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Orthodontics > Class 2 Div 1 > Flashcards

Class 2 Div 1 Flashcards

1
Q

Types of malocclusion

A

Class 2 div 1 - 15-20%

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2
Q

Definition of Class 2 div 1

A
  • lower incisor edges lie posterior to the cingulum plateau of upper incisors
  • increased OJ
  • upper central incisors are proclined or average inclination
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3
Q

Why treat class 2 div 1?

A
  • aesthetics
  • dental health
  • prominent incisors at risk of trauma especially if incompetent lips
  • OJ > 9mm twice as likely to suffer trauma
  • OJ > 9mm, IOTN 5a
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4
Q

What includes in aetiology and features?

A
  • skeletal pattern (A/P, vertical, transverse)
  • soft tissues
  • dental factors
  • habits
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5
Q

Skeletal pattern of class 2 div 1 (A/P)

A
  • associated with class 2 sk pattern
  • due to retrognathic mandible
  • less common to have maxillary protrusion
  • can happen in skeletal class 1
  • rarely in class 3
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6
Q

OJ might be due to?

A
  • sk pattern
  • tooth inclination
  • combination of both
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7
Q

Sk pattern - Vertical

A
  • found in association with a range of vertical sk pattern
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8
Q

Sk pattern (transverse)

A
  • no particular association with transverse
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9
Q

Normal values for SNA

A

81 +/- 3

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10
Q

Normal values of SNB

A

78 +/- 3

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11
Q

Normal values of ANB

A

3 +/- 2

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12
Q

Normal values of UI/MxP

A

109 +/- 6

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13
Q

Normal values of LI/ MnP

A

93 +/- 6

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14
Q

Lateral ceph labelling

A
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15
Q

Normal values for LAFH/ TAFH

A

55%

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16
Q

Presentation of Soft tissues

A
  • lips are often incompetent due to prominence of incisors and/ or underlying Sk pattern
  • lower lip trap can be aetiological factor in increased OJ
  • if lips incompetent, then special effort needed to achieve anterior oral seal
17
Q

Achieving an anterior oral seal

A
  1. lip to lip seal by activity of circum-oral musculature
    - mandible postured to allow lips to meet
  2. Lower lip drawn up behind upper incisors
    - tongue placed forwards between incisors to lower lip
  3. combi of both
18
Q

Dental factors of Class 2 div 1

A
  • increased OJ - incisors proclined/ average
  • Overbite varies
  • good alignment, crowding or spacing
  • molar relationship
  • parted lips may lead to drying of gingiva and exacerbation of any pre-existing gingivitis
19
Q

Sucking habits

A
  • thumb
  • fingers
  • blanket
  • lip
  • combination of all
  • NNSH - non nutritive sucking habits

** depends on duration and intensity

20
Q

Occlusal Features of Sucking Habits

A
  • proclination of upper anteriors
  • retroclination of lower anteriors
  • localised AOB/ incomplete OB
  • narrow upper arch
  • may see unilateral posterior crossbite
21
Q

How to stop habits?

A
  1. Stop habit
    - reinforcement
    - removable appliance habit breaker
    - fixed appliance habit breaker
  2. allow spontaneous improvement
  3. treat residual malocclusion if required
22
Q

Types of Management Options

A
  1. Accept
  2. Growth Modification
  3. Simple tipping of teeth
  4. Camouflage
  5. Orthognathic surgery
23
Q

Accept conditions

A
  • mildly increased OJ
  • significant OJ but not unhappy
  • will future tx options be more difficult in the future?
  • advise on mouthguard
24
Q

Growth Modification

A
  • Headgear to try and restrain growth of maxilla horizontally and vertically
  • functional appliance
25
Q

What is Functional appliance?

A
  • utilize, eliminate, guide the forces of muscle function, tooth eruption and growth to correct malocclusion
  • used mostly in class 2 div 1
26
Q

Types of functional appliances

A

Removable
- tooth borne: twin block, activator/ bionator
- ST borne: Frankel 2

Fixed
- Herbst

27
Q

Twin Block Appliances

A
28
Q

GM with Functional appliances

A
  • produce restraint of maxillary growth and encourage mandibular growth
  • depends on favourable growth and enthusiastic pt
29
Q

Therapeutic effect of Functional Appliances

A

Mostly dento-alveolar changes
- distal movement of upper dentition
- mesial movement lower dentition
- retroclination of upper incisors
- proclination of lower incisors

Minor degree of skeletal changes
- degree of maxillary restraint and mandibular growth is usually small (1-2mm)

30
Q

When to use functional appliances?

A
  • during growth
  • early use about 10 yrs old (2 phase tx)
  • later use for late mixed/ early permanent dentition (1 phase)
31
Q

Disadvantages of early tx

A
  • early skeletal effects from functional appliance/ headgear therapy not maintained in long term
  • overall tx time increased, 2 phase tx
    1. early functional appliances + retention
    2. fixed appliances in early perm dentition
32
Q

Benefits of Early tx

A
  • improve appearance earlier from teasing
  • reduce trauma
  • better compliance with appliance wear
33
Q

When to use simple tipping of teeth?

A
  • simple URA has limited role in tx of increased OJ

Unless
- very mild class 2/1
- OJ due to proclined and spaced incisors
- OB favourable
- after specialist assessment

34
Q

Retroclining anterior teeth

A
35
Q

Camouflage with fixed appliances

A
  • reduce OJ
  • may need upper arch extractions to give space/ distal movements
36
Q

Orthognathic surgery

A
  • when growth is complete
  • sk discrepancy is severe in A/P or vertical direction
  • usually involves mandibular surgery, but may involve maxillary surgery
  • fixed required before, during and after surgery

Orthodontics (6 decks)

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