Management Of Class 2 Malocclusion
Give the causes of class 2 malocclusion. Describe the treatment of a developing distocclusion with a functional appliance.
Or
Define Angle’s Class 2 malocclusion and give its etiology.
Or
Give the etiology of class 2 div. 1.
Give the etiology of class 2 div. 1.
Answer. According to Angle’s classification class 2 malocclusion indicates that the mandibular arch is in a distal relation to that of the maxilla.
Class 2 malocclusion is characterized by a class 2 molar relation where the distobuccal cusp of upper 1st molar occludes in the buccal groove of the lower Ist permanent molar.
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It Can Occur in Two Main Form
- Class 2 div. 1.
- Class 2 div. 2.
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Causes of Class 2 Malocclusion
- Prenatal factors.
- Natal factors.
- Postnatal factors.
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Prenatal Factors
- Hereditary: Skeletal abnormalities like prognathic maxilla or retrognathic mandible due to hereditary cause.
- Teratogenesis: Certain drugs taken during pregnancy lead to abnormal skeletal development.
- Irradiation: Radiation exposure to a pregnant woman causes altered development of dentofacial complex.
- Intrauterine fetal posture: Abnormal fetal posture like hands across the face is found to affect mandibular growth.
Natal Factors
Trauma to the condylar region during forcep delivery leads to firosis or ankylosis of TMJ leading to under development of the mandible.
Postnatal Factors
- Trauma to mandible or TMJ.
- Long-term irradiation therapy of skeletal craniofacial region.
- Infectious conditions like rheumatoid arthritis can affect mandibular growth.
- Abnormal function—oral respiration, abnormal swallowing and habits such as thumb sucking.
Treatment of Developing Distocclusion with Functional Appliances.
Functional appliances are applied in growth modification.
- The abnormal skeletal pattern intercepted by functional appliances is to reduce severity of skeletal relationship.
- Functional appliances are usually applied during mixed or early permanent dentition period prior to the cessation of growth.
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Mandibular Retrognathism
Retrognathic mandible with average FMA angle and lower facial height.
- Activator or FR – 1 is commonly used but bionator, biomodulator, cybernator, propulsor etc. are other functional appliances which are used less commonly.
- Functional appliance acts by placing the mandible in anterior position and also by eliminating the functional retrusion.
Retrognathic mandible with higher FMA angle and lower facial height
- Activator is used along with high pull headgear.
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Maxillary Prognathism
- Growth inhibition of the maxilla for maxillary prognathism, with distalization of upper buccal segments is achieved by using extraoral orthopedic force.
- Headgears are recommended for orthopedic force.
- Patient wears the appliance for around 12–14 hours daily.
- Orthopedic force of 350–450 g/side is applied with the help of headgear.
- High pull or occipital pull headgear is used in case of patients whose maxilla is growing vertically.
- Cervical pull headgear is used for patients whose maxilla is growing horizontally.
- In cases of vertical maxillary excess, maxillary intrusion splints are used.
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Combination of maxillary prognathism and mandibular retrognathism
- Combination of headgear and functional appliances is used for growth modification.
- Most commonly used combination is Activator with headgear.
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