Multistage Treatment of a Class II Division 1 Malocclusion With Severe Crowding

The improvement of facial aesthetics is one of the main reasons why patients with a class II division 1 malocclusion seek orthodontic treatment. There are various techniques available to treat class II malocclusions, one of which is a two-phase approach that includes functional jaw orthopedics as well as fixed orthodontic treatment. The following case report describes the case of a 12-year-old growing female patient AK with a severe class II division 1 malocclusion. The patient was treated initially with Haas-type rapid maxillary expansion. Pre-functional orthodontics was followed with a removable twin block functional appliance and a combination pull headgear for growth modification and correction of her overjet and profile. Thereafter, a fixed, pre-adjusted MBT (McLaughlin Bennet Trevsi) prescription orthodontic appliance was utilized following the extractions of the maxillary first premolars and two lower incisors in the final phase, to ensure well-aligned arches and improved aesthetics and function.

Intra- and interobserver agreement in the diagnosis of malocclusion in sleep-disordered breathing

Sleep-disordered breathing (SDB) is often related to malocclusion, and dentists should be able to recognize occlusal changes that may be associated with the development, onset, or persistence of SDB. Although clinical examination is routinely used by specialists in orthodontics and functional jaw orthopedics, differences in diagnosis are very common. Method : Two observers, both dentists specializing in functional jaw orthopedics, examined 56 children aged 7 to 9 years. Intra- and interobserver agreement in identification of functional orthopedic and orthodontic conditions were assessed. Results : Intraobserver agreement was strong for all variables. Interobserver agreement was also strong, except for the variable overbite, which showed good agreement. Conclusion : Diagnostic criteria provide an opportunity for dentists to recognize dental malocclusions that may be associated with sleep-disordered breathing.

Prediction of Individual Mandibular Changes Induced by Functional Jaw Orthopedics Followed by Fixed Appliances in Class II Patients

Objective: To identify pretreatment cephalometric variables for the prediction of individual mandibular outcomes of functional jaw orthopedics (FJO) followed by fixed appliances in Class II patients treated at the peak in mandibular growth. Materials and Methods: The study was performed on 51 subjects (24 females, 27 males) with Class II malocclusion. First-phase therapy was accomplished with a twin block in 16 subjects, a stainless steel crown Herbst in 15 subjects, and an acrylic splint Herbst in 20 subjects. Lateral cephalograms were available at the start of treatment with FJO and at the completion of fixed appliance therapy. All subjects received FJO at the peak in mandibular growth (CS 3 at T1). Individual responsiveness to Class II treatment including FJO was defined on the basis of the T2-T1 increment in total mandibular length (Co-Gn) when compared with untreated Class II subjects. Results: Discriminant analysis identified a single predictive parameter (Co-Go-Me°) with a classification power of 80%. Pretreatment vertical and sagittal parameters were not able to improve the prediction based upon the mandibular angle. Conclusions: A Class II patient at the peak in skeletal maturation (CS 3) with a pretreatment Co-Go-Me° smaller than 125.5° is expected to respond favorably to treatment including FJO. A Class II patient at CS 3 with a pretreatment value for Co-Go-Me° greater than 125.5° is expected to respond poorly to treatment including FJO.