Orthodontics: suggestions about class II malocclusion topic

[ApDS93]

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Hi everybody,

i've just signed up to this forum, i'm a 4th year student actually studying in Madrid. It's not simple to find good online communities for dental students in spain, so i decided to try this one!

I've been given an assignment in orthodontics, i'm supposed to give a 20min lecture about some topic related to class II malocclusion, it has to be something i can easily deal with by searching on pubmed or books but as the professor already went through the diagnostic, the incidence and treatment options (roughly, as expected from the orthodontics program of this university) so i'm afraid of ending up with something repetitive or not original.

Anyone has any suggestion? ideally something 4th year student-friendly

thanks!

 

[The Anhedonia]

Random thoughts from an OMFS/orthognatic perspective, Class 2 malocclusion is pretty unique for a number of reasons
- etiologies of class II - most often simple mandibular hypoplasia, but sometimes people develop idiopathic condylar absorbtion (article by Wolford, arguably one of the leading experts in TMJ anomalies)
- associated issues - people with severe class II almost always have a CO/CR discrepancy, which means in addition to the negative aesthetics, many of these patient suffer pretty bad TMJ disease from their posturing; sleep apnea can be a problem because the suspension of the suprahyoid musculature in class II is such that the airway is smaller. Here's a great article that runs through many of theses issues . Notably, "Orthodontic treatments coupled with orthognathic surgery remain the only resort to overcome this problem".
- treatment - the treatment for some one who has class II with NO maxillary hypoplasia/asymmetry is correctable by decompensating the dentition (proclining the maxillary incisors to appropriate angle. retroclining the mandibular incisors --> this worsens the discrepancy) followed by mandibular advancement (either BSSO vs IVRO). To me, from a single-jaw surgery perspective, this is a very satisfying aesthetic outcome as you bring fullness to the upper lip from proclining the maxillary teeth and to the bottom lip by advancement (google image)

 

[ApDS93]

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[ApDS93]

Random thoughts from an OMFS/orthognatic perspective, Class 2 malocclusion is pretty unique for a number of reasons
- etiologies of class II - most often simple mandibular hypoplasia, but sometimes people develop idiopathic condylar absorbtion (article by Wolford, arguably one of the leading experts in TMJ anomalies)
- associated issues - people with severe class II almost always have a CO/CR discrepancy, which means in addition to the negative aesthetics, many of these patient suffer pretty bad TMJ disease from their posturing; sleep apnea can be a problem because the suspension of the suprahyoid musculature in class II is such that the airway is smaller. Here's a great article that runs through many of theses issues . Notably, "Orthodontic treatments coupled with orthognathic surgery remain the only resort to overcome this problem".
- treatment - the treatment for some one who has class II with NO maxillary hypoplasia/asymmetry is correctable by decompensating the dentition (proclining the maxillary incisors to appropriate angle. retroclining the mandibular incisors --> this worsens the discrepancy) followed by mandibular advancement (either BSSO vs IVRO). To me, from a single-jaw surgery perspective, this is a very satisfying aesthetic outcome as you bring fullness to the upper lip from proclining the maxillary teeth and to the bottom lip by advancement (google image)

Thank you for answering!
i've been reading the bibliography you suggested, very interesting.
My comments are:
- etiology of class II: the ICR syndrome, from what the author states, for what concerns my case looks more like a consequence of a dolichocephalic model (that often already includes class II) than an etiology of class II malocclusion
- associated issues: the relationship between between class II malocclusion and TMDs has been discharged by many studies, however it's true that they are more likely to be present in class II patients than in those with a non-pathological occlusion (1, 2, 3)
- i really don't know anything about the surgical management of class II patients, i dug into the 2 techniques you mentioned, very interesting thank you. It would be helpful is someone can suggest me some bibliographic reference about the diagnostic criteria to distinguish between a class II patient that needs surgery and a class II patient that doesn't