Académique Documents
Professionnel Documents
Culture Documents
II ANOMALIES
Treatment objectives
Treatment planing
Treatment mechanics
Patients age
Patients desire/complaints
Cast analysis /occlusion
Profile
Cephalometric analysis
Patients compliance
Treatment of Class II
Patients age
Treatment of Class II
Is the patient still growing ?
Increase of Bodyhight
Removable
treatment
Fixed Orthodontic
treatment or
combined with
orthogantic surgery
Second transitional
period
Years
Univ. Prof.Dr.Dr.D. Muessig 5
Diagnostics
Treatment of Class II
Occlusion /Cast
analysis
What is important?
Molar-
relationship
Canine
-relationship
Overjet / Overbite
Molar Canine
relationship relationship
Overjet and
Overbite
Diagnostics
Treatment of Class II
Occlusion /Cast
analysis
What is important?
Molar-
relationship Demand of distalizing upper
Canine molars
Demand of anchoring upper
-relationship Treatment
molars of upper molars
Overjet / Overbite Space required in the upper arch
Need of intruding incisors
Maxillary anterior arch-width
Need of upper arch expansion
Incisor
s
Inclination and position of
uppers
Inclination and position of lowers
Overbite and overjet
SNA- convexity
SNB- angle
ANB- facial-plane
angle
Three categories of skeletal
class II anomalies
Correct a-p position of maxilla:
treatment focus on mandible
Treatment options: class II mechanics /
surgical advancement of the mandible
Inclination of ML
Proclined/protruded incisors:
You need space to correct
incisor postion
Distalization of upper
molars
Anchorage of upper
molars
Sometimes extractions
in the upper arch
Impact of incisor position on
treatment
Overbite:
Meso-facial
Symmetry
Sublabial fold
Treatment of choice?
Cephalometric analysis
Vertical analysis
NL=NSL= 4°
Counter-
clockwise
ML-NSL=23°Counter-
clockwise
ML-NL = 19°Hypo-divergent
Treatment of choice?
Cephalometric analysis
Overjet:
9mm
Overbite:
7,5mm
Facial-axis:
94°
Gonion-angle = 123°
Occlusion/Cast
analysis
Anterior upper arch
width
Molar Canine
relationship relationship
Overjet and
Overbite
Development of
Dentition
Problem - List
Skeletal problems:
Skeletal Class II /1 with orthognatic maxilla
and retrognathic mandible, skeletal deep bite
and counter clockwise growth pattern.
Dental problems:
Esthetic problems:
Treatment of Class II
Treatment planing
Treatment goals?
Skeletal:
Skeletal class I relationship
Improve vertical dimension
Dento-alveolar:
Reducing overjet and overbite
Class I molar and canine relationship
Harmonizing arch width
Levelling and alignment of teeth
Treatment of Class II
Treatment planning
Treatment Goals?
Function:
Improve occlusion
Improve lip-closure
Esthetics:
Improve lip and chin position
Straighten lower facial profile
Treatment of Class II
Treatment Mechanics, removable
Anterior expansion of upper dental
arch , anchorage and derotation of
molars
Treatment of Class II
Treatment Mechanics, removable
Vertical eruption of lateral teeth (bite
opening)
Protraction of the mandible
Bionator
Treatment of Class II
Treatment Mechanics, removable
Plate with expansion hinge screw
Anterior expansion
2. To move teeth
In class II cases
Distalization
Class II, brachy, deep bite Class I, meso, regular Class II, dolicho, open bite
overbite
Cervical pull, long Cervicall pull, long arm Cervical and high pull
arm downward upward traction, short arm
upward
Deep Bite
Do not use: Horizontal (brachyfacial)
growth pattern
Patient with high-pull Headgear and parallel arms
Flaring – out of molars with
high pull Headgear
Strong cutter
Pencil
Indirect Adaptation of Headgear
Impression of Headgear- Fit the inner arch with 5mm distance to
tube on band dental arch
Indirect Adaptation of Headgear
to the outside,
The stepwise
bending guaranties
distance to the
dental arch
Using a headgear
To reactivate Headgear,
use Stops which are welded
on the arch
When bending and wearing a headgear
always consider up- and downside!
Meassure the force you apply
Incisor Segment
Anterior Molarsegment
Bridge
Vertical Step
Posterior Vertical
Step
Prof. Dr. Dr. D. Muessig DPU Krems 113
Utility Arch
Activating Utility Arch:
Tip-back in Molar Segment:
Intruding and Proclining Incisors
Extrusion and Reclination of Molars
Torque =
Moment+Force
M/F >12
Utility
passiv
Tip-
back
Utility activ
α
Tip-
back
Utility activated.
β Ligated to
anterior brackets
Prof. Dr. Dr. D. Müßig Danube
Private University Krems Austria 124
Biomechanics Utility Arch
Buccal – Root – Torque:
Cortical Anchorage of Molar Roots
Reducing Tipping to the Distal
Reducing Extrusion
Needs Expansion of the Archwire
Expansion
3mm each side
Expansion
Toe-in
Tip-back
Toe-in
Smile
Intrusion Force:
2 x 0,35 N = 0,7N
Molares and Central
Incisors
Prof. Dr. Dr. D. Muessig DPU Krems 130
Biomechanics Utility
Arch
Calculating Forces and Moments
Modell 1:
Changing Incisor Angle =
Distance CR to Slot:
Slight asymmetry of
mandible to the right
side
Active mentalis
muscle
G. P. / f
Age: 10,11 Years
Treatment of Class II
Anomalies
Face in profile
Orthoganthic maxilla
Retrognathic mandible
Convex profle
G. P. / f
Age: 10,11 Years
Diagnostics
Treatment of Class II
Is the patient still growing ?
Increase of Bodyhight
Removable
treatment
Second transitional
period
Years
Univ. Prof.Dr.Dr.D. Muessig 135
Overbite?
0,5mm
Overjet?
4mm
Canine/molar
relation?
2-3mm class II
Spacing and bialveolar protrusion
All third molars developing
Your first
impression?
Funktionskieferorthopädie
Cephalometric analysis
Antero-posterior
analysis
Treatment of choice?
Cephalometric analysis
Vertical analysis
NL=NSL= 9°
clockwise
ML-NSL=°35clockwise
ML-NL = 26°Hyper-divergent
Treatment of choice?
Cephalometric analysis
Overjet:
4mm
Overbite:
0,5mm
Facial-axis:
86°
Gonion-angle = 133°
Treatment:
2,2 years removable
functional appliance
Funktionskieferorthopädie
Funktionskieferorthopädie
G. P. / f
Age: 14.04 years
Funktionskieferorthopädie
Funktionskieferorthopädie
Funktionskieferorthopädie
Funktionskieferorthopädie
G. P. /f
Age: 15,05 years
Effect of intensive class II -
mechanics
Lips Gummy- Profile
smile
G. P. / f
Age: 16.04 years
Funktionskieferorthopädie
Funktionskieferorthopädie
Funktionskieferorthopädie
Funktionskieferorthopädie
Funktionskieferorthopädie
After maxillary impaction
G.F./m 18,5
Class II/2
deep overbite missing one 1st lower molar
Very important:
Correcting deep overbite prior to class II
treatment
Late Treatment ClassII/2
Creating overjet
Correcting overbite
Finishing
Funktionskieferorthopädie
Final Profile
Surgical correction of
asymmetric Class II / 2