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Nonextraction Treatment of An Adult With Class Ii Division 2 Malocclusion
Nonextraction Treatment of An Adult With Class Ii Division 2 Malocclusion
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Correspondence
Hande Görücü Coşkuner, DDS
Department of Orthodontics,
Faculty of Dentistry,
Key words: Class II Division 2 Malocclusion, Fixed Functional
Hacettepe University,
Appliance, Non-Extraction Treatment
Sıhhıye, 6100, Ankara / Turkey
Phone : +90 312 305 22 90 Submitted for Publication: 02.04.2013
Fax : +90 312 309 11 38
Accepted for Publication : 10.07.2013
E-mail: hande.gorucu@hotmail.com
49
CLINICAL DENTISTRY AND RESEARCH 2013; 37(3): 49-56 Olgu Bildirimi
Sorumlu Yazar
Hande Görücü Coşkuner
Hacettepe Üniversitesi, Diş Hekimliği Fakültesi,
Ortodonti Anabilim Dalı
Anahtar Kelimeler: Sınıf II Divizyon 2 Maloklüzyon, Sabit
Sıhhiye, 6100, Ankara/Türkiye Fonksiyonel Aparey, Çekimsiz Tedavi
Telefon: +90 312 305 22 90
Yayın Başvuru Tarihi : 04.02.2013
Faks: +90 312 309 11 38
Yayına Kabul Tarihi : 07.10.2013
e-mail: hande.gorucu@hotmail.com
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Treatment Of An Adult With Class II Division 2 Malocclusion
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CLINICAL DENTISTRY AND RESEARCH
52
Treatment Of An Adult With Class II Division 2 Malocclusion
facial esthetics, we should make lips more prominent and During treatment, patient was instructed for extraction of
therefore, we planned nonextraction treatment strategy. third molars, so all third molars were extracted in finishing
Dental treatment objectives included correction of class phase. For retention; Hawley retainers were placed above
II molar and canine relations, correction of deep bite upper and lower bonded lingual retainers and the patient
and correction of crowding by protrusion of incisors and was instructed to wear them full time for one year. After
expansion of dental arches. one year patient was called for periodic evaluation.
Treatment Alternatives Treatment Results
First treatment option was mandibular surgery after the Favorable facial changes were obtained (Figure 9). Lower
extraction of right and left mandibular first premolars for lip was forwarded 2 mm according to E plane. Ideal tooth
crowding and coordination of dental arches by expansion aspect was gained on full smile. Intraorally, deepbite was
and upper incisor proclination. Because of prominent chin, resolved and ideal overjet and overbite relationships were
after mandibular surgery genioplasty could be necessary. achieved. Maxillary and mandibular dental midlines were
The patient was not willing for surgical treatment. coincident with facial midline and class 1 molar and canine
Second treatment option was extraction treatment with relationships were established (Figures 10, 11,12).
the extraction of upper first premolar and lower second Cephalometrically, ANB angle decreased to 4° from 6° and
premolar. In that case correction of crowding and class II lower anterior facial height changed to 47° from 46°. Upper
molar canine relationship would be easier but profile of and lower incisors were proclined relative to cranial and
patient would worsen and correction of deep bite would be apical bases, and this proclination also helped the correction
difficult. of deepbite (Figures 13, 14, 15). In final panoramic
In non-extraction treatment crowding can be solved by radiograph, all third molars were extracted (Figure 16).
expansion of the arches and proclination of upper and
DISCUSSION
lower incisors. This would improve esthetics and correction
of deep bite would be easier so we decided to apply non- Usually, when treating patients who have 6 mm or more
extraction treatment. crowding in the mandibular arch, we consider extraction.
But in the treatment of Class II division 2 malocclusion,
Treatment Progress
extraction would make the correction of deep bite difficult
After evaluation of the diagnostic records; the patient history and worsen the profile. In a case report, Asakawa et al.5
and the decision of the patient non-extraction orthodontic treated a girl with Class II division 2 malocclusion who has
correction was chosen as the treatment strategy. 8 mm mandibular crowding without extraction. They stated
Expansion was started with the application of a quad-helix that if the patient was treated with premolar or incisor
appliance. Then, upper incisors were bonded and after extraction, proper overjet and overbite couldn’t be obtained.
leveling with a utility arch, protrusion utility arch was placed For the reasons mentioned above and to improve facial
which has 45° intrusion bends. Concurrently mandibular profile we decided to treat the patient without extraction.
teeth were bonded and banded. After upper incisor After leveling of maxillary and mandibular arches, we
protraction, upper premolar and canines were bonded. corrected Class II molar and canine relationships by using
Later, for both upper and lower arches, 0,014 inch Ni-Ti, Forsus FRD. One of the main dental effects of Forsus
0,016 inch Ni-Ti, 0,016x0,016 inch Ni-Ti and 0,016x0,016 FRD is protrusion and intrusion of mandibular incisors
stainless steel wires are used respectively. When upper and with labial tipping.6,7 In our case both effects are seen and
lower leveling completed, 0.016x0.022 inch stainless steel also protrusion and intrusion of mandibular incisors had
wires were placed and Forsus Fatigue Resistant Device favorable effect on correction of deepbite.
(3M Unitek 2724 South Peck Road Monrovia, CA 91016 Proclination of lower incisors are considered to be a major
USA) was used. Five months later, Class I molar and canine factor for gingival recession. In a study, Melsen et al.8
relationships were achieved. Forsus FRD was removed concluded that the risk of periodontal damage secondary to
and for occlusal settling intermaxillary elastics was used. protrusion of incisors is small. Also, Hasund et al.9 noted that
2 months later, after 14 months from the beginning of mandibular incisors could be proclined more in the patients
treatment, patient was debonded. with hypodivergent skeletal patterns and prominent chins.
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CLINICAL DENTISTRY AND RESEARCH
Figure 10. Posttreatment maxillary arch Figure 11. Posttreatment mandibular arch
In treatment of a Class II division 2 female, Asakawa et al.5 end of treatment, large interincisal angle is associated with
also proclined upper and lower incisors significantly, but at relapse of deep overbite.
the end of the treatment no periodontal damage was noted. Our treatment lasted in 14 months. If we take a look at
By proclination of upper and lower incisors, interincisal angle treatment durations of Class II division 2 malocclusions,
decreased. In deepbite cases, it is chosen to achieve narrow we see prolonged durations. Chen et al.11 treated a 42-
interincisal angle for stability. Riedel 10 proposed that at the year old male with Class II division 2 malocclusion, deep
54
Treatment Of An Adult With Class II Division 2 Malocclusion
55
CLINICAL DENTISTRY AND RESEARCH
relationships were obtained; favorable changes were seen 12. Chiappone RC. Special considerations for adult orthodontics. J
in patient’s profile, smile and aesthetics. Lower lip was Clin Orthod 1976; 10: 535-545.
forwarded according to E plane so improvement in profile
13. Barrer HG. The adult orthodontic patient . Am J Orthod 1977;
was achieved. Upper arch was expanded and incisors were 72: 617-640.
proclined so patient’s smile was fulled and these results
improved her aesthetics. 14. Robb SI, Sadowsky C, Schneider BJ, BeGole EA. Effectiveness
and duration of orthodontic treatment in adults and adolescents.
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