Treatment of Skeletal Class II Malocclusion

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Questions and Answers

Class II skeletal profiles are typically (concave/convex) as a result of what 3 things?

Concave

Convex (correct)

What is a 'Sunday bite'?

Posturing the mandible forward to mask the skeletal and dental malocclusion.

Be sure to manipulate the mandible to ______________ during evaluation of the profile and skeletal relationship.

centric relation

What is lip entrapment?

When the lower lip gets caught between the upper and lower incisors. Signup and view all the answers

What is lip incompetence?

When the lips are not together at rest. Signup and view all the answers

When may you notice mentalis strain in a patient?

When a patient tries to overcome their lip incompetence and close their lips together. Signup and view all the answers

Patients with class II skeletal relationships are more likely to breathe through their:

Mouth Signup and view all the answers

What are 3 reasons that people with class II skeletal relationships may not be able to breathe through their nose?

Chronic allergies, chronic airway infections, enlarged tonsils. Signup and view all the answers

Breathing through the mouth can change the posture of the head, jaw, and tongue.

True Signup and view all the answers

Altered equilibrium of pressures on the jaws and teeth can affect both jaw growth and tooth position.

True Signup and view all the answers

What are three postural changes we see with habitual mouth breathing?

Mouth open and mandible lower, lower tongue position, head tipped back. Signup and view all the answers

What are 6 skeletal/dental changes we see with habitual mouth breathing?

Face height increases, posterior teeth supra-erupt, mandible rotates down and back, anterior open bite, increase in overjet, narrowing of the maxilla. Signup and view all the answers

Almost all patients who have a class II skeletal relationship also have a class II molar relationship.

True Signup and view all the answers

What are the 2 classifications of class II patients?

Class II division 1, Class II division 2. Signup and view all the answers

Which patient would be more likely to have proclined maxillary central incisors?

Class II division 1 Signup and view all the answers

Which patient would be more likely to have upright or retroclined maxillary central incisors?

Class II division 2 Signup and view all the answers

Which would be more likely to have a higher mandibular plane angle?

Class II division 1 Signup and view all the answers

Which would be more likely to have a longer lower face height?

Class II division 1 Signup and view all the answers

Which would be more likely to have a low mandibular plane angle?

Class II division 2 Signup and view all the answers

Which would be more likely to have a short lower face height?

Class II division 2 Signup and view all the answers

Which would be more likely to have a deep bite?

Class II division 2 Signup and view all the answers

Class II malocclusions usually improve with time if they aren't treated.

False Signup and view all the answers

Can treatment of children with class II malocclusions who are still growing present future surgery as an adult?

True Signup and view all the answers

What are 4 reasons that class II patients would benefit from ortho treatment?

Discrimination due to appearance, problems with oral function, susceptibility to trauma, airway problems. Signup and view all the answers

What are the 2 phases of treatment for class II patients?

Phase I, Phase II. Signup and view all the answers

For some class II patients, it is beneficial to have a first phase of early treatment with later second phase full orthodontic treatment.

True Signup and view all the answers

Orthodontic/orthopedic correction of a skeletal class II may only be attempted in a growing patient.

Orthopedic Signup and view all the answers

Orthopedic treatment should be (before/after) the majority of the growth is complete, (before/after) PHV.

Before; before. Signup and view all the answers

PHV occurs around age ____ for males.

<ol start="14"> <li></li> </ol> Signup and view all the answers

PHV occurs around age ____ for females.

<ol start="12"> <li></li> </ol> Signup and view all the answers

Patients get only one opportunity in life for orthopedic corrections.

True Signup and view all the answers

A (mesial/distal) step in primary second molar dentition would likely be seen in class II patients during the mixed dentition?

Distal Signup and view all the answers

The relationship of the first permanent molars is determined by that of the primary molars.

True Signup and view all the answers

A good rule of thumb is a distal step in the primary second molars with good growth will at best finish as:

An end on class II. Signup and view all the answers

What are the 3 treatment options for class II patients?

Orthopedic, orthodontic, surgical. Signup and view all the answers

What are the 2 types of orthopedic treatments for class II patients?

Headgear, functional appliance. Signup and view all the answers

Which type of orthopedic appliance restrains maxillary growth?

Headgear Signup and view all the answers

Which type of orthopedic appliance forces patients to position their mandible forward?

Functional appliance Signup and view all the answers

What are the 3 types of headgear for class II patients?

Cervical pull, combination pull, high pull. Signup and view all the answers

Which would be used for patients with short or normal face heights?

Cervical pull Signup and view all the answers

Which would be used for patients with a lower mandibular plane angle?

Cervical pull Signup and view all the answers

Which would be used for patients with an average face height?

Combination pull Signup and view all the answers

Which would be used for patients with a long face height?

High pull Signup and view all the answers

Which would be used for patients with a high mandibular plane angle?

High pull Signup and view all the answers

Headgear (mesializes/distalizes) the maxillary dentition.

Distalizes. Signup and view all the answers

Headgear (restrains/enhances) maxillary growth.

Restrains. Signup and view all the answers

What effect does headgear have on the mandibular teeth?

No effect. Signup and view all the answers

What are the 2 downsides to headgear?

Unaesthetic, patient compliance. Signup and view all the answers

What are 4 functional appliances used to treat class IIs?

Herbst, twin block, activator, Frankel. Signup and view all the answers

What is the goal of orthopedic correction for class II patients?

Improve skeletal relationship through differential growth. Signup and view all the answers

What is a common orthodontic treatment for class II patients?

Removal of 2 maxillary bicuspids. Signup and view all the answers

Removal of two maxillary bicuspids for class II patients is usually done when ____________ growth remains.

Little/no Signup and view all the answers

Removal of two maxillary bicuspids for class II patients is best indicated when the patient has what 3 dental problems?

Maxillary protrusion, excessive overjet, excessive maxillary crowding with minimal mandibular crowding. Signup and view all the answers

What are 5 surgical approaches for class II patients?

Mandibular advancement, sliding genioplasty, maxillary impaction, combination, distraction osteogenesis. Signup and view all the answers

What 10 factors determine the treatment selection for class II patients?

Age/growth, TMJ health, degree/type of malocclusion, degree/etiology of skeletal imbalance, patient motivation, orthodontic philosophy, facial esthetics, periodontal health, functional habits, desired mechanics. Signup and view all the answers

_____% of patients do not have malocclusions.

<ol start="30"> <li></li> </ol> Signup and view all the answers

_____% of patients have class I malocclusions.

<ol start="54"> <li></li> </ol> Signup and view all the answers

_____% of patients have class II malocclusions.

<ol start="15"> <li></li> </ol> Signup and view all the answers

_____% of patients have class III malocclusions.

<ol> <li></li> </ol> Signup and view all the answers

Class II patients typically present a 3-dimensional skeletal problem (vertical, AP, and transverse).

True Signup and view all the answers

Study Notes

Class II Skeletal Profiles

Class II skeletal profiles are typically convex, often due to:
- Mandibular retrognathism (most common cause)
- Maxillary prognathism (less common)
- A combination of both conditions
Characteristics:
- Profile line runs from glabella to pronasale and pogonion.
- Class I indicates relative straightness in maxilla and mandible; Class II indicates a discrepancy with maxilla too far forward or mandible too far back.

Horizontal Reference and Profile Evaluation

Frankfort horizontal line is established from the tragus of the ear to the estimated base of the orbit.
A vertical line dropped from nasale should align with subnasale and pogonion.
If the mandible is located posterior to this line, it suggests a retrognathic mandible.

Mandibular Posturing and Lip Issues

"Sunday bite" refers to the forward positioning of the mandible to mask malocclusion.
Lip entrapment occurs when the lower lip is trapped between incisors, often increasing overjet; commonly seen in Class II due to AP discrepancies.
Lip incompetence is defined as lips that do not meet at rest.

Breathing and Mouth Posture

Class II patients are more inclined to breathe through the mouth due to factors such as lip incompetence or nasal obstruction.
Possible reasons for nasal breathing difficulty include:
- Chronic allergies
- Chronic airway infections
- Enlarged tonsils
Mouth breathing leads to postural changes, including:
- Open mouth with a lowered mandible
- Lowered tongue position
- Tipped back head for easier breathing

Dental and Skeletal Implications

Mouth breathing can cause various changes:
- Increased face height due to supra-eruption of teeth
- Rotated mandible leading to anterior open bite and increased overjet
- Narrowed maxilla from low tongue posture effects
Class II skeletal relationships often correlate with Class II molar relationships.

Class II Classifications and Incisor Positions

Class II patients are divided into:
- Division 1: Proclined maxillary central incisors
- Division 2: Upright/retroclined central incisors and flared laterals
Division 1 features a higher mandibular plane angle, while Division 2 has a lower mandibular plane angle.

Treatment Considerations

Class II malocclusions typically worsen over time without treatment, leading to potential functional occlusion and facial balance issues.
Growth potential in children allows for orthopedic treatment to assist with future surgery needs.
Orthopedic correction methods may include functional appliances and headgear, aimed at facilitating mandibular growth.
Orthodontic camouflage may involve the removal of maxillary bicuspids for minor skeletal discrepancies.

Indicators for Orthopedic Treatment

Orthopedic treatments are most effective when administered before the majority of growth has occurred and before peak height velocity (PHV), which typically occurs at ages 14 for males and 12 for females.
Patients typically experience only one opportunity for orthopedic corrections.

Treatment Options and Classification

Two major phases of treatment exist:
- Phase I: Initiated during late mixed dentition.
- Phase II: Begins once all permanent teeth have erupted or just prior.
Three main treatment options for Class II include:
- Orthopedic treatments
- Orthodontic treatments
- Surgical options

Types of Appliances and Surgical Approaches

Types of orthopedic appliances:
- Headgear (restrains maxillary growth)
- Functional appliances (positions mandible forward)
Surgical options may involve:
- Mandibular advancement
- Sliding genioplasty
- Maxillary impaction

Demographics and Prevalence

30% of patients do not have malocclusions.
54% possess Class I malocclusions.
15% exhibit Class II malocclusions, a common case in practice.
1% experience Class III malocclusions.
Class II patients often present a complex 3-dimensional skeletal issue involving vertical, AP, and transverse dimensions.

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Description

This quiz focuses on the treatment of Skeletal Class II Malocclusion, particularly the characteristics of skeletal profiles. Learn about the distinctions between Class I and Class II malocclusion and the factors contributing to convex profiles.

Treatment of Skeletal Class II Malocclusion

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Questions and Answers

Class II skeletal profiles are typically (concave/convex) as a result of what 3 things?

What is a 'Sunday bite'?

Be sure to manipulate the mandible to ______________ during evaluation of the profile and skeletal relationship.

What is lip entrapment?

What is lip incompetence?

When may you notice mentalis strain in a patient?

Patients with class II skeletal relationships are more likely to breathe through their:

What are 3 reasons that people with class II skeletal relationships may not be able to breathe through their nose?

Breathing through the mouth can change the posture of the head, jaw, and tongue.

Altered equilibrium of pressures on the jaws and teeth can affect both jaw growth and tooth position.

What are three postural changes we see with habitual mouth breathing?

What are 6 skeletal/dental changes we see with habitual mouth breathing?

Almost all patients who have a class II skeletal relationship also have a class II molar relationship.

What are the 2 classifications of class II patients?

Which patient would be more likely to have proclined maxillary central incisors?

Which patient would be more likely to have upright or retroclined maxillary central incisors?

Which would be more likely to have a higher mandibular plane angle?

Which would be more likely to have a longer lower face height?

Which would be more likely to have a low mandibular plane angle?

Which would be more likely to have a short lower face height?

Which would be more likely to have a deep bite?

Class II malocclusions usually improve with time if they aren't treated.

Can treatment of children with class II malocclusions who are still growing present future surgery as an adult?

What are 4 reasons that class II patients would benefit from ortho treatment?

What are the 2 phases of treatment for class II patients?

For some class II patients, it is beneficial to have a first phase of early treatment with later second phase full orthodontic treatment.

Orthodontic/orthopedic correction of a skeletal class II may only be attempted in a growing patient.

Orthopedic treatment should be (before/after) the majority of the growth is complete, (before/after) PHV.

PHV occurs around age ____ for males.

PHV occurs around age ____ for females.

Patients get only one opportunity in life for orthopedic corrections.

A (mesial/distal) step in primary second molar dentition would likely be seen in class II patients during the mixed dentition?

The relationship of the first permanent molars is determined by that of the primary molars.

A good rule of thumb is a distal step in the primary second molars with good growth will at best finish as:

What are the 3 treatment options for class II patients?

What are the 2 types of orthopedic treatments for class II patients?

Which type of orthopedic appliance restrains maxillary growth?

Which type of orthopedic appliance forces patients to position their mandible forward?

What are the 3 types of headgear for class II patients?

Which would be used for patients with short or normal face heights?

Which would be used for patients with a lower mandibular plane angle?

Which would be used for patients with an average face height?

Which would be used for patients with a long face height?

Which would be used for patients with a high mandibular plane angle?

Headgear (mesializes/distalizes) the maxillary dentition.

Headgear (restrains/enhances) maxillary growth.

What effect does headgear have on the mandibular teeth?

What are the 2 downsides to headgear?

What are 4 functional appliances used to treat class IIs?

What is the goal of orthopedic correction for class II patients?

What is a common orthodontic treatment for class II patients?

Removal of two maxillary bicuspids for class II patients is usually done when ____________ growth remains.

Removal of two maxillary bicuspids for class II patients is best indicated when the patient has what 3 dental problems?

What are 5 surgical approaches for class II patients?

What 10 factors determine the treatment selection for class II patients?

_____% of patients do not have malocclusions.

_____% of patients have class I malocclusions.

_____% of patients have class II malocclusions.

_____% of patients have class III malocclusions.

Class II patients typically present a 3-dimensional skeletal problem (vertical, AP, and transverse).

Study Notes

Class II Skeletal Profiles

Horizontal Reference and Profile Evaluation

Mandibular Posturing and Lip Issues

Breathing and Mouth Posture

Dental and Skeletal Implications

Class II Classifications and Incisor Positions

Treatment Considerations

Indicators for Orthopedic Treatment

Treatment Options and Classification

Types of Appliances and Surgical Approaches

Demographics and Prevalence

Studying That Suits You

Description

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