Management Of Class II Malocclusion In Children

What is distoocclusion. Describe the management of distoocclusion of 8–9 years old male child.

Answer. Disto-occlusion is the condition where the mandibular molar is positioned distally in relation to upper molar.

It is also known as class II malocclusion or postnormal occlusion.

Management of Distoocclusion of 8–9 Years Old Male Child

The age of the male child is 8–9 years this indicates that the child is under the growing stage and is in mixed dentition period.
Management plan of the child is divided into skeletal class 2 and dentoalveolar class 2.

Correction of Skeletal Class 2 Malocclusion

Growth modulation is the treatment in patients with skeletal class 2 malocclusion.
Growth modulation is done as:

In Maxillary Prognathism

Distalization of maxillary buccal segment is done by using extraoral orthopedic force.
Orthopedic appliances which apply the orthopedic force are headgears.
Appliance should be worn for 12 to 14 hours a day.
Patients exhibiting vertical growth should undergo therapy by occipital pull headgear.
Patients exhibiting horizontal growth should undergo therapy by cervical pull headgear.
In cases with vertical maxillary excess maxillary intrusion splint is used.

In Mandibular Retrognathism

Retrognathic mandible with average FMA angle and lower facial height.
- Activator or FR – I 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.

In Combination of Prognathic Maxilla and Retrognathic Mandible

Growth modification is carried out by combining headgear and myofunctional appliance.
Most commonly used combination is activator with head gear.

Correction of Dentoalveolar Class 2 Malocclusion

During early correction incisor and molar relationship is established.
Crowding is corrected by space gaining methods such as extractions or distalization of molars.
Deep bite is corrected by anterior bite plate in low angle cases.
By utility arches incisor intrusion is carried out in high angle cases.
Retroclination of incisors is done by fixed appliance mechanotherapy and labial bows.
Posterior crossbite correction is done by crossbite elastics.
If any habit is present it should be corrected.

Retention After Correction in Disto-occlusion

Tweed’s type B retention plan is implicated.

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