CLASS II
MALOCCLUSIONS
Dr. Sohaib Hassan
Assistant Professor
Head, Department of Orthodontics
Multan Medical & Dental College, Multan
Class II Malocclusion
• Dental
• Class II Div 1
• Class II Div 2
• Class II Division & Subdivision (Rt & Lt)
• Skeletal
• Maxillary Prognathism
• Mandibular Retrognathism
• Combination of both
• Combination of Skeletal and Dental
Class II Div 1
• Also known as Disto-occlusion
• Increased Overjet
• Bimaxillary Protrusion (Proclination)
• Molars may be in ¼ unit or ½ unit or full unit or
supra class II relationship
Class II Div 2
• When along with molar relation in class II, incisors
are in class II relationship as well, i.e. lower incisor
edges lie behind the incisor platue, but overjet is
reduced than normal
• Type A; in which maxillary central incisors are
retracted only
• Type B; in which maxillary four incisors are retracted
• Type C; in which all maxillary anteriors are retracted
Skeletal Class II
• It is a normal finding that skeletal class II problems are
associated with Angle’s class II div. 1 or div. 2 dental mal
relationships
1. When maxilla is prognathic with normal mandible
2. When maxilla is normal but mandible is hypoplastic
or retrognathic
3. When maxilla is prognathic & mandible is
retrognathic (Composite Sk. Class II)
Etiology of Dental Class II
• Genetic or inherited factors
• Naso-respiratory problems (enlarged adenoids, tonsils, polyps)
• Habits
• Lip biting (upper lip)
• Localized anterior crowding
• Early loss of deciduous molars with mesial shift of molars
• Bolton morphological discrepancy of max 2nd PM
(microdontia)
• In case of congenitally missing mand. 2nd PMs & retained E’s
Etiology of Skeletal Class II
• Genetic or inherited factors (e.g. Pierr Robin sequence)
• Naso-respiratory problems (enlarged adenoids, tonsils,
polyps)
• Habits (thumb sucking, bottle or dummy sucking, tongue
thrust, lip biting etc)
• Early trauma to the jaw
• TMJ Ankylosis
EXTRA ORAL FEATURES
• Retrusive lips
• Convex profile
• Gummy smile (excessive gingival
display)
• Decreased lower anterior facial height
• Prominent chin button (forward &
upward rotation of the jaw)
• Deep mento-labial sulcus
• Tongue lip swallow
• Trapped lower lip
• Incompetent Lips
Intra Oral Features of Class II Div 1
• Increased overjet
• Class II molar & canine relationship
• Sunday Bite / Posture
• Posterior X-bite
• Anterior open bite (some of the cases)
• Deep bite (more common)
• Increased curve of Spee
• Crowding
• A mid line shift (in case of crowding)
Lateral Ceph Findings of Skeletal Class II
• Sagittal analysis of skeleton will show class II pattern
• ANB > will be more than +40,
• SNA increased, SNB decreased
• Vertical analysis may show normal, low or high angles
• Dental analysis may or may not show increased
• U.I. To SN >, U.I. To palatal plane >
• IMPA (Bi-max) {Dento-alveolar compensation}
• Soft tissue analysis will show +ve distances between lips
& E & S lines
• Acute naso-labial
OBJECTIVES
• Eliminating the habits or other etiological factors
• Restoring the normal soft tissue profile
• Achieving class I canine relationship
• Overbite correction Overjet correction
• Proper torquing of upper incisors
• Relieving crowding
TREATMENT OPTIONS
• Growth modification by Functional jaw orthopedics
• Comprehensive orthodontics
• Orthodontic camouflage
• Orthognathic surgery
GROWTH MODIFICATION
There are two ways of growth modification;
1. Restraining growth of Maxillla
2. Promoting growth of mandible
RESTRAINING GROWTH
• High / low / or combination HG depending upon the vertical
pattern of the patient
• HG basically restrain the skeletal growth by the action at
sutures, that is they do not let the bone to deposit & further
grow the Naso-maxillary complex (the action is at circum-
maxillary sutures)
GROWTH PROMOTION
1. Mesialization of lower dento-alveolus & Distalization of
upper dento-alveolus
2. Stimulating the condylar growth
3. Restriction of forward growth of maxilla
4. Remodeling in glenoid fossa
Comprehensive Orthodontics
• Depending upon individual case, extractions may or may not
be decided
• Molar distalization can be chosen if patient is growing, max
2nd molars are not erupted
• Lower arch is normally determinant for the extractions e.g.;
• The degree & extent of crowding
• Amount of Curve of Spee
• Conventionally, upper 1st bicuspids & lower 2nd bicuspids are
extracted
ORTHODONTIC CAMOUFLAGE
• The skeletal base bone problem is hidden (camouflage) by the
dento-alveolar movements by doing some extractions
• Normally it is done when skeletal Class II is due to upper jaw
& the case is not so severe (like ANB > is 60 – 80)
• The dento-alveolar movements are done by fixed orthodontic
mechanics
ORTHOGNATHIC SURGERY
Depending upon the jaw / jaws involved, one / combination of the
following surgical techniques may be adopted;
1. Anterior maxillary setback by Wassmond or Wonderer
technique
2. Mandibular advancement by BSSO, C- osteotomy, inverted-L
ramal osteotomy
3. Genioplasty
Single or double jaw surgery may be selected
HOW ORTHOGNATHIC SURGERY
CASE IS DECIDED
• Soft tissue paradigm
• When patient is adult or passed the peak of skeletal growth
• When ANB > is more than 80
• When there is severe dento-alveolar compensation
• When orthodontic treatment is failed
ORTHOGNATHIC SURGERY
Any of the surgical orthodontic case is done in 3 stages;
1. Pre-surgical orthodontics (12 - 18 months approximately)
2. Orthognathic surgery ( 3 months)
3. Post-surgical orthodontics (about 6 months)
GOALS OF PRE SURGICAL
ORTHODONTICS
1. Arches leveling & alignment
2. Arch co-ordination
3. De compensations
4. Leveling curve of Spee
5. Making room for surgical cuts in the dento-alveolus by root
divergence at that area
6. Means of attachment in the arch wires for elastics
WASSMUND PROCEDURE
OR ANTERIOR MAXILLARY OSTEOTOMY
BSSO
GENIOPLASTY
LE FORT 1, BSSO & GENIOPLASTY
GOALS OF POST SURGICAL
ORTHODONTICS
• Achieving a good interdigitation by inter-maxillary elastic
traction
• Active tooth movement is not commenced until 4 weeks after
surgery
• Any of the remaining discrepancy
Thank You
