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?

    <p>When the lower lip gets caught between the upper and lower incisors.</p> Signup and view all the answers

    What is lip incompetence?

    <p>When the lips are not together at rest.</p> Signup and view all the answers

    When may you notice mentalis strain in a patient?

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

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

    <p>Mouth</p> 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?

    <p>Chronic allergies, chronic airway infections, enlarged tonsils.</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

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

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

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

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

    <p>True</p> Signup and view all the answers

    What are the 2 classifications of class II patients?

    <p>Class II division 1, Class II division 2.</p> Signup and view all the answers

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

    <p>Class II division 1</p> Signup and view all the answers

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

    <p>Class II division 2</p> Signup and view all the answers

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

    <p>Class II division 1</p> Signup and view all the answers

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

    <p>Class II division 1</p> Signup and view all the answers

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

    <p>Class II division 2</p> Signup and view all the answers

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

    <p>Class II division 2</p> Signup and view all the answers

    Which would be more likely to have a deep bite?

    <p>Class II division 2</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

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

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

    <p>Phase I, Phase II.</p> 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.

    <p>True</p> Signup and view all the answers

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

    <p>Orthopedic</p> Signup and view all the answers

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

    <p>Before; before.</p> 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.

    <p>True</p> 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?

    <p>Distal</p> Signup and view all the answers

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

    <p>True</p> 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:

    <p>An end on class II.</p> Signup and view all the answers

    What are the 3 treatment options for class II patients?

    <p>Orthopedic, orthodontic, surgical.</p> Signup and view all the answers

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

    <p>Headgear, functional appliance.</p> Signup and view all the answers

    Which type of orthopedic appliance restrains maxillary growth?

    <p>Headgear</p> Signup and view all the answers

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

    <p>Functional appliance</p> Signup and view all the answers

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

    <p>Cervical pull, combination pull, high pull.</p> Signup and view all the answers

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

    <p>Cervical pull</p> Signup and view all the answers

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

    <p>Cervical pull</p> Signup and view all the answers

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

    <p>Combination pull</p> Signup and view all the answers

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

    <p>High pull</p> Signup and view all the answers

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

    <p>High pull</p> Signup and view all the answers

    Headgear (mesializes/distalizes) the maxillary dentition.

    <p>Distalizes.</p> Signup and view all the answers

    Headgear (restrains/enhances) maxillary growth.

    <p>Restrains.</p> Signup and view all the answers

    What effect does headgear have on the mandibular teeth?

    <p>No effect.</p> Signup and view all the answers

    What are the 2 downsides to headgear?

    <p>Unaesthetic, patient compliance.</p> Signup and view all the answers

    What are 4 functional appliances used to treat class IIs?

    <p>Herbst, twin block, activator, Frankel.</p> Signup and view all the answers

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

    <p>Improve skeletal relationship through differential growth.</p> Signup and view all the answers

    What is a common orthodontic treatment for class II patients?

    <p>Removal of 2 maxillary bicuspids.</p> Signup and view all the answers

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

    <p>Little/no</p> 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?

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

    What are 5 surgical approaches for class II patients?

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

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

    <p>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.</p> 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).

    <p>True</p> 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.

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