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BDS4 Orthodontics > Class II Division 1 Malocclusion > Flashcards

Class II Division 1 Malocclusion Flashcards

1
Q

What is the BSI definition of a class II division 1 malocclusion?

A
  • the lower incisor edges lie posterior to the cingulum plateau of the upper incisors
  • there is an increased overjet
  • the upper central incisors are proclined or of average inclination
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2
Q

What is the prevalence of Class II Div 1 malocclusions?

A

15-20%

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3
Q

What are the possible reasons for treating a class II div 1 malocclusion?

A
  • concerns about aesthetics
  • concerns about dental health
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4
Q

What are the dental health concerns for a class II div 1 malocclusion?

A

trauma

  • prominent incisors are at increased risk of trauma
    • especially in case of incompetent lips
  • overjet >9mm twice as likely to suffer trauma
    • IOTN 5a
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5
Q

What are the aesthetic concerns for a class II div 1 malocclusion?

A
  • may be self-conscious
  • may be getting bullied at school
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6
Q

What are the dental health concerns for a class II div 1 malocclusion?

A
  • risk of trauma
    • prominent incisors
    • increased by incompetent lips
    • overjet >9mm twice as likely for trauma
      • IOTN 5a
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7
Q

What are the A/P skeletal pattern features of a Class II Div 1 malocclusion?

A
  • usually associated with class II skeletal base
    • can be seen on class I
    • rarely seen on class III
      • tipping of teeth
  • commonly retrognathic mandible
    • maxillary protrusion less common
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8
Q

What can cause overjets is class II div. 1 malocclusions?

A
  • skeletal pattern
  • tooth inclination
  • combination of both
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9
Q

What vertical skeletal patterns are associated with class II div 1 malocclusions?

A
  • associated with a range of vertical skeletal patterns
    • reduced overbite
    • anterior open bite
    • reduced FMPA
      • more horizontal
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10
Q

What transverse skeletal patterns are associated with class II div 1 malocclusions?

A
  • no particular association with transverse problems
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11
Q

What soft tissue features may be seen in a class II div 1 malocclusion?

A
  • incompetent lips
    • prominence of incisors
    • underlying skeletal pattern
    • difficulty achieving anterior oral seal
  • lower lip trap
    • aetiological factor in increased overjet
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12
Q

How may patients with a class II div 1 malocclusion achieve an anterior oral seal?

A
  • activity of circum-oral musculature
  • mandible postured to allow lips to meet
  • lower lip drawn up behind incisors
  • tongue placed forwards between incisors and lower lip
  • combination of all of the above
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13
Q

What dental factors are involved in a class II div.1 malocclusion?

A
  • increased overjet
    • proclined or average incisors
  • overbite varies
  • aligned, crowded or spaced
  • molar relationships
  • habitually parted lips
    • dying of gingiva
    • exacerbation of pre-existing gingivitis
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14
Q

How can sucking habits be involved in class II div 1 malocclusions?

A
  • effects depend on the duration and intensity
    • thumb
    • fingers
    • blanket
    • lip
    • combination of the above
  • angulation of incisors
    • proclination of upper anteriors
    • retroclination of lower incisors
  • localised AOB or incomplete OB
    • usually asymmetrical AOB
  • narrow upper arch
    • unilateral posterior crossbite possible
    • buccinator muscles left unopposed
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15
Q

What must be done about a sucking habit before commencing orthodontic treatment?

A
  • stop habit
    • reinforcement
      • motivated patient
    • removable appliance habit breaker
      • motivated patient
      • can be removed
    • fixed appliance habit breaker
  • allow spontaneous improvement
    • AOB and overjet
    • around 1-1.5 years
  • treat residual malocclusion
    • if required
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16
Q

What are the 5 management options for Class II Div 1 malocclusion?

A
  1. accept
  2. attempt growth modification
  3. simple tipping of teeth
  4. camouflage
  5. orthographic surgery
17
Q

When can a class II div 1 malocclusion be accepted?

A
  • mildly increased overjet
  • significant overjet but not unhappy with teeth
18
Q

What advice must be given surrounding accepting a classII div 1 malocclusion?

A
  • increased risk of trauma
    • especially young patients
    • consider a mouthguard
  • future treatment options reduced
    • beyond 14 growth modification challenging
19
Q

What are the different options for growth modification for a class II div 1 malocclusion?

A
  • headgear
    • restrain maxillary growth
      • horizontally
      • vertically
  • functional appliance
20
Q

What is a functional appliance?

A

functional appliances utilise, eliminate or guide the forces of muscle function, tooth eruption and growth to correct a malocclusion

21
Q

How is the mandible postured by a functional appliance for a class II div 1 malocclusion?

A
  • downwards
  • forwards
22
Q

What are the different types of functional appliance available?

A
  • removable
    • tooth borne
      • twin-block
      • activator/bionator
    • soft tissue borne
      • Frankel (FRII)
  • fixed
    - Herbst
23
Q

What is the aim of functional appliance use and what does success depend on?

A
  • aim
    • produce restraint of maxillary growth
    • encourage mandibular growth
  • success
    • favourable growth
    • motivated patient
24
Q

What are the therapeutic effects of functional appliances?

A
  • mostly dento-alveolar changes
    • distal movement of upper dentition
    • mesial movement of lower dentition
    • retroclination of upper incisors
    • proclination of lower incisors
  • minor degree of skeletal changes
    • maxillary restraint
      • 1-2mm
    • mandibular growth
      • 1-2mm
    • significant variation
25
Q

When should a functional appliance be used?

A
  • during growth
    • ideally coinciding with pubertal growth
      • males - 13-15 years
      • females - 11-13 years
  • early use
    • 10 years old
    • 2 phase treatment
  • later use
    • late mixed or early permanent
    • 1 phase treatment
26
Q

What are possible disadvantages of early treatment of a class II div 1 malocclusion with a functional appliance?

A
  • early skeletal effects not maintained long term
  • overall treatment time increased
    • 2 phase treatment
      • early functional appliance + retention
      • fixed appliance in early permanent
27
Q

What are the potential benefits of early treatment of a class II div 1 malocclusion with a functional appliance?

A
  • improved appearance early
    • reduced teasing
    • potential psychological benefit
  • reduced risk of trauma
  • often better compliance
    • appliance wear
28
Q

How can simple tipping of teeth be used to treat a class II div 1 malocclusion?

A
  • limited role in treatment of increased overjets
  • suitable for:
    • very mild class II or class I
    • overjet due to proclination and spacing
      • incisors
    • overbite favourable
29
Q

Describe an appliance design for retroclining anterior teeth

A

A: Robert’s Retractor 0.5mm tubing
R: Adam’s clasp 6/6, 0.7mm HSSW
A: stops mesial to 3/3
B: flat anterior bite plane

30
Q

How can camouflage be used for a class II Div I malocclusion?

A
  • upper arch extractions
    • space for distal movement
    • overjet reduction
  • fixed appliances
    • better for moving roots
31
Q

How can orthographic surgery be used to treat a class II div 1 malocclusion?

A
  • carried out when growth is complete
  • used for severe skeletal discrepancies in the antero-posterior or vertical direction
    • usually involves mandibular surgery
    • may also involve maxillary surgery
  • fixed appliances required
    • before surgery
    • during surgery
    • after surgery

BDS4 Orthodontics (8 decks)

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