal discrepancy
Camouflage hide skeletal discrepancy
Treatment Principles I
Ideal correct skeletal discrepancy
Camouflage hide skeletal discrepancy
Depends on patient
Treatment Principles I
Ideal correct skeletal discrepancy
Camouflage hide skeletal discrepancy
Depends on patient
Growing?
Non-growing??
Skeletal discrepancy
Growing patient
Can we make patients
grow?????
Skeletal discrepancy
Growing patient Can we make patients
grow?????
Research studies:
One patient and it works
Series of patients treated and it works
Randomised Clinical Trial
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Skeletal discrepancy Growing patient
Can we make patientsgrow?????
Research studies: Randomised Controlled Trails
North Carolina study
Manchester/UK study
Skeletal discrepancy Growing patient
Functional appliances produce slightly more
mandibular growth
Functional reduce the need for orthognathic surgery
Headgear reduces maxillary growth
Shorter time with fixed, but longer overall
treatment time
North Carolina study shows:Am J Orthod Dentofacial Orthop1998:113:62-72
Skeletal discrepancy Growing patient
Functional appliances produce slightly more
mandibular growth
Early treatment improves self image
Twin blocks as effective as Herbst appliances
UK study shows:OBrien et al 2004
Conclusion
Orthodontic treatment results in
camouflage of skeletal discrepancies
UNLESS patient grows favourably
or surgery is used
Treatment Options
Ideal Correct skeletal discrepancy
Orthognathic Surgery
Functional (if growth occurs)
Camouflage Accept skeletal discrepancy
Reduce overjet within
skeletal limits
Camouflage
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Treatment principles II Treatment principles II
1. Reduce Overbite
Treatment principles II
1. Reduce Overbite
Treatment principles II
1. Reduce Overbite
2. Create space (extraction/non extraction)
..for
Treatment principles II
1. Reduce Overbite
2. Create space (extraction/non extraction)
..for3. Reduction of Overjet +/- relief of Crowding
Treatment options
Non extraction
Extraction
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Non extraction1. Space analysis
2. DMUBS(Distal Movement of Upper
Buccal Segments)
3. Functional
appliances
OR
Space analysis
Assumptions:1. Aims of treatment is Class I occlusion
2. Skeletal I occlusion
3. Premolar extractions
4. Complaint patient
5. Skilled operator using Fixed Appliances
Space analysis
1. Lower labial segment crowding
2. move canines to align lower incisors
3. Add/subtract any lower centre line shift
4. Add lower buccal segment crowding
5. Total = space requirements
Plan lower arch
Space analysis
Plan upper arch
Space analysis
1. Move canines to Class I
2. Add upper buccal segment crowding
3. Total = space requirements
Plan upper arch
Space analysisWhich extractions?
Space less than 2mm non extraction
Space 2-4mm extract 2ndpremolar
Space 4-6mm extract 1stpremolar
Space greater than 6mm anchorage
?
?
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Non extraction
DMUBS
Mild cases needs co-operative patient
Non extraction
Functional
Growing patient
Well aligned arches
Extraction
Most commonly premolars
Space analysis
premolar = 7mm
Extraction
Most commonly premolars
Removable appliance
Extraction
Most commonly
premolars
Removable appliance
Fixed appliance
Suitable for removable
appliances?
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Suitable for removableappliances?
Indications:
1. proclined incisors
2. Mesial angulation of canines
3. Acceptable lower arch
Suitable for removableappliances?
Take Cephalogram and undertake a Prognosis tracing
Suitable for removable appliances?Trace tip upper incisor about a point from apex
Suitable for removable appliances?Extraction
Removable appliance
reduction of overjet.
Indications:
1. proclined incisors
2. Mesial angulation of canines
3. Acceptable lower arch
Usually a compromised result
1. Overbite reduction
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1. Overbite reduction 1. Overbite reductionFlat Anterior Bite Plane
when retracting canines and BEFORE incisor retraction
1. Overbite reductionFlat Anterior Bite Plane - Design
Design must include:
1.Height of bite plane required
2. Length of bite plane
(ie Overjet)
1. Overbite reductionFlat Anterior Bite Plane - Fitting
1. Overbite reductionFlat Anterior Bite Plane - Fitting
Molars
2mm apart
1. Overbite reductionFlat Anterior Bite Plane - USE
FABP may need building up/addition
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2. Overjet reductionDesign:
Flat Anterior Bite Plane maintains OB reduction
Incisor retraction spring e.g. Strap spring e.g.Labial Bow
2. Overjet reductionFlat Anterior Bite Plane maintains OB reduction
2. Overjet reductionFlat Anterior Bite Plane adjustment
Trim behind incisors
to allow retraction
2. Overjet reductionFlat Anterior Bite Plane adjustment
Trim behind incisors
to allow retraction
To be continued