Class II Malocclusions: Diagnostic and Clinical Considerations With and Without Treatment

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Class II malocclusions are of interest to the practicing orthodontists since they constitute a significant percentage of the cases they treat. In individuals with normal occlusion and skeletal relationship, the amount of maxillary and mandibular growth is synchronized and the result is a well-balanced and esthetically pleasing profile. In individuals with Class II malocclusions, there is an anteroposterior discrepancy between the maxillary and mandibular dentitions, which may or may not be accompanied with a skeletal discrepancy. In growing individuals, the success of treatment is dependent, to a great extent, on the ability of the clinician to influence the relative growth changes in the maxilla and mandible. The purpose of this article is to provide a perspective on the characteristics, development, etiology, and broad treatment considerations in Class II malocclusions.

Section snippets

Incidence of Class II Malocclusions

Ast and coworkers1 examined 1413 high school students aged 15 to 18 years from upstate New York and found that 23.8% had Class II malocclusions, while 69.9% had Class I malocclusions. This relative frequency, which is approximately 1:3, was similar to that reported by Goldstein and Stanton2 for white American children aged 2 through 12 years, and by Massler and Frankel3 for children aged 14 through 18 years. On the other hand, in a group of American blacks studied by Altemus4 the ratio of Class

General concepts

Growth of the skeletal craniofacial complex involves an increase in the absolute size of the various bones as well as changes in their position and form.

The maxillary complex is usually displaced in a downward and forward direction.38 Bone is deposited on the posterior surface of the maxillary tuberosity, adding to the length of the dental arch as well as the anteroposterior dimension of the maxilla to accommodate for the eruption of the posterior teeth. As the maxilla moves downward and

Conclusions

Angle classification is a useful means of identifying Class II malocclusions, but it oversimplifies the description of a complex pattern of skeletal, dental, and profile relationships that are present.

A Class II malocclusion may be accompanied by an anteroposterior skeletal discrepancy between the maxilla and mandible, often with mandibular retrusion, however the maxilla may also be protrusive. These relationships are superimposed on an equally broad variation in the vertical facial pattern

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