Class Ii Malocclusion: Usman & Mehmood

CLASS II MALOCCLUSION
Usman &
Mehmood
 DEFINITION:
The lower dental
arch is posterior to
the upper in one or
both the lateral
segments.1
The lower first molar is
distal to the upper
first molar.1
 DIVISIONS:
Division 1
Division 2
DIVISIONS
 Class II division 1:
Bilaterally distal with
narrow maxillary arch
with protruding upper
incisors.1
DIVISIONS
 Class II division 2
Bilaterally distal with
normal or square
shape maxillary arch,
retruded maxillary
central incisors, and
an excessive
overbite.1
TYPES OF CLASS II
DIVISION 2
 TYPE A: central incisors

retroclined and laterals
proclined
 TYPE B: central and

lateral incisors retroclined
and canines buccally
placed
 TYPE C: all anterior teeth

retroclined
ETIOLOGY OF
MALOCCLUSION
 Heredity
 Habits
 Thumb sucking
 Digit sucking
 Tongue thrust
 Lip thrust
 Lip trap
 Lip biting
 Nail biting
ETIOLOGY OF
MALOCCLUSION
 Speech defects
 Abnormal sucking habits
 Psychogenic problems
CHARACTERISTICS
CHARACTERISTICS DIV 2 DIV 1
PROFILE Straight to mildly Convex

convex
LIPS
a. Upper Normal Short
b. Lower Normal Everted
c. Competency Competent Incompetent
MENTOLABIAL SULCUS Deep or normal Deep
MENTALIS MUSCLE Normal Hyperactive

CHARACTERISTICS contd.
Prominent Not prominent Malar process
Decreased Normal or increased Lower facial height
Square, U shaped V shaped Arch form
Normal Deep Palatal vault
Central retroclined; Proclined Incisors

laterals proclined
CHARACTERISTICS contd…
Decreased Increased Overjet
Axis of crown and Normal angle Crown root

root bent; collum angulations
angle
Backward path of Normal Path of closure
closure
Increased Normal/ Increased/ Interocclusal

Decreased clearance
Class II division 1
malocclusion
Class II division 2
malocclusion
CEPHALOMETRIC
ANALYSIS
 Except for the maxillary incisor positions,
no basic difference in dentoskeletal
morphology exists between class II
division 1 and class II division 2
malocclusions
CEPHALOMETRIC
ANALYSIS
 Class II division 1
 Upper incisor to SN
plane angle
increased
 Increased upper
incisor-soft tissue
linear measurements
CEPHALOMETRIC
ANALYSIS
 Class II division 2:
 Upper incisor to SN
plane angle
decreased
 Decreased upper
incisor-soft tissue
linear measurements
MANAGEMENT
Class II Division 1
Class II Division 2
MANAGEMENT
 PROBLEMS:
 Skeletal
 Dental
 Combination
MANAGEMENT
Class II Division 1
OBJECTIVES:
 Improvement of esthetics
 Correction of increased overjet
 Correction of deep bite
 Alignment of anterior teeth
 Correction of class II molar
relationship
 Correction of deep Curve of
Spee
 Correction of any individual
problems
MANAGEMENT
Class II Division 1
IN DECIDUOUS
DENTITION:
Habit control
Supportive aids
MANAGEMENT
Class II Division 1
 IN MIXED DENTITION:
 DENTAL DISCREPANCY:
 Removable appliances
 Molar distalization
 Space maintainers
 Space gainers
 Habit breaking appliances
 Vestibular shields
 Tongue guards/cribs
 Myofuntional therapy
 Tongue positioning excercises
 Lip excercises
MANAGEMENT
Class II Division 1
 SKELETAL
DISCREPANCY:
 FOR MANDIBULAR
DEFICIENCY
 Myofunctional appliances
FR 1
Activator
Bionator
 Fixed functional appliances
(late mixed dentition)
Herbst appliance
Jasper Jumper
MANAGEMENT
Class II Division 1
 FOR MAXILLARY
PROGNATHISM
Face bow with head gear
 FOR COMBINATION
Activator with head gear
MANAGEMENT
Class II Division 1
 IN PERMANENT DENTITION:
 EXTRACTION
a. more than 5mm discrepancy in both the
arches – extraction of all first premolars
b. 5mm discrepancy in upper arch only –
extraction of upper first premolars only
c. >5mm in upper arch, 2.5 – 5mm in lower arch
--- extraction of upper first premolars and lower
second premolars
d. Extraction of first or second molars
MANAGEMENT
Class II Division 1
MANAGEMENT
Class II Division 1
CLASS II ELASTICS
MANAGEMENT
Class II Division 1
 NON EXTRACTION:
 Spacing
 ALD less than 5mm
MANAGEMENT
Class II Division 1
 SKELETAL DISCREPANCY:
 MAXILLARY PROGNATHISM:
 Segmental osteotomy
 Lefort 1
 Alveolar corticotomy
 MANDIBULAR DEFICIENCY:
 BSSO
MANAGEMENT
Class II Division 2
 TREATMENT OBJECTIVES:
Improvement of esthetics
Correction of incisor
relationship
Correction of closed bite
realtionship
Correction of incisor inclination
and gingival trauma
Correction of molar
relationship
Correction of occlusal plane
Correction of any individual
abnormality
MANAGEMENT
Class II Division 2
 IN DECIDUOUS DENTITION:
 Usually not diagnosed
 Orthodontic treatment not required
MANAGEMENT
Class II Division 2
 IN MIXED DENTITION:
 Correction of deep bite;
anterior bite plane
therapy
MANAGEMENT
Class II Division 2
 With normal incisor
pattern, aligning of
anteriors followed by
myofunctional
appliances to correct
Class II relationship
MANAGEMENT
Class II Division 2
 In case of mild
discrepancy (2 – 3
mm) distalizing upper
first permanent
molars to gain space
for anteriors
MANAGEMENT
Class II Division 2
 IN PERMANENT DENTITION:
 Extraction ---- usually not required;
managed by combination of palatal
expansion and proximal stripping
 Anteriors aligned by a combination of
double cantilever spring and labial bow,
with or without expansion screw
MANAGEMENT
Class II Division 2
MANAGEMENT
Class II Division 2
 In case of severe crowding upper first
premolars extracted
 If crowding in both arches – extraction of
first/second premolars in both the arches
MANAGEMENT
Class II Division 2
 SKELETAL DISCEPANCY:
 Usually not seen
 Mandibular segmental osteotomy
MANAGEMENT
 POST TREATMENT RETENTION

 Temporary or permanent
 Removable or fixed
THANK YOU

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What are the different types of Class II malocclusion?

What are some common etiological factors for malocclusion?

CLASS II MALOCCLUSION

 TYPE A: central incisors

 TYPE B: central and

 TYPE C: all anterior teeth

PROFILE Straight to mildly Convex

MENTOLABIAL SULCUS Deep or normal Deep

MENTALIS MUSCLE Normal Hyperactive

Decreased Normal or increased Lower facial height

Square, U shaped V shaped Arch form

Normal Deep Palatal vault

Central retroclined; Proclined Incisors

Axis of crown and Normal angle Crown root

Increased Normal/ Increased/ Interocclusal

 POST TREATMENT RETENTION

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