SlideShare une entreprise Scribd logo
1  sur  93
PRINCIPLES OF
CLASS II
TREATMENT
www.indiandentalacademy.comwww.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
IntroductionIntroduction
Treatment of class II has a controversialTreatment of class II has a controversial
historyhistory
Americans – head gears and class IIAmericans – head gears and class II
elasticselastics
Europe – popularized – functionalEurope – popularized – functional
appliancesappliances
Surgical options – given new diemensionsSurgical options – given new diemensions
to the treatment of adult class IIto the treatment of adult class II
www.indiandentalacademy.comwww.indiandentalacademy.com
CLASSIFICATION:CLASSIFICATION:
 According to Edward H. AngleAccording to Edward H. Angle
CLASS II
Class II div 1
(distoocclusion with
labioversion of
upper incisors)
Class II div 2
(disto occlusion with
llinguo
version of
maxillary incisors)
Class II div1 subdivision
classII div2 subdivision
www.indiandentalacademy.comwww.indiandentalacademy.com
EXTRA ORAL FEATURESEXTRA ORAL FEATURES
 CONVEX PROFILECONVEX PROFILE
 INCOMPETENT LIPSINCOMPETENT LIPS
 LOWER FACIAL HEIGHT,LOWER FACIAL HEIGHT,
OR AVGOR AVG
 DEEP MENTO LABIALDEEP MENTO LABIAL
SULCUSSULCUS
 ABNORMALABNORMAL
MUSCULATUREMUSCULATURE
• STRAIGHT TO
CONVEX PROFILE
• COMPETENT LIPS
• LOWER FACIAL
HEIGHT -
DECREASED
CLASS II DIV 1 CLASS II DIV 2
www.indiandentalacademy.comwww.indiandentalacademy.com
INTRA ORAL FEATURESINTRA ORAL FEATURES
 TAPERED ARCHTAPERED ARCH
 UPPER ANTERIORSUPPER ANTERIORS
PROCLINEDPROCLINED
 OVER BITE –OVER BITE –
VARIABLEVARIABLE
 INCREASEDINCREASED
OVERJETOVERJET
• SQUARE ARCH
• CENTRALS
RETOCLINED,
LATERALS ARE
PROCLINED
• DEEP OVER BITE
• NORMAL TO MILD
INCREASE IN
OVERJET
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com
Class II, subdivisionClass II, subdivision
 When a class II molar relation exists on oneWhen a class II molar relation exists on one
side and a class I relation on the other, it isside and a class I relation on the other, it is
referred to as class II subdivision.referred to as class II subdivision.
Based on whether it is a division 1 or divisionBased on whether it is a division 1 or division
2 it can be called a class II, division 1,2 it can be called a class II, division 1,
subdivision or a class II, division 2,subdivision or a class II, division 2,
subdivision.subdivision.
www.indiandentalacademy.comwww.indiandentalacademy.com
ETIOLOGY:ETIOLOGY:
It is important to distinguish class II malocclusions thatIt is important to distinguish class II malocclusions that
are primarily of genetic origin from those ofare primarily of genetic origin from those of
primarily environmental when choosing theprimarily environmental when choosing the
appropriate treatment andappropriate treatment and retention.retention.
A.A. Genetic causesGenetic causes:: HERIDITYHERIDITY
B.B. ..Environmental causes:Environmental causes:
1.1.HabitsHabits::
2. Trauma-T M J Ankylosis2. Trauma-T M J Ankylosis
Forceps deliveryForceps delivery
3.Early Exfoliation of primary molars.3.Early Exfoliation of primary molars.
www.indiandentalacademy.comwww.indiandentalacademy.com
4. Retained deciduous molars.4. Retained deciduous molars.
5. Proximal caries.5. Proximal caries.
6. Missing teeth.6. Missing teeth.
7 . Supernumerary teeth7 . Supernumerary teeth
8. Delayed eruption.8. Delayed eruption.
9. Abnormal eruptive path way.9. Abnormal eruptive path way.
10. Improper restorations.10. Improper restorations.
www.indiandentalacademy.comwww.indiandentalacademy.com
TREATMENT PLANTREATMENT PLAN
SKELETAL CLASS II DENTAL CLASS II
MAXILLARY EXCESS
MANDIBULAR
DEFICIENCY
COMBINATION
MAXILLARY MOLARS
MOVED FORWARD
MESIAL IN ROTATION OF
MAXILLARY MOLARS
www.indiandentalacademy.comwww.indiandentalacademy.com
SKELETAL – TREATMENTSKELETAL – TREATMENT
OPTIONSOPTIONS
GROWTH
PRESENT
GROWTH
COMPLETED
PRIMARY DENTITION
MIXED DENTITION
PERMANENT DENTITION
CAMOUFLAGE
SURGICAL
www.indiandentalacademy.comwww.indiandentalacademy.com
PRIMARY DENTITION(3-6Yrs)PRIMARY DENTITION(3-6Yrs)
A.Space maintenance in primary molarA.Space maintenance in primary molar
area.area.
B.Incisor protrusion-Habit breakingB.Incisor protrusion-Habit breaking
appliances are given.appliances are given.
C. Antero posterior discrepancy- A distalC. Antero posterior discrepancy- A distal
step has to be identified at this stage andstep has to be identified at this stage and
growth modification is to be attemptedgrowth modification is to be attempted
only in severe cases as continuing growthonly in severe cases as continuing growth
complicates this problem.complicates this problem.
www.indiandentalacademy.comwww.indiandentalacademy.com
MIXED DENTITIONMIXED DENTITION
MAXILLARY EXCESS
MANDIBULAR
DEFICIENCY
COMBINATION
VERTICAL
HORIZONTAL
AVERAGE
SKELETAL GROWTH PATTERN
www.indiandentalacademy.comwww.indiandentalacademy.com
Maxillary prognathismMaxillary prognathism
Head gears
 The type of head gear is chosen according toThe type of head gear is chosen according to
the growth patternthe growth pattern
 Consists of the face bow, force module and theConsists of the face bow, force module and the
strapstrap
 The strap will differ according to the growthThe strap will differ according to the growth
patternpattern
 The angulation and length of the face bow canThe angulation and length of the face bow can
be changed to achieve the desired moments andbe changed to achieve the desired moments and
force required for a particular clinical situationforce required for a particular clinical situation
www.indiandentalacademy.comwww.indiandentalacademy.com
CERVICAL PULL HEADCERVICAL PULL HEAD
GEARGEAR
 Indicated in patients withIndicated in patients with
decreased verticaldecreased vertical
dimension.dimension.
 Outer bow lies above theOuter bow lies above the
plane of occlusion toplane of occlusion to
direct force throughdirect force through
centre of resistance andcentre of resistance and
prevent distal tipping ofprevent distal tipping of
the molars.the molars.
www.indiandentalacademy.comwww.indiandentalacademy.com
High pull head gearHigh pull head gear
 Indicated in patients with increasedIndicated in patients with increased
vertical dimension.vertical dimension.
 Face bow is anchored to an occipitalFace bow is anchored to an occipital
anchoring unit to produce a verticallyanchoring unit to produce a vertically
directing force.directing force.
 High pull head gear- can redirect theHigh pull head gear- can redirect the
vertical diemension of the maxilla thusvertical diemension of the maxilla thus
allowing the auto rotation of the mandibleallowing the auto rotation of the mandiblewww.indiandentalacademy.comwww.indiandentalacademy.com
Force magnitude for HG:Force magnitude for HG:
Recommended force values per sideRecommended force values per side
Full permanent dentition – 400-600 gmsFull permanent dentition – 400-600 gms
Early mixed dentition – 150-250 gmsEarly mixed dentition – 150-250 gms
Late mixed dentition – 300-400 gmsLate mixed dentition – 300-400 gms
Retention in permanent dentition – 150-Retention in permanent dentition – 150-
400 gms.400 gms. www.indiandentalacademy.comwww.indiandentalacademy.com
Head gear are tooth borne Attached to the molar tube
Intermittent forces
Minimizes tooth movement
Provide skeletal change
Less damaging to the tissue
Due to the rest period
 Duration:Duration: Graber, forces of 12-16 hourGraber, forces of 12-16 hour
durationduration
www.indiandentalacademy.comwww.indiandentalacademy.com
Mandibular deficiencyMandibular deficiency
Functional appliances is the choice ofFunctional appliances is the choice of
treatment for mandibular deficiency intreatment for mandibular deficiency in
growing children.growing children.
Criteria for case selection are:Criteria for case selection are:
 Individuals with growth potentialIndividuals with growth potential
 Retrognathic mandibleRetrognathic mandible
 Deep biteDeep bite
 Low mandibular plane angleLow mandibular plane angle
 Favourable V T OFavourable V T O
 Upright lower incisorUpright lower incisorwww.indiandentalacademy.comwww.indiandentalacademy.com
Mandibular deficiencyMandibular deficiency
Anatomical
retrusion
Functional
retrusion
Functional appliances
Not favourable
Occlusal
prematurities
Surgical option Functional appliance
www.indiandentalacademy.comwww.indiandentalacademy.com
TREATMENT FOR HORIZONTALTREATMENT FOR HORIZONTAL
GROWTH PATTERNGROWTH PATTERN
Short face (skeletal deep bite) class IIShort face (skeletal deep bite) class II
 Obtain differential growth of the jaws such that theObtain differential growth of the jaws such that the
mandible catches up with the maxilla and themandible catches up with the maxilla and the
skeletal problem improves or disappears.skeletal problem improves or disappears.
 Allow more eruption of the lower than the upper teethAllow more eruption of the lower than the upper teeth
so that the occlusal plane rotates up posteriorly, inso that the occlusal plane rotates up posteriorly, in
the direction that facilitates Class II correction, deepthe direction that facilitates Class II correction, deep
bite and increase lower facial heightbite and increase lower facial height
www.indiandentalacademy.comwww.indiandentalacademy.com
Treatment optionsTreatment options
Functional jaw orthopedicsFunctional jaw orthopedics
Functional appliance therapy.Functional appliance therapy.
Cervical headgear tends to open the biteCervical headgear tends to open the bite
anteriorly. It differentially erupts the upperanteriorly. It differentially erupts the upper
rather than the lower molars and does notrather than the lower molars and does not
produce the desired change in orientationproduce the desired change in orientation
of the occlusal plane.of the occlusal plane.
Functional appliances is most useful inFunctional appliances is most useful in
the treatment of short face class IIthe treatment of short face class II
treatmenttreatment www.indiandentalacademy.comwww.indiandentalacademy.com
Class II children with normal facialClass II children with normal facial
height.height.
May have anterior deep bite because ofMay have anterior deep bite because of
excessive eruption of the lower incisors.excessive eruption of the lower incisors.
Current guidelines for treatment are:Current guidelines for treatment are:
 Functional jaw orthopaedics.Functional jaw orthopaedics.
 Functional appliance therapy.Functional appliance therapy.
 Straight-pull headgear is preferred. This reducesStraight-pull headgear is preferred. This reduces
elongation of maxillary molars and better controlelongation of maxillary molars and better control
the inclination of the mandibular planethe inclination of the mandibular planewww.indiandentalacademy.comwww.indiandentalacademy.com
The objective of treatment are:The objective of treatment are:
1.1. Restriction of the forward maxillary growthRestriction of the forward maxillary growth
2.2. Inhibition of the mesial and verticalInhibition of the mesial and vertical
displacement of the maxillary teeth.displacement of the maxillary teeth.
3.3. Improvement of the mandibular horizontalImprovement of the mandibular horizontal
growth.growth.
4.4. Condylar and glenoid fossa remodelling.Condylar and glenoid fossa remodelling.
5.5. Improvement in muscle pattern.Improvement in muscle pattern.
www.indiandentalacademy.comwww.indiandentalacademy.com
Treatment optionsTreatment options
Functional jaw orthopaedicsFunctional jaw orthopaedics
Functional appliance therapy.Functional appliance therapy.
High pull head gear to a maxillary splintHigh pull head gear to a maxillary splint
is used as it controls the eruption of theis used as it controls the eruption of the
teeth.teeth.
Eruption of lower teeth is controlledEruption of lower teeth is controlled
most readily with interocclusal bite blocks.most readily with interocclusal bite blocks.
www.indiandentalacademy.comwww.indiandentalacademy.com
Vertically-directed extraoral force to theVertically-directed extraoral force to the
functional appliance gives better control offunctional appliance gives better control of
maxillary growth, so the most effectivemaxillary growth, so the most effective
treatment is a combination of a functionaltreatment is a combination of a functional
appliance with bite blocks and high-pullappliance with bite blocks and high-pull
headgear.headgear.
www.indiandentalacademy.comwww.indiandentalacademy.com
FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES
““A functional appliance harnesses naturalA functional appliance harnesses natural
forces which it transmits to the teeth andforces which it transmits to the teeth and
alveolar bone in a pre determined direction”.alveolar bone in a pre determined direction”.
(White, Gardiner, Leighton)(White, Gardiner, Leighton)
..
www.indiandentalacademy.comwww.indiandentalacademy.com
FUNCTIONAL APPLIANCES
Removable functional
-preferred during the
early mixed dentition
Fixed functional-
Preferred during the
permanent dentition
www.indiandentalacademy.comwww.indiandentalacademy.com
Long face(skeletal open bite)Long face(skeletal open bite)
 Characterized by excessive anterior facialCharacterized by excessive anterior facial
height.height.
Major diagnostic criteria:Major diagnostic criteria:
 Short mandibular ramus.Short mandibular ramus.
 Rotation of palatal plane down posteriorlyRotation of palatal plane down posteriorly
Typical growth pattern showsTypical growth pattern shows
 Vertical growth of maxilla often posteriorly thanVertical growth of maxilla often posteriorly than
anteriorly.anteriorly.
 Downward-Backward rotation of the mandibleDownward-Backward rotation of the mandible
and an excessive eruption of maxillary andand an excessive eruption of maxillary and
mandibular teeth.mandibular teeth.
www.indiandentalacademy.comwww.indiandentalacademy.com
REMOVABLE FUNCTIONALREMOVABLE FUNCTIONAL
Removable Functional appliancesRemovable Functional appliances
used in the treatment of class IIused in the treatment of class II
malocclusion.malocclusion.
 ACTIVATORACTIVATOR
 BIONATORBIONATOR
 FRANKEL APPLIANCEFRANKEL APPLIANCE
 TWIN BLOCKTWIN BLOCK
 THE MODIFIED BASS APPLIANCETHE MODIFIED BASS APPLIANCE
 MANDIBULAR GROWTH APPLIANCEMANDIBULAR GROWTH APPLIANCE
 MAGNETIC FUNCTIONAL SYSTEMMAGNETIC FUNCTIONAL SYSTEM
www.indiandentalacademy.comwww.indiandentalacademy.com
ACTIVATORACTIVATOR
Introduced by Viggo Andreson in theIntroduced by Viggo Andreson in the
year 1908.year 1908.
www.indiandentalacademy.comwww.indiandentalacademy.com
Mode of action of activator: (Mode of action of activator: ( Aus-Aus-
Ortho-1985-March Graeme. L. Roberts)Ortho-1985-March Graeme. L. Roberts)
 Re-education of musculature.Re-education of musculature.
 Lateral pterygoid muscle stimulationLateral pterygoid muscle stimulation
(LPM).(LPM).
 Unloading of the mandibular condyle.Unloading of the mandibular condyle.
 Transduction of viscoelastic force.Transduction of viscoelastic force.
 Differential eruptions.Differential eruptions.
www.indiandentalacademy.comwww.indiandentalacademy.com
Antero-posterior effects ofAntero-posterior effects of
activator:activator:
 A forward displacement of the lowerA forward displacement of the lower
arch.arch.
 A distal movement of maxillary arch.A distal movement of maxillary arch.
 An inhibition of the forward growth of theAn inhibition of the forward growth of the
maxilla.maxilla.
 A stimulation of condylar growth.A stimulation of condylar growth.
 A remodelling of the mandibular fossa.A remodelling of the mandibular fossa.
 An elimination of interferences.An elimination of interferences.
www.indiandentalacademy.comwww.indiandentalacademy.com
The vertical effects:The vertical effects:
Successful overbite reduction found to beSuccessful overbite reduction found to be
accompanied by:accompanied by:
 Inhibition of lower incisor eruption.Inhibition of lower incisor eruption.
 Facilitation molar eruption.Facilitation molar eruption.
 Encouragement of forward mandibularEncouragement of forward mandibular
rotation.rotation.
 An increase in lower face height.An increase in lower face height.
www.indiandentalacademy.comwww.indiandentalacademy.com
Treatment Effect Of Mandibular ProtrusiveTreatment Effect Of Mandibular Protrusive
Appliance On The Glenoid Fossa For Class IIAppliance On The Glenoid Fossa For Class II
Correction.Correction.
Katsavrias et alKatsavrias et al
-A. O. 2004-A. O. 2004
The glenoid fossa does not change in morphology
radiographically.
Glenoid fossa does not appear radiographically to
contribute positive growth modifications to the class
II correction by active bone modeling.www.indiandentalacademy.comwww.indiandentalacademy.com
Combination Headgear-ActivatorCombination Headgear-Activator
(JCO 1984 DR. HERMAN VAN BE)(JCO 1984 DR. HERMAN VAN BE)
The headgear-activator has the followingThe headgear-activator has the following
modes of action:modes of action:
1. Intrusion and retraction of upper front1. Intrusion and retraction of upper front
teethteeth
2. Distalization of upper molars2. Distalization of upper molars
3. Maxilla retraction3. Maxilla retraction
4. Mandibular growth stimulation,4. Mandibular growth stimulation,
especially in the brachyfacial groupespecially in the brachyfacial group
www.indiandentalacademy.comwww.indiandentalacademy.com
5. Opening of the facial axis in the5. Opening of the facial axis in the
brachyfacial groupbrachyfacial group
6. Maintenance of the facial axis in the6. Maintenance of the facial axis in the
dolichofacial groupdolichofacial group
7. Minor, if any, tilting of lower incisors7. Minor, if any, tilting of lower incisors
8. Stopping lower incisor eruption8. Stopping lower incisor eruption
9. Stopping the descent of the palate9. Stopping the descent of the palate
www.indiandentalacademy.comwww.indiandentalacademy.com
Stability of class II div 1 treatment with the head gear-Stability of class II div 1 treatment with the head gear-
activator combinationactivator combination
Guilherme and associatesGuilherme and associates
A. O. 2004A. O. 2004
Results of their studyResults of their study
 Sagittal position of both the maxilla andSagittal position of both the maxilla and
the mandible was stable in the long term.the mandible was stable in the long term.
 A slight relapse of the maxillo-mandibularA slight relapse of the maxillo-mandibular
relation correction occurred, probablyrelation correction occurred, probably
because the maxilla resumed its normalbecause the maxilla resumed its normal
development and the mandible showed adevelopment and the mandible showed a
growth rate significantly smaller.growth rate significantly smaller.
www.indiandentalacademy.comwww.indiandentalacademy.com
BIONATOR: Introduced byBIONATOR: Introduced by
Baltors in 1960Baltors in 1960
www.indiandentalacademy.comwww.indiandentalacademy.com
PrinciplesPrinciples
The essential part of Balters concept is the roleThe essential part of Balters concept is the role
of theof the tonguetongue..
““The equilibrium between the tongue andThe equilibrium between the tongue and
cheeks, especially between the tongue and lipscheeks, especially between the tongue and lips
in the height, breadth and depth in an oralin the height, breadth and depth in an oral
space of maximum size and optimal limits,space of maximum size and optimal limits,
providing functional space for the tongue ,isproviding functional space for the tongue ,is
essential for the natural health of the dentalessential for the natural health of the dental
arches and their relation to each other”arches and their relation to each other”
www.indiandentalacademy.comwww.indiandentalacademy.com
Aims of RxAims of Rx ::
1.1. Accomplish lip closure and establishAccomplish lip closure and establish
contact b/w back of the tongue and softcontact b/w back of the tongue and soft
palatepalate
2.2. Enlarge oral spaceEnlarge oral space
3.3. Incisors in edge to edgeIncisors in edge to edge
4.4. Elongation of the mandibleElongation of the mandible
5.5. Leading to an improved relationship b/wLeading to an improved relationship b/w
the jaws, tongue, dentition and soft tissuesthe jaws, tongue, dentition and soft tissues
www.indiandentalacademy.comwww.indiandentalacademy.com
Skeletal, Dentoalveolar and Soft tissuesSkeletal, Dentoalveolar and Soft tissues
changes with the standard bionatorchanges with the standard bionator.(Varun.(Varun
Kalra AJO-95)Kalra AJO-95)
Skeletal changes-Skeletal changes-
Mandible-pt.B is moved forwardMandible-pt.B is moved forward
 -length of mandible (Ar-Go) is increased-length of mandible (Ar-Go) is increased
Dentition-Dentition-
Overjet and overbite is decreasedOverjet and overbite is decreased
Soft tissuesSoft tissues--
Facial convexity is decreasedFacial convexity is decreased
Uncurling of the lower lip.Uncurling of the lower lip.www.indiandentalacademy.comwww.indiandentalacademy.com
Changes in soft tissue profile following treatmentChanges in soft tissue profile following treatment
with bionatorwith bionator
A.O. 1995A.O. 1995
 Decreased skeletal convexity;Decreased skeletal convexity;
 Increased anterior and posterior faceIncreased anterior and posterior face
heights;heights;
 Reduced overjet and overbite;Reduced overjet and overbite;
 Decreased facial convexity;Decreased facial convexity;
 Uncurling and increase in length of theUncurling and increase in length of the
lower lip;lower lip;
 Minimal effect on the upper lip.Minimal effect on the upper lip.www.indiandentalacademy.comwww.indiandentalacademy.com
FRANKEL APPLIANCEFRANKEL APPLIANCE
Introduced by FRANKEL in the yearIntroduced by FRANKEL in the year
19661966
PhilosophyPhilosophy
 Vestibular arena of operations.Vestibular arena of operations.
 Sagittal correction via tooth borneSagittal correction via tooth borne
maxillary anchorage.maxillary anchorage.
 Minimal maxillary basal effect.Minimal maxillary basal effect.
 Lip pads, buccal shields and periostealLip pads, buccal shields and periosteal
pull.pull. www.indiandentalacademy.comwww.indiandentalacademy.com
Mechanism of action:Mechanism of action:
This appliance is used as oral gymnasticThis appliance is used as oral gymnastic
appliance to help in overcoming abnormalappliance to help in overcoming abnormal
perioral muscle activity and rehabilitates theperioral muscle activity and rehabilitates the
muscles and to establish proper lip seal.muscles and to establish proper lip seal.
www.indiandentalacademy.comwww.indiandentalacademy.com
TWIN BLOCK:TWIN BLOCK:
 Introduced by William Clark(1977)Introduced by William Clark(1977)
 Mechanism of actionMechanism of action ::
Forces of occlusion are used as functionalForces of occlusion are used as functional
mechanism to correct malocclusion.mechanism to correct malocclusion.
www.indiandentalacademy.comwww.indiandentalacademy.com
MANDIBULAR GROWTH ADVANCERMANDIBULAR GROWTH ADVANCER ::
INTRODUCED BY YOKOTA IN THE YEARINTRODUCED BY YOKOTA IN THE YEAR
1993.1993.
It advances the mandibleIt advances the mandible
progressively with a splint, with theprogressively with a splint, with the
objective of remodelling the condyle andobjective of remodelling the condyle and
the glenoid fossa in the TMJ.the glenoid fossa in the TMJ.
www.indiandentalacademy.comwww.indiandentalacademy.com
Advantage:Advantage:
Since this appliance is simple, it canSince this appliance is simple, it can
be used concomitantly with a fixedbe used concomitantly with a fixed
appliance. Thus tooth irregularity can beappliance. Thus tooth irregularity can be
corrected simultaneously with thecorrected simultaneously with the
correction of the skeletal discrepancy.correction of the skeletal discrepancy.
www.indiandentalacademy.comwww.indiandentalacademy.com
Permanent dentitionPermanent dentition
FFA comes to play in adolescent.FFA comes to play in adolescent.
A complete FFA cannot be used in theA complete FFA cannot be used in the
mixed dentition period.mixed dentition period.
In permanent dentition, there is no reasonIn permanent dentition, there is no reason
to delay aligning the teeth , and a growthto delay aligning the teeth , and a growth
modification that makes this difficult ormodification that makes this difficult or
impossible is s disadvantage.impossible is s disadvantage.
www.indiandentalacademy.comwww.indiandentalacademy.com
Growth modification with FIXEDGrowth modification with FIXED
functional appliancesfunctional appliances
In adolescent, often a fixed functionalIn adolescent, often a fixed functional
appliance that allows brackets on the incisorappliance that allows brackets on the incisor
teeth is the best choice.teeth is the best choice.
Fixed functional appliances can be classified asFixed functional appliances can be classified as
eithereither
 Flexible (Flexible Fixed Functional Appliance)Flexible (Flexible Fixed Functional Appliance)
 Rigid (Rigid Fixed Functional Appliance -Rigid (Rigid Fixed Functional Appliance -
RFFA).RFFA).
 HYBRID APPLAINCESHYBRID APPLAINCES
www.indiandentalacademy.comwww.indiandentalacademy.com
Flexible fixed functional appliancesFlexible fixed functional appliances
 Jasper JumperJasper Jumper
 Amoric torsion coilsAmoric torsion coils
 Adjustable bite correctorAdjustable bite corrector
 Scandee tubular jumper.Scandee tubular jumper.
 Klapper super spring IIKlapper super spring II
 Bite fixerBite fixer
 Churro jumperChurro jumper
www.indiandentalacademy.comwww.indiandentalacademy.com
JASPER JUMPERJASPER JUMPER
Advantages:
1.Ease of insertion
and activation.
2.Generation of the
intrusive forces on
molars and incisors
Introduced by
J.J. Jasper
1980
www.indiandentalacademy.comwww.indiandentalacademy.com
Disadvantages include:Disadvantages include:
 Large inventory five sizes of left and right.Large inventory five sizes of left and right.
Breakage and a lack of force when theBreakage and a lack of force when the
mouth is held open slightly.mouth is held open slightly.
www.indiandentalacademy.comwww.indiandentalacademy.com
THE AMORIC TORSION COILSTHE AMORIC TORSION COILS
Introduced by AMORIC. M IN 1994Introduced by AMORIC. M IN 1994
www.indiandentalacademy.comwww.indiandentalacademy.com
ADJUSTABLE BITEADJUSTABLE BITE
CORRECTORCORRECTOR
Introduced by RICHARD P. WEST 1995Introduced by RICHARD P. WEST 1995
This is an appliance which is assembledThis is an appliance which is assembled
by the orthodontist as it is composed ofby the orthodontist as it is composed of
various pieces – caps, closed coil springs,various pieces – caps, closed coil springs,
nickel titanium wire.nickel titanium wire.
www.indiandentalacademy.comwww.indiandentalacademy.com
SCANDEE TUBULAR JUMPERSCANDEE TUBULAR JUMPER
 (Saga Dental AS, 2201 Kongsvinger, Norway).(Saga Dental AS, 2201 Kongsvinger, Norway).
www.indiandentalacademy.comwww.indiandentalacademy.com
Klapper SUPER Spring IIKlapper SUPER Spring II
 Introduced by Lewis Klapper, 1999Introduced by Lewis Klapper, 1999
 The SUPER spring II has proven to be excellentThe SUPER spring II has proven to be excellent
for TMD patients who require orthodonticfor TMD patients who require orthodontic
treatment after splint therapytreatment after splint therapy..
www.indiandentalacademy.comwww.indiandentalacademy.com
BITE FIXERBITE FIXER
(Ormco 1717 West Collins Avenue, Orange,(Ormco 1717 West Collins Avenue, Orange,
CA 92867)CA 92867)
This is a new inter maxillary spring coil.This is a new inter maxillary spring coil.
The spring is attached and crimped to theThe spring is attached and crimped to the
end fitting to prevent breakage betweenend fitting to prevent breakage between
the spring and the end fitting.the spring and the end fitting.
Polyurethane tubing is inside the spring toPolyurethane tubing is inside the spring to
prevent it from becoming a food trap .prevent it from becoming a food trap .
www.indiandentalacademy.comwww.indiandentalacademy.com
CHURRO JUMPERCHURRO JUMPER
Introduced by Castañon R. et al., 1998Introduced by Castañon R. et al., 1998
www.indiandentalacademy.comwww.indiandentalacademy.com
Rigid Fixed Functional Appliances.Rigid Fixed Functional Appliances.
1.Herbst appliance1.Herbst appliance
2. Cantilever bite jumper2. Cantilever bite jumper
3. Malu herbst appliance3. Malu herbst appliance
4.Flip lock herbst appliance4.Flip lock herbst appliance
5. The ventral telescope5. The ventral telescope
6. The magnetic telescopic6. The magnetic telescopic
www.indiandentalacademy.comwww.indiandentalacademy.com
7. The mandibular protraction appliance7. The mandibular protraction appliance
8The universal bite jumper8The universal bite jumper
9.The biopedic appliance9.The biopedic appliance
10. Mandibular anterior repositiong10. Mandibular anterior repositiong
applianceappliance
11. RITTO appliance11. RITTO appliance
12.SABBAGH UNIVERSAL spring12.SABBAGH UNIVERSAL spring
www.indiandentalacademy.comwww.indiandentalacademy.com
THE HERBST APPLIANCETHE HERBST APPLIANCE
Introduced by Emil Herbst in the year 1907
Popularized by PANCHERZ
Mechanics: Bilateral
telescopic mechanism
advancing the mandible
into a new position
www.indiandentalacademy.comwww.indiandentalacademy.com
HERBST APPLIANCEHERBST APPLIANCE
TREATMENT EFFECTS OF HERBSTTREATMENT EFFECTS OF HERBST
DENTAL CHANGESDENTAL CHANGES
The mandibular teeth are moved anteriorlyThe mandibular teeth are moved anteriorly
Mandibular incisors are proclinedMandibular incisors are proclined
Maxillary teeth are moved posteriorlyMaxillary teeth are moved posteriorly
Maxillary teeth are distalized as well asMaxillary teeth are distalized as well as
intrudedintruded
www.indiandentalacademy.comwww.indiandentalacademy.com
THE VENTRAL TELESCOPETHE VENTRAL TELESCOPE
 This was the first telescopic RFFA that appeared as aThis was the first telescopic RFFA that appeared as a
single unit; i.e. upon reaching maximum opening it doessingle unit; i.e. upon reaching maximum opening it does
not come apart .not come apart .
 Its disadvantages lie in the fact that it is quite thick andIts disadvantages lie in the fact that it is quite thick and
suffers from fractures to the brake which stabilizes thesuffers from fractures to the brake which stabilizes the
joint. As with the other appliances where fixing isjoint. As with the other appliances where fixing is
achieved through ball attachments, great accuracy isachieved through ball attachments, great accuracy is
necessary with regard to inclination and the welding ofnecessary with regard to inclination and the welding of
components.components.
www.indiandentalacademy.comwww.indiandentalacademy.com
THE MAGNETIC TELESCOPICTHE MAGNETIC TELESCOPIC
DEVICEDEVICE
This appliance has the advantage ofThis appliance has the advantage of
linking a magnetic field to the functionallinking a magnetic field to the functional
appliance. Its main disadvantages are itsappliance. Its main disadvantages are its
thickness, the laboratory work necessarythickness, the laboratory work necessary
to prepare it and the covering of theto prepare it and the covering of the
magnets.magnets.
www.indiandentalacademy.comwww.indiandentalacademy.com
THE UNIVERSAL BITETHE UNIVERSAL BITE
JUMPER(UBJ)JUMPER(UBJ) (Calvez X., 1998).(Calvez X., 1998).
 This is like a Herbst but is smaller in size andThis is like a Herbst but is smaller in size and
more versatile – it can be used in all phases ofmore versatile – it can be used in all phases of
treatment in mixed or permanent dentition, Classtreatment in mixed or permanent dentition, Class
II or III malocclusions.II or III malocclusions.
 UBJs with nickel titanium coil springs do notUBJs with nickel titanium coil springs do not
need to be reactivatedneed to be reactivated
www.indiandentalacademy.comwww.indiandentalacademy.com
THE BIOPEDIC APPLIANCETHE BIOPEDIC APPLIANCE
Designed by Jay Collins in 1997Designed by Jay Collins in 1997
www.indiandentalacademy.comwww.indiandentalacademy.com
The Mandibular AnteriorThe Mandibular Anterior
Repositioning Appliance (MARARepositioning Appliance (MARA
Introduced by Douglas Toll of Germany inIntroduced by Douglas Toll of Germany in
1991.1991.
Mechanics: Bilateral
cams fitted to molar
stainless steel crowns
to advance mandible
www.indiandentalacademy.comwww.indiandentalacademy.com
SABBAGH UNIVERSAL SPRINGSABBAGH UNIVERSAL SPRING
Is ideal for treating patients withIs ideal for treating patients with
 Insufficient cooperationInsufficient cooperation
 Late cases with little remainingLate cases with little remaining
growthgrowth
 Illnesses of the upper respiratoryIllnesses of the upper respiratory
tract system, such as asthmatract system, such as asthma
 Patients who are allergic to plasticsPatients who are allergic to plastics
www.indiandentalacademy.comwww.indiandentalacademy.com
RITTO APPLIANCERITTO APPLIANCE
The Ritto Appliance can be described as aThe Ritto Appliance can be described as a
miniaturized telescopic device withminiaturized telescopic device with
simplified intra oral application andsimplified intra oral application and
activation The construction of thisactivation The construction of this
appliance is based on the mechanism andappliance is based on the mechanism and
function used in the Ventral Telescopefunction used in the Ventral Telescope
adapted for use in conjunction with a fixedadapted for use in conjunction with a fixed
applianceappliance
www.indiandentalacademy.comwww.indiandentalacademy.com
HYBRID APPLIANCESHYBRID APPLIANCES
 The calibrated force module.The calibrated force module.
 Eureka spring.Eureka spring.
 The twin force bite corrector.The twin force bite corrector.
 FORSUS Nitinol flat spring.FORSUS Nitinol flat spring.
www.indiandentalacademy.comwww.indiandentalacademy.com
THE CALIBRATED FORCETHE CALIBRATED FORCE
MODULEMODULE
 It was a fixed appliance designed to substituteIt was a fixed appliance designed to substitute
Class II elastics and it was developed in 1988Class II elastics and it was developed in 1988
by the CorMar Inc.by the CorMar Inc.
 Its coil spring produced a force of 150 gmsIts coil spring produced a force of 150 gms
www.indiandentalacademy.comwww.indiandentalacademy.com
EUREKA SPRINGEUREKA SPRING
This appliance appeared on the marketThis appliance appeared on the market
in 1996 and it was developed byin 1996 and it was developed by
DeVicenzo and Steve Prins .DeVicenzo and Steve Prins .
Mechanics:
Telescopic rods
with integral
light force
compression
springs.
www.indiandentalacademy.comwww.indiandentalacademy.com
FORSUS NITINOL FLATFORSUS NITINOL FLAT
SPRINGSPRING
The Forsus Nitinol Flat Spring is slim,The Forsus Nitinol Flat Spring is slim,
flat and made of Super-Elastic Nitinol.flat and made of Super-Elastic Nitinol.
Nitinol is always at work, deliveringNitinol is always at work, delivering
consistent forces. Force levels remainconsistent forces. Force levels remain
constant from the initial setup to theconstant from the initial setup to the
time of removal.time of removal.
www.indiandentalacademy.comwww.indiandentalacademy.com
ALPERN CLASS II CLOSERSALPERN CLASS II CLOSERS
It consists of a small telescopic applianceIt consists of a small telescopic appliance
with an interior coil spring and two hookswith an interior coil spring and two hooks
for fixing .for fixing .
It functions in the same way as elasticsIt functions in the same way as elastics
and, similarly, is fixed to the lower molarand, similarly, is fixed to the lower molar
and to the upper cuspid.and to the upper cuspid.
www.indiandentalacademy.comwww.indiandentalacademy.com
DENTAL CLASS II – TREATMENTDENTAL CLASS II – TREATMENT
OPTIONSOPTIONS
MAXILLARY MOLARS
MOVED FORWARD
MESIAL IN ROTATION
OF THE MAXILLARY
MOLARS
www.indiandentalacademy.comwww.indiandentalacademy.com
MAXILLARY MOLARS MOVEDMAXILLARY MOLARS MOVED
FORWARDFORWARD
GOOD FACIAL
PROFILE
POOR FACIAL
PROFILE
MOLAR
DISTALIZATION
EXTRACTION
PROXIMAL
STRIPPING
14, 24, 35, 45 AND
FINISH THE CASE IN CLASS I
14, 24, AND
FINISH THE CASE IN CLASS II
www.indiandentalacademy.comwww.indiandentalacademy.com
A number of appliances have beenA number of appliances have been
introduced for molar distalisation.introduced for molar distalisation.
CLASSIFICATIONCLASSIFICATION
EXTRA ORALEXTRA ORAL
Head gears--- a. cervicalHead gears--- a. cervical
b. occipitalb. occipital
INTRA ORALINTRA ORAL
RemovableRemovable
Fixed------------- Buccally actingFixed------------- Buccally acting
Palatally actingPalatally acting
www.indiandentalacademy.comwww.indiandentalacademy.com
Buccally actingBuccally acting
Super elastic Niti.Super elastic Niti.
Niti coil spring.Niti coil spring.
Jones Jig.Jones Jig.
Lokars Appliance.Lokars Appliance.
Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance.
www.indiandentalacademy.comwww.indiandentalacademy.com
Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance.
K loop distaliser.K loop distaliser.
Magnets.Magnets.
C space regainer.C space regainer.
Molar distalisation splint.Molar distalisation splint.
CARIERE distaliserCARIERE distaliserwww.indiandentalacademy.comwww.indiandentalacademy.com
Palatally actingPalatally acting
 Distal jet applianceDistal jet appliance
 Cricket applianceCricket appliance
 Nance applianceNance appliance
 Pendulum appliance and its modificationPendulum appliance and its modification
 Simple molar distaliserSimple molar distaliser
 Intra oral bodily distalising applianceIntra oral bodily distalising appliance
www.indiandentalacademy.comwww.indiandentalacademy.com
MESIAL IN ROTATIONMESIAL IN ROTATION
Often, in a class II malocclusion,Often, in a class II malocclusion,
the maxillary first molars are rotatedthe maxillary first molars are rotated
mesiolingually. Correcting this rotationmesiolingually. Correcting this rotation
moves the buccal cusps posteriorly andmoves the buccal cusps posteriorly and
provides at least a small space mesial toprovides at least a small space mesial to
the molars.the molars.
Cetlin, JCO, 1988
www.indiandentalacademy.comwww.indiandentalacademy.com
Treatment plan – molar rotationTreatment plan – molar rotation
Transpalatal archTranspalatal arch
Tip back bendTip back bend
Nance palatal archNance palatal arch
Head gearHead gear
Couple forceCouple force
www.indiandentalacademy.comwww.indiandentalacademy.com
GROWTH COMPLETEDGROWTH COMPLETED
CAMOUFLAGE SURGICAL
www.indiandentalacademy.comwww.indiandentalacademy.com
CAMOUFLAGE TREATMENTCAMOUFLAGE TREATMENT
Beyond the adolescent growthBeyond the adolescent growth
spurt to correct a skeletal problem teethspurt to correct a skeletal problem teeth
should be displaced relative to theirshould be displaced relative to their
supporting bone to compensate for thesupporting bone to compensate for the
underlying jaw discrepacy. This is termedunderlying jaw discrepacy. This is termed
camouflage treatment.camouflage treatment.
www.indiandentalacademy.comwww.indiandentalacademy.com
Indications for class II camouflage treatment:Indications for class II camouflage treatment:
 Too old for successful growth modification.Too old for successful growth modification.
 Mild to moderate skeltal class II.Mild to moderate skeltal class II.
 Reasonably good alignment of teeth.Reasonably good alignment of teeth.
 Good vertical facial propotionsGood vertical facial propotions
www.indiandentalacademy.comwww.indiandentalacademy.com
Extractions in class II:Extractions in class II:
 Extraction of upper first bicuspids only withExtraction of upper first bicuspids only with
lower non extractionlower non extraction
 Extraction of upper first bicuspids andExtraction of upper first bicuspids and
lower second bicuspidslower second bicuspids
 Extraction of upper and lower bicuspids inExtraction of upper and lower bicuspids in
cases with severe lower crowdingcases with severe lower crowding
 Distalization of molars with second molarDistalization of molars with second molar
extraction.extraction.
www.indiandentalacademy.comwww.indiandentalacademy.com
SURGICAL TREATMENTSURGICAL TREATMENT
SURGICAL
POST SURGICAL
PRESURGICAL
www.indiandentalacademy.comwww.indiandentalacademy.com
PRESURGICALPRESURGICAL
 TO REMOVE THE DENTAL COMPENSATIONSTO REMOVE THE DENTAL COMPENSATIONS
THAT HAVE OCCURRED TO MASK THETHAT HAVE OCCURRED TO MASK THE
SKELETAL MALOCCLUSION AND TOSKELETAL MALOCCLUSION AND TO
FACILITATE THE SURGICAL PROCEDUREFACILITATE THE SURGICAL PROCEDURE
 EXTRACTION PATTERN FOLLOWEDEXTRACTION PATTERN FOLLOWED
ACCORDING TO THE CLINICAL SITUATIONACCORDING TO THE CLINICAL SITUATION
 TO CORRECT THE AXIAL INCLINATION OF THETO CORRECT THE AXIAL INCLINATION OF THE
ANTERIORSANTERIORS
 TO BRING THE MOLARS TO FULL CUSP CLASSTO BRING THE MOLARS TO FULL CUSP CLASS
IIII
 TO CREATE SUFFICENT OVERJETTO CREATE SUFFICENT OVERJET
 –– 15, 25 AND 34 AND 4415, 25 AND 34 AND 44www.indiandentalacademy.comwww.indiandentalacademy.com
SURGICAL PROCEDURES:SURGICAL PROCEDURES:
In case of,In case of,
 Maxillary excess- Le Fort I OsteotomyMaxillary excess- Le Fort I Osteotomy
 Mandibular deficiency- Saggital splitMandibular deficiency- Saggital split
osteotomyosteotomy
 Deficient chin- Advancement genioplasty.Deficient chin- Advancement genioplasty.
www.indiandentalacademy.comwww.indiandentalacademy.com
POST SUGICALPOST SUGICAL
ORTHODONTICSORTHODONTICS
Can be initiated 3 to 4 weeks afterCan be initiated 3 to 4 weeks after
the release of immobilization. Stabilizationthe release of immobilization. Stabilization
arch wires are removed and replaced byarch wires are removed and replaced by
working arch wires with light vertical forcesworking arch wires with light vertical forces
till a good stable occlusion is achieved.till a good stable occlusion is achieved.
www.indiandentalacademy.comwww.indiandentalacademy.com
CONCLUSIONCONCLUSION
WITH SUCH A WIDE RANGE OFWITH SUCH A WIDE RANGE OF
TREATMENT MODALITIES ANDTREATMENT MODALITIES AND
APPLIANCES LISTED OUT FOR CLASSAPPLIANCES LISTED OUT FOR CLASS
II MALOCCLUSION, IT IS AT THEII MALOCCLUSION, IT IS AT THE
HANDS OF A SKILLEDHANDS OF A SKILLED
ORTHODONTIST TO APPROPRIATELYORTHODONTIST TO APPROPRIATELY
TIME AND CHOOSE THE RIGHTTIME AND CHOOSE THE RIGHT
TREATMENT ACCORDING TO THETREATMENT ACCORDING TO THE
INDIVIDUAL PATIENT NEEDS.INDIVIDUAL PATIENT NEEDS.
www.indiandentalacademy.comwww.indiandentalacademy.com
THANK
YOU
www.indiandentalacademy.comwww.indiandentalacademy.com
For more details please visitFor more details please visit
www.indiandentalacademy.comwww.indiandentalacademy.com

Contenu connexe

Tendances

Management of skeletal discrepancies
Management of skeletal discrepanciesManagement of skeletal discrepancies
Management of skeletal discrepanciesIndian dental academy
 
finishing and detailing in orthodontics
finishing and detailing in orthodonticsfinishing and detailing in orthodontics
finishing and detailing in orthodonticsJasmine Arneja
 
Functional & ceph analysis for functional appliance /certified fixed ortho...
Functional & ceph analysis for functional appliance    /certified fixed ortho...Functional & ceph analysis for functional appliance    /certified fixed ortho...
Functional & ceph analysis for functional appliance /certified fixed ortho...Indian dental academy
 
Development of contemporary fixed appliance /certified fixed orthodontic cour...
Development of contemporary fixed appliance /certified fixed orthodontic cour...Development of contemporary fixed appliance /certified fixed orthodontic cour...
Development of contemporary fixed appliance /certified fixed orthodontic cour...Indian dental academy
 
Intrusion mechanics
Intrusion mechanics Intrusion mechanics
Intrusion mechanics Tony Pious
 
hygenic rapid maxillary expansion in orthodontics
hygenic rapid maxillary expansion in orthodonticshygenic rapid maxillary expansion in orthodontics
hygenic rapid maxillary expansion in orthodonticsDhanyabhiram Chowdary
 
Comparison of The Roth prescription,Alexander prescription & MBT prescription...
Comparison of The Roth prescription,Alexander prescription & MBT prescription...Comparison of The Roth prescription,Alexander prescription & MBT prescription...
Comparison of The Roth prescription,Alexander prescription & MBT prescription...Indian dental academy
 
Anchorage in orthodontics
Anchorage in orthodontics Anchorage in orthodontics
Anchorage in orthodontics Anu Yaragani
 
orthodontic finishing and retention
 orthodontic finishing and retention orthodontic finishing and retention
orthodontic finishing and retentionIndian dental academy
 
Biomechanical principles of orthodontics /certified fixed orthodontic courses...
Biomechanical principles of orthodontics /certified fixed orthodontic courses...Biomechanical principles of orthodontics /certified fixed orthodontic courses...
Biomechanical principles of orthodontics /certified fixed orthodontic courses...Indian dental academy
 
Part one the royal london space planning
Part one the royal london space planningPart one the royal london space planning
Part one the royal london space planningMohanad Elsherif
 
Tongue and its importance in orthodontic treatment /certified fixed orthodont...
Tongue and its importance in orthodontic treatment /certified fixed orthodont...Tongue and its importance in orthodontic treatment /certified fixed orthodont...
Tongue and its importance in orthodontic treatment /certified fixed orthodont...Indian dental academy
 
Roth philosophy /certified fixed orthodontic courses by Indian dental academy
Roth philosophy /certified fixed orthodontic courses by Indian dental academy Roth philosophy /certified fixed orthodontic courses by Indian dental academy
Roth philosophy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
 

Tendances (20)

Management of skeletal discrepancies
Management of skeletal discrepanciesManagement of skeletal discrepancies
Management of skeletal discrepancies
 
finishing and detailing in orthodontics
finishing and detailing in orthodonticsfinishing and detailing in orthodontics
finishing and detailing in orthodontics
 
Molar distalization
Molar distalization   Molar distalization
Molar distalization
 
18 - versus & 22 - slot
18 - versus & 22 - slot18 - versus & 22 - slot
18 - versus & 22 - slot
 
Types of torqueing auxiliary
Types of torqueing auxiliaryTypes of torqueing auxiliary
Types of torqueing auxiliary
 
Functional & ceph analysis for functional appliance /certified fixed ortho...
Functional & ceph analysis for functional appliance    /certified fixed ortho...Functional & ceph analysis for functional appliance    /certified fixed ortho...
Functional & ceph analysis for functional appliance /certified fixed ortho...
 
Development of contemporary fixed appliance /certified fixed orthodontic cour...
Development of contemporary fixed appliance /certified fixed orthodontic cour...Development of contemporary fixed appliance /certified fixed orthodontic cour...
Development of contemporary fixed appliance /certified fixed orthodontic cour...
 
Intrusion mechanics
Intrusion mechanics Intrusion mechanics
Intrusion mechanics
 
hygenic rapid maxillary expansion in orthodontics
hygenic rapid maxillary expansion in orthodonticshygenic rapid maxillary expansion in orthodontics
hygenic rapid maxillary expansion in orthodontics
 
Comparison of The Roth prescription,Alexander prescription & MBT prescription...
Comparison of The Roth prescription,Alexander prescription & MBT prescription...Comparison of The Roth prescription,Alexander prescription & MBT prescription...
Comparison of The Roth prescription,Alexander prescription & MBT prescription...
 
Anchorage in orthodontics
Anchorage in orthodontics Anchorage in orthodontics
Anchorage in orthodontics
 
orthodontic finishing and retention
 orthodontic finishing and retention orthodontic finishing and retention
orthodontic finishing and retention
 
Biomechanical principles of orthodontics /certified fixed orthodontic courses...
Biomechanical principles of orthodontics /certified fixed orthodontic courses...Biomechanical principles of orthodontics /certified fixed orthodontic courses...
Biomechanical principles of orthodontics /certified fixed orthodontic courses...
 
Part one the royal london space planning
Part one the royal london space planningPart one the royal london space planning
Part one the royal london space planning
 
Opus loop
Opus loopOpus loop
Opus loop
 
Tongue and its importance in orthodontic treatment /certified fixed orthodont...
Tongue and its importance in orthodontic treatment /certified fixed orthodont...Tongue and its importance in orthodontic treatment /certified fixed orthodont...
Tongue and its importance in orthodontic treatment /certified fixed orthodont...
 
Bends
BendsBends
Bends
 
Tweed philosophy
Tweed philosophyTweed philosophy
Tweed philosophy
 
Roth philosophy /certified fixed orthodontic courses by Indian dental academy
Roth philosophy /certified fixed orthodontic courses by Indian dental academy Roth philosophy /certified fixed orthodontic courses by Indian dental academy
Roth philosophy /certified fixed orthodontic courses by Indian dental academy
 
Bite jumpers
Bite jumpersBite jumpers
Bite jumpers
 

En vedette

Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Indian dental academy
 
Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Indian dental academy
 
Fixed functional appliances dds
Fixed functional appliances ddsFixed functional appliances dds
Fixed functional appliances ddsNeha Singh
 
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...Fixed functional appliances / /certified fixed orthodontic courses by Indian ...
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...Indian dental academy
 
Fixed functional appliances/dental courses
Fixed functional appliances/dental coursesFixed functional appliances/dental courses
Fixed functional appliances/dental coursesIndian dental academy
 
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...Fixed functional appliiances /certified fixed orthodontic courses by Indian d...
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...Indian dental academy
 
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...Biomechanics of fixed functional appliances /certified fixed orthodontic cour...
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...Indian dental academy
 
Fixed functional appliances /certified fixed orthodontic courses by Indian de...
Fixed functional appliances /certified fixed orthodontic courses by Indian de...Fixed functional appliances /certified fixed orthodontic courses by Indian de...
Fixed functional appliances /certified fixed orthodontic courses by Indian de...Indian dental academy
 
Functional appliances
Functional appliancesFunctional appliances
Functional applianceshanadentcare
 
Functional Appliances
Functional AppliancesFunctional Appliances
Functional Appliancesshabeel pn
 
Recent advancements in fixed functional appliances /certified fixed orthodont...
Recent advancements in fixed functional appliances /certified fixed orthodont...Recent advancements in fixed functional appliances /certified fixed orthodont...
Recent advancements in fixed functional appliances /certified fixed orthodont...Indian dental academy
 
Part II-Management of class ii malocclusion with speed appliance part ii
Part II-Management of class ii malocclusion with speed appliance part iiPart II-Management of class ii malocclusion with speed appliance part ii
Part II-Management of class ii malocclusion with speed appliance part iiDr Sylvain Chamberland
 
Fixed functional appliances
Fixed functional appliancesFixed functional appliances
Fixed functional appliancesRakhi Bharat
 

En vedette (20)

Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...
 
Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...Fixed functional appliance /certified fixed orthodontic courses by Indian den...
Fixed functional appliance /certified fixed orthodontic courses by Indian den...
 
Fixed functional appliances dds
Fixed functional appliances ddsFixed functional appliances dds
Fixed functional appliances dds
 
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...Fixed functional appliances / /certified fixed orthodontic courses by Indian ...
Fixed functional appliances / /certified fixed orthodontic courses by Indian ...
 
Fixed functional appliances/dental courses
Fixed functional appliances/dental coursesFixed functional appliances/dental courses
Fixed functional appliances/dental courses
 
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...Fixed functional appliiances /certified fixed orthodontic courses by Indian d...
Fixed functional appliiances /certified fixed orthodontic courses by Indian d...
 
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...Biomechanics of fixed functional appliances /certified fixed orthodontic cour...
Biomechanics of fixed functional appliances /certified fixed orthodontic cour...
 
Fixed functional appliances /certified fixed orthodontic courses by Indian de...
Fixed functional appliances /certified fixed orthodontic courses by Indian de...Fixed functional appliances /certified fixed orthodontic courses by Indian de...
Fixed functional appliances /certified fixed orthodontic courses by Indian de...
 
Functional appliances
Functional appliancesFunctional appliances
Functional appliances
 
Functional Appliances
Functional AppliancesFunctional Appliances
Functional Appliances
 
Presentation1 (2)
Presentation1 (2)Presentation1 (2)
Presentation1 (2)
 
Fixed functional appliance
Fixed functional applianceFixed functional appliance
Fixed functional appliance
 
Biomechanics of hg copy
Biomechanics of hg   copyBiomechanics of hg   copy
Biomechanics of hg copy
 
Fixed functional appliances
Fixed functional appliancesFixed functional appliances
Fixed functional appliances
 
Recent advancements in fixed functional appliances /certified fixed orthodont...
Recent advancements in fixed functional appliances /certified fixed orthodont...Recent advancements in fixed functional appliances /certified fixed orthodont...
Recent advancements in fixed functional appliances /certified fixed orthodont...
 
Evolution of functional appliances
Evolution of functional appliancesEvolution of functional appliances
Evolution of functional appliances
 
Part II-Management of class ii malocclusion with speed appliance part ii
Part II-Management of class ii malocclusion with speed appliance part iiPart II-Management of class ii malocclusion with speed appliance part ii
Part II-Management of class ii malocclusion with speed appliance part ii
 
V bend principle
V bend principleV bend principle
V bend principle
 
ORTODONCIA: expansion clase I
ORTODONCIA:  expansion clase IORTODONCIA:  expansion clase I
ORTODONCIA: expansion clase I
 
Fixed functional appliances
Fixed functional appliancesFixed functional appliances
Fixed functional appliances
 

Similaire à Principles of class ii treatment /certified fixed orthodontic courses by Indian dental academy

Prosthodontic rehabilitation of the mandibulectomy patient
Prosthodontic rehabilitation of the mandibulectomy patientProsthodontic rehabilitation of the mandibulectomy patient
Prosthodontic rehabilitation of the mandibulectomy patientIndian dental academy
 
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic courses
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic coursesProsthodontic rehabilitation of the mandibulectomy patient/endodontic courses
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic coursesIndian dental academy
 
An overview of class 2 & class 3 treatment plan
An overview of class 2 & class 3 treatment planAn overview of class 2 & class 3 treatment plan
An overview of class 2 & class 3 treatment planIndian dental academy
 
Various functional appliances & its components /certified fixed orthodontic c...
Various functional appliances & its components /certified fixed orthodontic c...Various functional appliances & its components /certified fixed orthodontic c...
Various functional appliances & its components /certified fixed orthodontic c...Indian dental academy
 
Management of class2.div2 /certified fixed orthodontic courses by Indian de...
Management of class2.div2   /certified fixed orthodontic courses by Indian de...Management of class2.div2   /certified fixed orthodontic courses by Indian de...
Management of class2.div2 /certified fixed orthodontic courses by Indian de...Indian dental academy
 
Initial intrusion of the molars in the treatment
Initial intrusion of the molars in the treatmentInitial intrusion of the molars in the treatment
Initial intrusion of the molars in the treatmentIndian dental academy
 
Twin block 2/ dental crown & bridge courses
Twin block 2/ dental crown & bridge coursesTwin block 2/ dental crown & bridge courses
Twin block 2/ dental crown & bridge coursesIndian dental academy
 
Twin block 2/cosmetic dentistry courses
Twin block 2/cosmetic dentistry coursesTwin block 2/cosmetic dentistry courses
Twin block 2/cosmetic dentistry coursesIndian dental academy
 
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...Indian dental academy
 
Management of class-2 division-2 malocclusion
Management of class-2 division-2 malocclusionManagement of class-2 division-2 malocclusion
Management of class-2 division-2 malocclusionIndian dental academy
 
Angles Class2. div2 malocclusion management
Angles Class2. div2 malocclusion managementAngles Class2. div2 malocclusion management
Angles Class2. div2 malocclusion managementIndian dental academy
 

Similaire à Principles of class ii treatment /certified fixed orthodontic courses by Indian dental academy (20)

Treatment of Class 2 malocclusion
Treatment of Class 2 malocclusionTreatment of Class 2 malocclusion
Treatment of Class 2 malocclusion
 
Prosthodontic rehabilitation of the mandibulectomy patient
Prosthodontic rehabilitation of the mandibulectomy patientProsthodontic rehabilitation of the mandibulectomy patient
Prosthodontic rehabilitation of the mandibulectomy patient
 
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic courses
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic coursesProsthodontic rehabilitation of the mandibulectomy patient/endodontic courses
Prosthodontic rehabilitation of the mandibulectomy patient/endodontic courses
 
An overview of class 2 & class 3 treatment plan
An overview of class 2 & class 3 treatment planAn overview of class 2 & class 3 treatment plan
An overview of class 2 & class 3 treatment plan
 
Various functional appliances & its components /certified fixed orthodontic c...
Various functional appliances & its components /certified fixed orthodontic c...Various functional appliances & its components /certified fixed orthodontic c...
Various functional appliances & its components /certified fixed orthodontic c...
 
Early diagnosis for 4 year
Early diagnosis for 4 yearEarly diagnosis for 4 year
Early diagnosis for 4 year
 
Early diagnosis in orthodontics
Early diagnosis in orthodonticsEarly diagnosis in orthodontics
Early diagnosis in orthodontics
 
Management of class2.div2 /certified fixed orthodontic courses by Indian de...
Management of class2.div2   /certified fixed orthodontic courses by Indian de...Management of class2.div2   /certified fixed orthodontic courses by Indian de...
Management of class2.div2 /certified fixed orthodontic courses by Indian de...
 
Initial intrusion of the molars in the treatment
Initial intrusion of the molars in the treatmentInitial intrusion of the molars in the treatment
Initial intrusion of the molars in the treatment
 
extraction in orthodontics
extraction in orthodonticsextraction in orthodontics
extraction in orthodontics
 
Extraction..
Extraction..Extraction..
Extraction..
 
Twin block 2/ dental crown & bridge courses
Twin block 2/ dental crown & bridge coursesTwin block 2/ dental crown & bridge courses
Twin block 2/ dental crown & bridge courses
 
Twin block 2/cosmetic dentistry courses
Twin block 2/cosmetic dentistry coursesTwin block 2/cosmetic dentistry courses
Twin block 2/cosmetic dentistry courses
 
Twin block
Twin blockTwin block
Twin block
 
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...
 
Refinements in begg technique
Refinements in begg techniqueRefinements in begg technique
Refinements in begg technique
 
Management of class-2 division-2 malocclusion
Management of class-2 division-2 malocclusionManagement of class-2 division-2 malocclusion
Management of class-2 division-2 malocclusion
 
Manag of cl2 div1
Manag of cl2 div1Manag of cl2 div1
Manag of cl2 div1
 
Angles Class2. div2 malocclusion management
Angles Class2. div2 malocclusion managementAngles Class2. div2 malocclusion management
Angles Class2. div2 malocclusion management
 
Class 2. div 2
Class 2. div 2Class 2. div 2
Class 2. div 2
 

Plus de Indian dental academy

Indian Dentist - relocate to united kingdom
Indian Dentist - relocate to united kingdomIndian Dentist - relocate to united kingdom
Indian Dentist - relocate to united kingdomIndian dental academy
 
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
 
Invisalign -invisible aligners course in india
Invisalign -invisible aligners course in india Invisalign -invisible aligners course in india
Invisalign -invisible aligners course in india Indian dental academy
 
Invisible aligners for your orthodontics pratice
Invisible aligners for your orthodontics praticeInvisible aligners for your orthodontics pratice
Invisible aligners for your orthodontics praticeIndian dental academy
 
Development of muscles of mastication / dental implant courses
Development of muscles of mastication / dental implant coursesDevelopment of muscles of mastication / dental implant courses
Development of muscles of mastication / dental implant coursesIndian dental academy
 
Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Indian dental academy
 
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
 
Diagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesDiagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
 
Properties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesProperties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
 
Use of modified tooth forms in complete denture occlusion / dental implant...
Use of modified  tooth forms  in  complete denture occlusion / dental implant...Use of modified  tooth forms  in  complete denture occlusion / dental implant...
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
 
Dental luting cements / oral surgery courses  
Dental   luting cements / oral surgery courses  Dental   luting cements / oral surgery courses  
Dental luting cements / oral surgery courses  Indian dental academy
 
Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Indian dental academy
 
Dental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesDental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesIndian dental academy
 
Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Indian dental academy
 
Dental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesDental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesIndian dental academy
 
Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Indian dental academy
 
Dental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesDental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesIndian dental academy
 
Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Indian dental academy
 

Plus de Indian dental academy (20)

Indian Dentist - relocate to united kingdom
Indian Dentist - relocate to united kingdomIndian Dentist - relocate to united kingdom
Indian Dentist - relocate to united kingdom
 
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...
 
Invisalign -invisible aligners course in india
Invisalign -invisible aligners course in india Invisalign -invisible aligners course in india
Invisalign -invisible aligners course in india
 
Invisible aligners for your orthodontics pratice
Invisible aligners for your orthodontics praticeInvisible aligners for your orthodontics pratice
Invisible aligners for your orthodontics pratice
 
online fixed orthodontics course
online fixed orthodontics courseonline fixed orthodontics course
online fixed orthodontics course
 
online orthodontics course
online orthodontics courseonline orthodontics course
online orthodontics course
 
Development of muscles of mastication / dental implant courses
Development of muscles of mastication / dental implant coursesDevelopment of muscles of mastication / dental implant courses
Development of muscles of mastication / dental implant courses
 
Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  
 
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
 
Diagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesDiagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental courses
 
Properties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesProperties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic courses
 
Use of modified tooth forms in complete denture occlusion / dental implant...
Use of modified  tooth forms  in  complete denture occlusion / dental implant...Use of modified  tooth forms  in  complete denture occlusion / dental implant...
Use of modified tooth forms in complete denture occlusion / dental implant...
 
Dental luting cements / oral surgery courses  
Dental   luting cements / oral surgery courses  Dental   luting cements / oral surgery courses  
Dental luting cements / oral surgery courses  
 
Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  
 
Dental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesDental casting investment materials/endodontic courses
Dental casting investment materials/endodontic courses
 
Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  
 
Dental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesDental ceramics/prosthodontic courses
Dental ceramics/prosthodontic courses
 
Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  
 
Dental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesDental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry courses
 
Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  
 

Dernier

CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 

Dernier (20)

CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 

Principles of class ii treatment /certified fixed orthodontic courses by Indian dental academy

  • 1. PRINCIPLES OF CLASS II TREATMENT www.indiandentalacademy.comwww.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  • 2. IntroductionIntroduction Treatment of class II has a controversialTreatment of class II has a controversial historyhistory Americans – head gears and class IIAmericans – head gears and class II elasticselastics Europe – popularized – functionalEurope – popularized – functional appliancesappliances Surgical options – given new diemensionsSurgical options – given new diemensions to the treatment of adult class IIto the treatment of adult class II www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3. CLASSIFICATION:CLASSIFICATION:  According to Edward H. AngleAccording to Edward H. Angle CLASS II Class II div 1 (distoocclusion with labioversion of upper incisors) Class II div 2 (disto occlusion with llinguo version of maxillary incisors) Class II div1 subdivision classII div2 subdivision www.indiandentalacademy.comwww.indiandentalacademy.com
  • 4. EXTRA ORAL FEATURESEXTRA ORAL FEATURES  CONVEX PROFILECONVEX PROFILE  INCOMPETENT LIPSINCOMPETENT LIPS  LOWER FACIAL HEIGHT,LOWER FACIAL HEIGHT, OR AVGOR AVG  DEEP MENTO LABIALDEEP MENTO LABIAL SULCUSSULCUS  ABNORMALABNORMAL MUSCULATUREMUSCULATURE • STRAIGHT TO CONVEX PROFILE • COMPETENT LIPS • LOWER FACIAL HEIGHT - DECREASED CLASS II DIV 1 CLASS II DIV 2 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 5. INTRA ORAL FEATURESINTRA ORAL FEATURES  TAPERED ARCHTAPERED ARCH  UPPER ANTERIORSUPPER ANTERIORS PROCLINEDPROCLINED  OVER BITE –OVER BITE – VARIABLEVARIABLE  INCREASEDINCREASED OVERJETOVERJET • SQUARE ARCH • CENTRALS RETOCLINED, LATERALS ARE PROCLINED • DEEP OVER BITE • NORMAL TO MILD INCREASE IN OVERJET www.indiandentalacademy.comwww.indiandentalacademy.com
  • 7. Class II, subdivisionClass II, subdivision  When a class II molar relation exists on oneWhen a class II molar relation exists on one side and a class I relation on the other, it isside and a class I relation on the other, it is referred to as class II subdivision.referred to as class II subdivision. Based on whether it is a division 1 or divisionBased on whether it is a division 1 or division 2 it can be called a class II, division 1,2 it can be called a class II, division 1, subdivision or a class II, division 2,subdivision or a class II, division 2, subdivision.subdivision. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 8. ETIOLOGY:ETIOLOGY: It is important to distinguish class II malocclusions thatIt is important to distinguish class II malocclusions that are primarily of genetic origin from those ofare primarily of genetic origin from those of primarily environmental when choosing theprimarily environmental when choosing the appropriate treatment andappropriate treatment and retention.retention. A.A. Genetic causesGenetic causes:: HERIDITYHERIDITY B.B. ..Environmental causes:Environmental causes: 1.1.HabitsHabits:: 2. Trauma-T M J Ankylosis2. Trauma-T M J Ankylosis Forceps deliveryForceps delivery 3.Early Exfoliation of primary molars.3.Early Exfoliation of primary molars. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 9. 4. Retained deciduous molars.4. Retained deciduous molars. 5. Proximal caries.5. Proximal caries. 6. Missing teeth.6. Missing teeth. 7 . Supernumerary teeth7 . Supernumerary teeth 8. Delayed eruption.8. Delayed eruption. 9. Abnormal eruptive path way.9. Abnormal eruptive path way. 10. Improper restorations.10. Improper restorations. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 10. TREATMENT PLANTREATMENT PLAN SKELETAL CLASS II DENTAL CLASS II MAXILLARY EXCESS MANDIBULAR DEFICIENCY COMBINATION MAXILLARY MOLARS MOVED FORWARD MESIAL IN ROTATION OF MAXILLARY MOLARS www.indiandentalacademy.comwww.indiandentalacademy.com
  • 11. SKELETAL – TREATMENTSKELETAL – TREATMENT OPTIONSOPTIONS GROWTH PRESENT GROWTH COMPLETED PRIMARY DENTITION MIXED DENTITION PERMANENT DENTITION CAMOUFLAGE SURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  • 12. PRIMARY DENTITION(3-6Yrs)PRIMARY DENTITION(3-6Yrs) A.Space maintenance in primary molarA.Space maintenance in primary molar area.area. B.Incisor protrusion-Habit breakingB.Incisor protrusion-Habit breaking appliances are given.appliances are given. C. Antero posterior discrepancy- A distalC. Antero posterior discrepancy- A distal step has to be identified at this stage andstep has to be identified at this stage and growth modification is to be attemptedgrowth modification is to be attempted only in severe cases as continuing growthonly in severe cases as continuing growth complicates this problem.complicates this problem. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 13. MIXED DENTITIONMIXED DENTITION MAXILLARY EXCESS MANDIBULAR DEFICIENCY COMBINATION VERTICAL HORIZONTAL AVERAGE SKELETAL GROWTH PATTERN www.indiandentalacademy.comwww.indiandentalacademy.com
  • 14. Maxillary prognathismMaxillary prognathism Head gears  The type of head gear is chosen according toThe type of head gear is chosen according to the growth patternthe growth pattern  Consists of the face bow, force module and theConsists of the face bow, force module and the strapstrap  The strap will differ according to the growthThe strap will differ according to the growth patternpattern  The angulation and length of the face bow canThe angulation and length of the face bow can be changed to achieve the desired moments andbe changed to achieve the desired moments and force required for a particular clinical situationforce required for a particular clinical situation www.indiandentalacademy.comwww.indiandentalacademy.com
  • 15. CERVICAL PULL HEADCERVICAL PULL HEAD GEARGEAR  Indicated in patients withIndicated in patients with decreased verticaldecreased vertical dimension.dimension.  Outer bow lies above theOuter bow lies above the plane of occlusion toplane of occlusion to direct force throughdirect force through centre of resistance andcentre of resistance and prevent distal tipping ofprevent distal tipping of the molars.the molars. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 16. High pull head gearHigh pull head gear  Indicated in patients with increasedIndicated in patients with increased vertical dimension.vertical dimension.  Face bow is anchored to an occipitalFace bow is anchored to an occipital anchoring unit to produce a verticallyanchoring unit to produce a vertically directing force.directing force.  High pull head gear- can redirect theHigh pull head gear- can redirect the vertical diemension of the maxilla thusvertical diemension of the maxilla thus allowing the auto rotation of the mandibleallowing the auto rotation of the mandiblewww.indiandentalacademy.comwww.indiandentalacademy.com
  • 17. Force magnitude for HG:Force magnitude for HG: Recommended force values per sideRecommended force values per side Full permanent dentition – 400-600 gmsFull permanent dentition – 400-600 gms Early mixed dentition – 150-250 gmsEarly mixed dentition – 150-250 gms Late mixed dentition – 300-400 gmsLate mixed dentition – 300-400 gms Retention in permanent dentition – 150-Retention in permanent dentition – 150- 400 gms.400 gms. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 18. Head gear are tooth borne Attached to the molar tube Intermittent forces Minimizes tooth movement Provide skeletal change Less damaging to the tissue Due to the rest period  Duration:Duration: Graber, forces of 12-16 hourGraber, forces of 12-16 hour durationduration www.indiandentalacademy.comwww.indiandentalacademy.com
  • 19. Mandibular deficiencyMandibular deficiency Functional appliances is the choice ofFunctional appliances is the choice of treatment for mandibular deficiency intreatment for mandibular deficiency in growing children.growing children. Criteria for case selection are:Criteria for case selection are:  Individuals with growth potentialIndividuals with growth potential  Retrognathic mandibleRetrognathic mandible  Deep biteDeep bite  Low mandibular plane angleLow mandibular plane angle  Favourable V T OFavourable V T O  Upright lower incisorUpright lower incisorwww.indiandentalacademy.comwww.indiandentalacademy.com
  • 20. Mandibular deficiencyMandibular deficiency Anatomical retrusion Functional retrusion Functional appliances Not favourable Occlusal prematurities Surgical option Functional appliance www.indiandentalacademy.comwww.indiandentalacademy.com
  • 21. TREATMENT FOR HORIZONTALTREATMENT FOR HORIZONTAL GROWTH PATTERNGROWTH PATTERN Short face (skeletal deep bite) class IIShort face (skeletal deep bite) class II  Obtain differential growth of the jaws such that theObtain differential growth of the jaws such that the mandible catches up with the maxilla and themandible catches up with the maxilla and the skeletal problem improves or disappears.skeletal problem improves or disappears.  Allow more eruption of the lower than the upper teethAllow more eruption of the lower than the upper teeth so that the occlusal plane rotates up posteriorly, inso that the occlusal plane rotates up posteriorly, in the direction that facilitates Class II correction, deepthe direction that facilitates Class II correction, deep bite and increase lower facial heightbite and increase lower facial height www.indiandentalacademy.comwww.indiandentalacademy.com
  • 22. Treatment optionsTreatment options Functional jaw orthopedicsFunctional jaw orthopedics Functional appliance therapy.Functional appliance therapy. Cervical headgear tends to open the biteCervical headgear tends to open the bite anteriorly. It differentially erupts the upperanteriorly. It differentially erupts the upper rather than the lower molars and does notrather than the lower molars and does not produce the desired change in orientationproduce the desired change in orientation of the occlusal plane.of the occlusal plane. Functional appliances is most useful inFunctional appliances is most useful in the treatment of short face class IIthe treatment of short face class II treatmenttreatment www.indiandentalacademy.comwww.indiandentalacademy.com
  • 23. Class II children with normal facialClass II children with normal facial height.height. May have anterior deep bite because ofMay have anterior deep bite because of excessive eruption of the lower incisors.excessive eruption of the lower incisors. Current guidelines for treatment are:Current guidelines for treatment are:  Functional jaw orthopaedics.Functional jaw orthopaedics.  Functional appliance therapy.Functional appliance therapy.  Straight-pull headgear is preferred. This reducesStraight-pull headgear is preferred. This reduces elongation of maxillary molars and better controlelongation of maxillary molars and better control the inclination of the mandibular planethe inclination of the mandibular planewww.indiandentalacademy.comwww.indiandentalacademy.com
  • 24. The objective of treatment are:The objective of treatment are: 1.1. Restriction of the forward maxillary growthRestriction of the forward maxillary growth 2.2. Inhibition of the mesial and verticalInhibition of the mesial and vertical displacement of the maxillary teeth.displacement of the maxillary teeth. 3.3. Improvement of the mandibular horizontalImprovement of the mandibular horizontal growth.growth. 4.4. Condylar and glenoid fossa remodelling.Condylar and glenoid fossa remodelling. 5.5. Improvement in muscle pattern.Improvement in muscle pattern. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 25. Treatment optionsTreatment options Functional jaw orthopaedicsFunctional jaw orthopaedics Functional appliance therapy.Functional appliance therapy. High pull head gear to a maxillary splintHigh pull head gear to a maxillary splint is used as it controls the eruption of theis used as it controls the eruption of the teeth.teeth. Eruption of lower teeth is controlledEruption of lower teeth is controlled most readily with interocclusal bite blocks.most readily with interocclusal bite blocks. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 26. Vertically-directed extraoral force to theVertically-directed extraoral force to the functional appliance gives better control offunctional appliance gives better control of maxillary growth, so the most effectivemaxillary growth, so the most effective treatment is a combination of a functionaltreatment is a combination of a functional appliance with bite blocks and high-pullappliance with bite blocks and high-pull headgear.headgear. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 27. FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES ““A functional appliance harnesses naturalA functional appliance harnesses natural forces which it transmits to the teeth andforces which it transmits to the teeth and alveolar bone in a pre determined direction”.alveolar bone in a pre determined direction”. (White, Gardiner, Leighton)(White, Gardiner, Leighton) .. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 28. FUNCTIONAL APPLIANCES Removable functional -preferred during the early mixed dentition Fixed functional- Preferred during the permanent dentition www.indiandentalacademy.comwww.indiandentalacademy.com
  • 29. Long face(skeletal open bite)Long face(skeletal open bite)  Characterized by excessive anterior facialCharacterized by excessive anterior facial height.height. Major diagnostic criteria:Major diagnostic criteria:  Short mandibular ramus.Short mandibular ramus.  Rotation of palatal plane down posteriorlyRotation of palatal plane down posteriorly Typical growth pattern showsTypical growth pattern shows  Vertical growth of maxilla often posteriorly thanVertical growth of maxilla often posteriorly than anteriorly.anteriorly.  Downward-Backward rotation of the mandibleDownward-Backward rotation of the mandible and an excessive eruption of maxillary andand an excessive eruption of maxillary and mandibular teeth.mandibular teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 30. REMOVABLE FUNCTIONALREMOVABLE FUNCTIONAL Removable Functional appliancesRemovable Functional appliances used in the treatment of class IIused in the treatment of class II malocclusion.malocclusion.  ACTIVATORACTIVATOR  BIONATORBIONATOR  FRANKEL APPLIANCEFRANKEL APPLIANCE  TWIN BLOCKTWIN BLOCK  THE MODIFIED BASS APPLIANCETHE MODIFIED BASS APPLIANCE  MANDIBULAR GROWTH APPLIANCEMANDIBULAR GROWTH APPLIANCE  MAGNETIC FUNCTIONAL SYSTEMMAGNETIC FUNCTIONAL SYSTEM www.indiandentalacademy.comwww.indiandentalacademy.com
  • 31. ACTIVATORACTIVATOR Introduced by Viggo Andreson in theIntroduced by Viggo Andreson in the year 1908.year 1908. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 32. Mode of action of activator: (Mode of action of activator: ( Aus-Aus- Ortho-1985-March Graeme. L. Roberts)Ortho-1985-March Graeme. L. Roberts)  Re-education of musculature.Re-education of musculature.  Lateral pterygoid muscle stimulationLateral pterygoid muscle stimulation (LPM).(LPM).  Unloading of the mandibular condyle.Unloading of the mandibular condyle.  Transduction of viscoelastic force.Transduction of viscoelastic force.  Differential eruptions.Differential eruptions. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 33. Antero-posterior effects ofAntero-posterior effects of activator:activator:  A forward displacement of the lowerA forward displacement of the lower arch.arch.  A distal movement of maxillary arch.A distal movement of maxillary arch.  An inhibition of the forward growth of theAn inhibition of the forward growth of the maxilla.maxilla.  A stimulation of condylar growth.A stimulation of condylar growth.  A remodelling of the mandibular fossa.A remodelling of the mandibular fossa.  An elimination of interferences.An elimination of interferences. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 34. The vertical effects:The vertical effects: Successful overbite reduction found to beSuccessful overbite reduction found to be accompanied by:accompanied by:  Inhibition of lower incisor eruption.Inhibition of lower incisor eruption.  Facilitation molar eruption.Facilitation molar eruption.  Encouragement of forward mandibularEncouragement of forward mandibular rotation.rotation.  An increase in lower face height.An increase in lower face height. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 35. Treatment Effect Of Mandibular ProtrusiveTreatment Effect Of Mandibular Protrusive Appliance On The Glenoid Fossa For Class IIAppliance On The Glenoid Fossa For Class II Correction.Correction. Katsavrias et alKatsavrias et al -A. O. 2004-A. O. 2004 The glenoid fossa does not change in morphology radiographically. Glenoid fossa does not appear radiographically to contribute positive growth modifications to the class II correction by active bone modeling.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 36. Combination Headgear-ActivatorCombination Headgear-Activator (JCO 1984 DR. HERMAN VAN BE)(JCO 1984 DR. HERMAN VAN BE) The headgear-activator has the followingThe headgear-activator has the following modes of action:modes of action: 1. Intrusion and retraction of upper front1. Intrusion and retraction of upper front teethteeth 2. Distalization of upper molars2. Distalization of upper molars 3. Maxilla retraction3. Maxilla retraction 4. Mandibular growth stimulation,4. Mandibular growth stimulation, especially in the brachyfacial groupespecially in the brachyfacial group www.indiandentalacademy.comwww.indiandentalacademy.com
  • 37. 5. Opening of the facial axis in the5. Opening of the facial axis in the brachyfacial groupbrachyfacial group 6. Maintenance of the facial axis in the6. Maintenance of the facial axis in the dolichofacial groupdolichofacial group 7. Minor, if any, tilting of lower incisors7. Minor, if any, tilting of lower incisors 8. Stopping lower incisor eruption8. Stopping lower incisor eruption 9. Stopping the descent of the palate9. Stopping the descent of the palate www.indiandentalacademy.comwww.indiandentalacademy.com
  • 38. Stability of class II div 1 treatment with the head gear-Stability of class II div 1 treatment with the head gear- activator combinationactivator combination Guilherme and associatesGuilherme and associates A. O. 2004A. O. 2004 Results of their studyResults of their study  Sagittal position of both the maxilla andSagittal position of both the maxilla and the mandible was stable in the long term.the mandible was stable in the long term.  A slight relapse of the maxillo-mandibularA slight relapse of the maxillo-mandibular relation correction occurred, probablyrelation correction occurred, probably because the maxilla resumed its normalbecause the maxilla resumed its normal development and the mandible showed adevelopment and the mandible showed a growth rate significantly smaller.growth rate significantly smaller. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 39. BIONATOR: Introduced byBIONATOR: Introduced by Baltors in 1960Baltors in 1960 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 40. PrinciplesPrinciples The essential part of Balters concept is the roleThe essential part of Balters concept is the role of theof the tonguetongue.. ““The equilibrium between the tongue andThe equilibrium between the tongue and cheeks, especially between the tongue and lipscheeks, especially between the tongue and lips in the height, breadth and depth in an oralin the height, breadth and depth in an oral space of maximum size and optimal limits,space of maximum size and optimal limits, providing functional space for the tongue ,isproviding functional space for the tongue ,is essential for the natural health of the dentalessential for the natural health of the dental arches and their relation to each other”arches and their relation to each other” www.indiandentalacademy.comwww.indiandentalacademy.com
  • 41. Aims of RxAims of Rx :: 1.1. Accomplish lip closure and establishAccomplish lip closure and establish contact b/w back of the tongue and softcontact b/w back of the tongue and soft palatepalate 2.2. Enlarge oral spaceEnlarge oral space 3.3. Incisors in edge to edgeIncisors in edge to edge 4.4. Elongation of the mandibleElongation of the mandible 5.5. Leading to an improved relationship b/wLeading to an improved relationship b/w the jaws, tongue, dentition and soft tissuesthe jaws, tongue, dentition and soft tissues www.indiandentalacademy.comwww.indiandentalacademy.com
  • 42. Skeletal, Dentoalveolar and Soft tissuesSkeletal, Dentoalveolar and Soft tissues changes with the standard bionatorchanges with the standard bionator.(Varun.(Varun Kalra AJO-95)Kalra AJO-95) Skeletal changes-Skeletal changes- Mandible-pt.B is moved forwardMandible-pt.B is moved forward  -length of mandible (Ar-Go) is increased-length of mandible (Ar-Go) is increased Dentition-Dentition- Overjet and overbite is decreasedOverjet and overbite is decreased Soft tissuesSoft tissues-- Facial convexity is decreasedFacial convexity is decreased Uncurling of the lower lip.Uncurling of the lower lip.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 43. Changes in soft tissue profile following treatmentChanges in soft tissue profile following treatment with bionatorwith bionator A.O. 1995A.O. 1995  Decreased skeletal convexity;Decreased skeletal convexity;  Increased anterior and posterior faceIncreased anterior and posterior face heights;heights;  Reduced overjet and overbite;Reduced overjet and overbite;  Decreased facial convexity;Decreased facial convexity;  Uncurling and increase in length of theUncurling and increase in length of the lower lip;lower lip;  Minimal effect on the upper lip.Minimal effect on the upper lip.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 44. FRANKEL APPLIANCEFRANKEL APPLIANCE Introduced by FRANKEL in the yearIntroduced by FRANKEL in the year 19661966 PhilosophyPhilosophy  Vestibular arena of operations.Vestibular arena of operations.  Sagittal correction via tooth borneSagittal correction via tooth borne maxillary anchorage.maxillary anchorage.  Minimal maxillary basal effect.Minimal maxillary basal effect.  Lip pads, buccal shields and periostealLip pads, buccal shields and periosteal pull.pull. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 45. Mechanism of action:Mechanism of action: This appliance is used as oral gymnasticThis appliance is used as oral gymnastic appliance to help in overcoming abnormalappliance to help in overcoming abnormal perioral muscle activity and rehabilitates theperioral muscle activity and rehabilitates the muscles and to establish proper lip seal.muscles and to establish proper lip seal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 46. TWIN BLOCK:TWIN BLOCK:  Introduced by William Clark(1977)Introduced by William Clark(1977)  Mechanism of actionMechanism of action :: Forces of occlusion are used as functionalForces of occlusion are used as functional mechanism to correct malocclusion.mechanism to correct malocclusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 47. MANDIBULAR GROWTH ADVANCERMANDIBULAR GROWTH ADVANCER :: INTRODUCED BY YOKOTA IN THE YEARINTRODUCED BY YOKOTA IN THE YEAR 1993.1993. It advances the mandibleIt advances the mandible progressively with a splint, with theprogressively with a splint, with the objective of remodelling the condyle andobjective of remodelling the condyle and the glenoid fossa in the TMJ.the glenoid fossa in the TMJ. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 48. Advantage:Advantage: Since this appliance is simple, it canSince this appliance is simple, it can be used concomitantly with a fixedbe used concomitantly with a fixed appliance. Thus tooth irregularity can beappliance. Thus tooth irregularity can be corrected simultaneously with thecorrected simultaneously with the correction of the skeletal discrepancy.correction of the skeletal discrepancy. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 49. Permanent dentitionPermanent dentition FFA comes to play in adolescent.FFA comes to play in adolescent. A complete FFA cannot be used in theA complete FFA cannot be used in the mixed dentition period.mixed dentition period. In permanent dentition, there is no reasonIn permanent dentition, there is no reason to delay aligning the teeth , and a growthto delay aligning the teeth , and a growth modification that makes this difficult ormodification that makes this difficult or impossible is s disadvantage.impossible is s disadvantage. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 50. Growth modification with FIXEDGrowth modification with FIXED functional appliancesfunctional appliances In adolescent, often a fixed functionalIn adolescent, often a fixed functional appliance that allows brackets on the incisorappliance that allows brackets on the incisor teeth is the best choice.teeth is the best choice. Fixed functional appliances can be classified asFixed functional appliances can be classified as eithereither  Flexible (Flexible Fixed Functional Appliance)Flexible (Flexible Fixed Functional Appliance)  Rigid (Rigid Fixed Functional Appliance -Rigid (Rigid Fixed Functional Appliance - RFFA).RFFA).  HYBRID APPLAINCESHYBRID APPLAINCES www.indiandentalacademy.comwww.indiandentalacademy.com
  • 51. Flexible fixed functional appliancesFlexible fixed functional appliances  Jasper JumperJasper Jumper  Amoric torsion coilsAmoric torsion coils  Adjustable bite correctorAdjustable bite corrector  Scandee tubular jumper.Scandee tubular jumper.  Klapper super spring IIKlapper super spring II  Bite fixerBite fixer  Churro jumperChurro jumper www.indiandentalacademy.comwww.indiandentalacademy.com
  • 52. JASPER JUMPERJASPER JUMPER Advantages: 1.Ease of insertion and activation. 2.Generation of the intrusive forces on molars and incisors Introduced by J.J. Jasper 1980 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 53. Disadvantages include:Disadvantages include:  Large inventory five sizes of left and right.Large inventory five sizes of left and right. Breakage and a lack of force when theBreakage and a lack of force when the mouth is held open slightly.mouth is held open slightly. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 54. THE AMORIC TORSION COILSTHE AMORIC TORSION COILS Introduced by AMORIC. M IN 1994Introduced by AMORIC. M IN 1994 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 55. ADJUSTABLE BITEADJUSTABLE BITE CORRECTORCORRECTOR Introduced by RICHARD P. WEST 1995Introduced by RICHARD P. WEST 1995 This is an appliance which is assembledThis is an appliance which is assembled by the orthodontist as it is composed ofby the orthodontist as it is composed of various pieces – caps, closed coil springs,various pieces – caps, closed coil springs, nickel titanium wire.nickel titanium wire. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 56. SCANDEE TUBULAR JUMPERSCANDEE TUBULAR JUMPER  (Saga Dental AS, 2201 Kongsvinger, Norway).(Saga Dental AS, 2201 Kongsvinger, Norway). www.indiandentalacademy.comwww.indiandentalacademy.com
  • 57. Klapper SUPER Spring IIKlapper SUPER Spring II  Introduced by Lewis Klapper, 1999Introduced by Lewis Klapper, 1999  The SUPER spring II has proven to be excellentThe SUPER spring II has proven to be excellent for TMD patients who require orthodonticfor TMD patients who require orthodontic treatment after splint therapytreatment after splint therapy.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 58. BITE FIXERBITE FIXER (Ormco 1717 West Collins Avenue, Orange,(Ormco 1717 West Collins Avenue, Orange, CA 92867)CA 92867) This is a new inter maxillary spring coil.This is a new inter maxillary spring coil. The spring is attached and crimped to theThe spring is attached and crimped to the end fitting to prevent breakage betweenend fitting to prevent breakage between the spring and the end fitting.the spring and the end fitting. Polyurethane tubing is inside the spring toPolyurethane tubing is inside the spring to prevent it from becoming a food trap .prevent it from becoming a food trap . www.indiandentalacademy.comwww.indiandentalacademy.com
  • 59. CHURRO JUMPERCHURRO JUMPER Introduced by Castañon R. et al., 1998Introduced by Castañon R. et al., 1998 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 60. Rigid Fixed Functional Appliances.Rigid Fixed Functional Appliances. 1.Herbst appliance1.Herbst appliance 2. Cantilever bite jumper2. Cantilever bite jumper 3. Malu herbst appliance3. Malu herbst appliance 4.Flip lock herbst appliance4.Flip lock herbst appliance 5. The ventral telescope5. The ventral telescope 6. The magnetic telescopic6. The magnetic telescopic www.indiandentalacademy.comwww.indiandentalacademy.com
  • 61. 7. The mandibular protraction appliance7. The mandibular protraction appliance 8The universal bite jumper8The universal bite jumper 9.The biopedic appliance9.The biopedic appliance 10. Mandibular anterior repositiong10. Mandibular anterior repositiong applianceappliance 11. RITTO appliance11. RITTO appliance 12.SABBAGH UNIVERSAL spring12.SABBAGH UNIVERSAL spring www.indiandentalacademy.comwww.indiandentalacademy.com
  • 62. THE HERBST APPLIANCETHE HERBST APPLIANCE Introduced by Emil Herbst in the year 1907 Popularized by PANCHERZ Mechanics: Bilateral telescopic mechanism advancing the mandible into a new position www.indiandentalacademy.comwww.indiandentalacademy.com
  • 63. HERBST APPLIANCEHERBST APPLIANCE TREATMENT EFFECTS OF HERBSTTREATMENT EFFECTS OF HERBST DENTAL CHANGESDENTAL CHANGES The mandibular teeth are moved anteriorlyThe mandibular teeth are moved anteriorly Mandibular incisors are proclinedMandibular incisors are proclined Maxillary teeth are moved posteriorlyMaxillary teeth are moved posteriorly Maxillary teeth are distalized as well asMaxillary teeth are distalized as well as intrudedintruded www.indiandentalacademy.comwww.indiandentalacademy.com
  • 64. THE VENTRAL TELESCOPETHE VENTRAL TELESCOPE  This was the first telescopic RFFA that appeared as aThis was the first telescopic RFFA that appeared as a single unit; i.e. upon reaching maximum opening it doessingle unit; i.e. upon reaching maximum opening it does not come apart .not come apart .  Its disadvantages lie in the fact that it is quite thick andIts disadvantages lie in the fact that it is quite thick and suffers from fractures to the brake which stabilizes thesuffers from fractures to the brake which stabilizes the joint. As with the other appliances where fixing isjoint. As with the other appliances where fixing is achieved through ball attachments, great accuracy isachieved through ball attachments, great accuracy is necessary with regard to inclination and the welding ofnecessary with regard to inclination and the welding of components.components. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 65. THE MAGNETIC TELESCOPICTHE MAGNETIC TELESCOPIC DEVICEDEVICE This appliance has the advantage ofThis appliance has the advantage of linking a magnetic field to the functionallinking a magnetic field to the functional appliance. Its main disadvantages are itsappliance. Its main disadvantages are its thickness, the laboratory work necessarythickness, the laboratory work necessary to prepare it and the covering of theto prepare it and the covering of the magnets.magnets. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 66. THE UNIVERSAL BITETHE UNIVERSAL BITE JUMPER(UBJ)JUMPER(UBJ) (Calvez X., 1998).(Calvez X., 1998).  This is like a Herbst but is smaller in size andThis is like a Herbst but is smaller in size and more versatile – it can be used in all phases ofmore versatile – it can be used in all phases of treatment in mixed or permanent dentition, Classtreatment in mixed or permanent dentition, Class II or III malocclusions.II or III malocclusions.  UBJs with nickel titanium coil springs do notUBJs with nickel titanium coil springs do not need to be reactivatedneed to be reactivated www.indiandentalacademy.comwww.indiandentalacademy.com
  • 67. THE BIOPEDIC APPLIANCETHE BIOPEDIC APPLIANCE Designed by Jay Collins in 1997Designed by Jay Collins in 1997 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 68. The Mandibular AnteriorThe Mandibular Anterior Repositioning Appliance (MARARepositioning Appliance (MARA Introduced by Douglas Toll of Germany inIntroduced by Douglas Toll of Germany in 1991.1991. Mechanics: Bilateral cams fitted to molar stainless steel crowns to advance mandible www.indiandentalacademy.comwww.indiandentalacademy.com
  • 69. SABBAGH UNIVERSAL SPRINGSABBAGH UNIVERSAL SPRING Is ideal for treating patients withIs ideal for treating patients with  Insufficient cooperationInsufficient cooperation  Late cases with little remainingLate cases with little remaining growthgrowth  Illnesses of the upper respiratoryIllnesses of the upper respiratory tract system, such as asthmatract system, such as asthma  Patients who are allergic to plasticsPatients who are allergic to plastics www.indiandentalacademy.comwww.indiandentalacademy.com
  • 70. RITTO APPLIANCERITTO APPLIANCE The Ritto Appliance can be described as aThe Ritto Appliance can be described as a miniaturized telescopic device withminiaturized telescopic device with simplified intra oral application andsimplified intra oral application and activation The construction of thisactivation The construction of this appliance is based on the mechanism andappliance is based on the mechanism and function used in the Ventral Telescopefunction used in the Ventral Telescope adapted for use in conjunction with a fixedadapted for use in conjunction with a fixed applianceappliance www.indiandentalacademy.comwww.indiandentalacademy.com
  • 71. HYBRID APPLIANCESHYBRID APPLIANCES  The calibrated force module.The calibrated force module.  Eureka spring.Eureka spring.  The twin force bite corrector.The twin force bite corrector.  FORSUS Nitinol flat spring.FORSUS Nitinol flat spring. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 72. THE CALIBRATED FORCETHE CALIBRATED FORCE MODULEMODULE  It was a fixed appliance designed to substituteIt was a fixed appliance designed to substitute Class II elastics and it was developed in 1988Class II elastics and it was developed in 1988 by the CorMar Inc.by the CorMar Inc.  Its coil spring produced a force of 150 gmsIts coil spring produced a force of 150 gms www.indiandentalacademy.comwww.indiandentalacademy.com
  • 73. EUREKA SPRINGEUREKA SPRING This appliance appeared on the marketThis appliance appeared on the market in 1996 and it was developed byin 1996 and it was developed by DeVicenzo and Steve Prins .DeVicenzo and Steve Prins . Mechanics: Telescopic rods with integral light force compression springs. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 74. FORSUS NITINOL FLATFORSUS NITINOL FLAT SPRINGSPRING The Forsus Nitinol Flat Spring is slim,The Forsus Nitinol Flat Spring is slim, flat and made of Super-Elastic Nitinol.flat and made of Super-Elastic Nitinol. Nitinol is always at work, deliveringNitinol is always at work, delivering consistent forces. Force levels remainconsistent forces. Force levels remain constant from the initial setup to theconstant from the initial setup to the time of removal.time of removal. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 75. ALPERN CLASS II CLOSERSALPERN CLASS II CLOSERS It consists of a small telescopic applianceIt consists of a small telescopic appliance with an interior coil spring and two hookswith an interior coil spring and two hooks for fixing .for fixing . It functions in the same way as elasticsIt functions in the same way as elastics and, similarly, is fixed to the lower molarand, similarly, is fixed to the lower molar and to the upper cuspid.and to the upper cuspid. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 76. DENTAL CLASS II – TREATMENTDENTAL CLASS II – TREATMENT OPTIONSOPTIONS MAXILLARY MOLARS MOVED FORWARD MESIAL IN ROTATION OF THE MAXILLARY MOLARS www.indiandentalacademy.comwww.indiandentalacademy.com
  • 77. MAXILLARY MOLARS MOVEDMAXILLARY MOLARS MOVED FORWARDFORWARD GOOD FACIAL PROFILE POOR FACIAL PROFILE MOLAR DISTALIZATION EXTRACTION PROXIMAL STRIPPING 14, 24, 35, 45 AND FINISH THE CASE IN CLASS I 14, 24, AND FINISH THE CASE IN CLASS II www.indiandentalacademy.comwww.indiandentalacademy.com
  • 78. A number of appliances have beenA number of appliances have been introduced for molar distalisation.introduced for molar distalisation. CLASSIFICATIONCLASSIFICATION EXTRA ORALEXTRA ORAL Head gears--- a. cervicalHead gears--- a. cervical b. occipitalb. occipital INTRA ORALINTRA ORAL RemovableRemovable Fixed------------- Buccally actingFixed------------- Buccally acting Palatally actingPalatally acting www.indiandentalacademy.comwww.indiandentalacademy.com
  • 79. Buccally actingBuccally acting Super elastic Niti.Super elastic Niti. Niti coil spring.Niti coil spring. Jones Jig.Jones Jig. Lokars Appliance.Lokars Appliance. Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 80. Wilson rapid molar distalising appliance.Wilson rapid molar distalising appliance. K loop distaliser.K loop distaliser. Magnets.Magnets. C space regainer.C space regainer. Molar distalisation splint.Molar distalisation splint. CARIERE distaliserCARIERE distaliserwww.indiandentalacademy.comwww.indiandentalacademy.com
  • 81. Palatally actingPalatally acting  Distal jet applianceDistal jet appliance  Cricket applianceCricket appliance  Nance applianceNance appliance  Pendulum appliance and its modificationPendulum appliance and its modification  Simple molar distaliserSimple molar distaliser  Intra oral bodily distalising applianceIntra oral bodily distalising appliance www.indiandentalacademy.comwww.indiandentalacademy.com
  • 82. MESIAL IN ROTATIONMESIAL IN ROTATION Often, in a class II malocclusion,Often, in a class II malocclusion, the maxillary first molars are rotatedthe maxillary first molars are rotated mesiolingually. Correcting this rotationmesiolingually. Correcting this rotation moves the buccal cusps posteriorly andmoves the buccal cusps posteriorly and provides at least a small space mesial toprovides at least a small space mesial to the molars.the molars. Cetlin, JCO, 1988 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 83. Treatment plan – molar rotationTreatment plan – molar rotation Transpalatal archTranspalatal arch Tip back bendTip back bend Nance palatal archNance palatal arch Head gearHead gear Couple forceCouple force www.indiandentalacademy.comwww.indiandentalacademy.com
  • 84. GROWTH COMPLETEDGROWTH COMPLETED CAMOUFLAGE SURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  • 85. CAMOUFLAGE TREATMENTCAMOUFLAGE TREATMENT Beyond the adolescent growthBeyond the adolescent growth spurt to correct a skeletal problem teethspurt to correct a skeletal problem teeth should be displaced relative to theirshould be displaced relative to their supporting bone to compensate for thesupporting bone to compensate for the underlying jaw discrepacy. This is termedunderlying jaw discrepacy. This is termed camouflage treatment.camouflage treatment. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 86. Indications for class II camouflage treatment:Indications for class II camouflage treatment:  Too old for successful growth modification.Too old for successful growth modification.  Mild to moderate skeltal class II.Mild to moderate skeltal class II.  Reasonably good alignment of teeth.Reasonably good alignment of teeth.  Good vertical facial propotionsGood vertical facial propotions www.indiandentalacademy.comwww.indiandentalacademy.com
  • 87. Extractions in class II:Extractions in class II:  Extraction of upper first bicuspids only withExtraction of upper first bicuspids only with lower non extractionlower non extraction  Extraction of upper first bicuspids andExtraction of upper first bicuspids and lower second bicuspidslower second bicuspids  Extraction of upper and lower bicuspids inExtraction of upper and lower bicuspids in cases with severe lower crowdingcases with severe lower crowding  Distalization of molars with second molarDistalization of molars with second molar extraction.extraction. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 88. SURGICAL TREATMENTSURGICAL TREATMENT SURGICAL POST SURGICAL PRESURGICAL www.indiandentalacademy.comwww.indiandentalacademy.com
  • 89. PRESURGICALPRESURGICAL  TO REMOVE THE DENTAL COMPENSATIONSTO REMOVE THE DENTAL COMPENSATIONS THAT HAVE OCCURRED TO MASK THETHAT HAVE OCCURRED TO MASK THE SKELETAL MALOCCLUSION AND TOSKELETAL MALOCCLUSION AND TO FACILITATE THE SURGICAL PROCEDUREFACILITATE THE SURGICAL PROCEDURE  EXTRACTION PATTERN FOLLOWEDEXTRACTION PATTERN FOLLOWED ACCORDING TO THE CLINICAL SITUATIONACCORDING TO THE CLINICAL SITUATION  TO CORRECT THE AXIAL INCLINATION OF THETO CORRECT THE AXIAL INCLINATION OF THE ANTERIORSANTERIORS  TO BRING THE MOLARS TO FULL CUSP CLASSTO BRING THE MOLARS TO FULL CUSP CLASS IIII  TO CREATE SUFFICENT OVERJETTO CREATE SUFFICENT OVERJET  –– 15, 25 AND 34 AND 4415, 25 AND 34 AND 44www.indiandentalacademy.comwww.indiandentalacademy.com
  • 90. SURGICAL PROCEDURES:SURGICAL PROCEDURES: In case of,In case of,  Maxillary excess- Le Fort I OsteotomyMaxillary excess- Le Fort I Osteotomy  Mandibular deficiency- Saggital splitMandibular deficiency- Saggital split osteotomyosteotomy  Deficient chin- Advancement genioplasty.Deficient chin- Advancement genioplasty. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 91. POST SUGICALPOST SUGICAL ORTHODONTICSORTHODONTICS Can be initiated 3 to 4 weeks afterCan be initiated 3 to 4 weeks after the release of immobilization. Stabilizationthe release of immobilization. Stabilization arch wires are removed and replaced byarch wires are removed and replaced by working arch wires with light vertical forcesworking arch wires with light vertical forces till a good stable occlusion is achieved.till a good stable occlusion is achieved. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 92. CONCLUSIONCONCLUSION WITH SUCH A WIDE RANGE OFWITH SUCH A WIDE RANGE OF TREATMENT MODALITIES ANDTREATMENT MODALITIES AND APPLIANCES LISTED OUT FOR CLASSAPPLIANCES LISTED OUT FOR CLASS II MALOCCLUSION, IT IS AT THEII MALOCCLUSION, IT IS AT THE HANDS OF A SKILLEDHANDS OF A SKILLED ORTHODONTIST TO APPROPRIATELYORTHODONTIST TO APPROPRIATELY TIME AND CHOOSE THE RIGHTTIME AND CHOOSE THE RIGHT TREATMENT ACCORDING TO THETREATMENT ACCORDING TO THE INDIVIDUAL PATIENT NEEDS.INDIVIDUAL PATIENT NEEDS. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 93. THANK YOU www.indiandentalacademy.comwww.indiandentalacademy.com For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com