The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

1. Treatment of class II
malocclusion
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com

2. Introduction





In class II malocclusion lower dental arch is in a distal
or posterior relation to the upper arch as reflected by
the first permanent molar relationship.
The mesiobuccal groove of the mandibular first molar
no longer receives the mesiobuccal cusp of maxillary
first molar but usually contacts the distobuccal cusp of
the maxillary first molar
There are two divisions to class II malocclusion
Class II Div 1 malocclusion –characterized by class II
molar relationship with proclined maxillary anterior
teeth
Class II Div 2 malocclusion –characterized by class II
molar relationship with retroclined upper centrals that
overlapped by the lateral incisors
www.indiandentalacademy.com

3. Etiology

Prenatal factors-

1. Hereditary
2. Teratogens
3. Irradiation
4. Intra-uterine fetal posture

Natal factors –
1.Trauma induced by improper forceps application during
delivery . Trauma to condylar region lead to underdevelopment of the
mandible

Post-natal –
1.Traumatic injury to mandible and TMJ
2.Long term irradiation therapy of the skeletal cranio-facial
region
3.Infectious conditions such as rheumatoid arthritis can influence
mandibular growth
4. sleeping habits
www.indiandentalacademy.com

4. Management of class II





-
Treatment principles depends on three important factors -:
1. the age at which patient is seen
2. the nature and severity of the problem
3. the underline etiologic factors
Treatment objectives in class II div 1 malocclusion
Reduction of overjet
Reduction of overbite
Correction of crowding and local irregularities
Correction of unstable molar relationship
Normalizing the musculature
Correction of posterior cross bites if any
www.indiandentalacademy.com

5. Treatment approaches







1. To prevent the malocclusion from occurring
2. To intercept a developing malocclusion
3. To correct already developed malocclusion
1. Management by preventing the etiological factors like
functional disturbances, abnormal habits, etc. that would have
contributed or exaggerated the class II malocclusion
2. Management by modifying the growth either by restricting
the maxillary growth or enhancing the mandibular growth
3. If patient is seen after the growth period then camouflaging
of skeletal jaw discrepancy by fixed mechanotherapy is the
treatment of choice. It’s a compromise treatment for mild to
moderate skeletal discrepancy
4. If the skeletal discrepancy is severe, then surgical
intervention is the only alternative choice and should be
undertaken after the cessation of growth.
www.indiandentalacademy.com

6. Management of functional
disturbances
Mouth breathing

- habit breaking appliance such as oral screen
Abnormal tongue position and swallowing patterns

-adequate motivation of the patient

-habit breaking appliance ; fixed / removable

-surgical reduction of abnormally large tongue

- any other secondary causes, leading to nasal airway abstraction, should be
looked for and eliminated
Lip posture and activity

Following Exercises suggested

Patient should try to take the lower lip over the labial surface and try to exert a
backward pressure

Extending the lower lip over the upper lip or the reverse way and holding it as long
as possible

Holding the ice-cream stick between the lips and holding it as long as possible

Button pull exercises
all the above exercises are done a minimum of 30 minutes in divided period of five
www.indiandentalacademy.com
minutes

7. Management of abnormal habits like
thumb sucking and finger sucking





No intervention is needed until decidous teeth are
erupted because they usually tend to stop by then
Adult approach by giving a mature talk
Reward system and reminder system suggested
The offending digit can be painted with a pungent
substance
If all the above fails, then treatment by fixed or
removable habit breaking appliances is the treatment
choice
www.indiandentalacademy.com

8. Management during mixed dentition




Three important considerations are
Age of the patient
Location of the fault ( maxilla, mandible or
combination )
Type of growth pattern (horizontal or vertical)
www.indiandentalacademy.com

9. Management of maxillary
prognathism with normal mandible



Goal is mainly to restrict the excessively
growing maxilla
Manage by extraoral force using headgears
Maxillary splint can also be used
www.indiandentalacademy.com

10. Management of mandibular
deficiency






Goal is to enhance mandibular growth
The appliances used are
- Activator
- Frankel
- Herbst
- & various other mandibular advancing
devices
www.indiandentalacademy.com

11. Management of dentoalveolar Class II malocclusion
with normal skeletal relationship:

1.
2.
3.
Based on etiological factors :
Avoiding premature extraction and if necessary space
should be maintained to prevent mesial drift of molars.
In premature exfoliated cases where mesial drift has
already occurred , space regaining devices like
springs, screws or extraoral appliances for distalization
of upper buccal segment can be done
In cases where the upper and lower anteriors are
proclined with spacing & deep bite, persistence of any
abnormal habit like : thumb sucking , cheek sucking
etc. should be looked for and eliminated before
retracting.
www.indiandentalacademy.com

12. Management of Class II malocclusion in adults:
 Dentoalveolar compensation for the skeletal
defect through reduction of tooth material is
the treatment of choice.
 Dentoalveolar is brought about by various
multibanded appliance therapies.
Class II malocclusion can also be treated by
various orthognathic surgeries
www.indiandentalacademy.com

13. Treatment objectives of Class II Div 2:
1.
2.
3.
4.
Relief of gingival trauma
Correction of incisor relationship
Relief of crowding & local irregularities
Correction of buccal segment relationship
www.indiandentalacademy.com

14. Management of Class II Div 2:
 In mixed dentition phase:
 Maxillary anteriors can also be proclined by
functional appliance.
 Reduction in incisal overbite by use anterior
bite plane or fixed appliances incorporating
anchor bends or reverse curve of spee.
www.indiandentalacademy.com

15. Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com