Pacific Coast Society of Orthodontists Bulletin Fall 2013 - (Page 11)
The Class II, Division 2
Malocclusion Part II
By Ib Leth Nielsen, DDS, MSc
Ed.: Dr. Nielsen brings a clinically useful understanding to treatment planning for a Class II div. 2.
Clinicians can surely benefit from taking another
look at the landmark growth study by Björk, where
he followed mandibular growth over many years with
implants serving as the superimposition landmarks.
— G.N.
I
n a previous article (Summer 2013 PCSO Bulletin)
on the topic of the class II, division 2 malocclusion,
we discussed the etiological factors that lead to the
development of this malocclusion. These factors
include growth rotation during the active growth phase
of the maxilla and mandible, as well as the soft tissues
surrounding the dentition (in particular the lower lip).
The anterior occlusion that is achieved during the
eruption of the front teeth also plays a large role in a
development that may result in a deep overbite. It is
important for the clinician to be able to anticipate this
development from an early age so that he or she can
prevent the situation from getting worse over time.
Anticipating this development allows one to choose the
most practical time for treatment.
FORWARD JAW ROtAtiOn
AnD OCCLuSiOn
Mandibular Growth Rotation
As long ago as 1969, Björk explained that the
mandible does not just grow linearly, as seen in
2
the Broadbent-Bolton Atlas ; it also rotates during
growth, and under certain circumstances this may
result in a deep overbite.3 Björk also explained that
when the anterior teeth reach a good occlusion,
the mandibular growth pattern does not cause an
increase in overbite, but remains stable.
An example of this situation is seen in Björk’s Case
3, as illustrated in Figure 1.1. The general facial
growth pattern is analyzed by superimposing on
stable structures in the cranial base. Growth of the
maxilla and mandible is analyzed in this example by
superimposition on the maxillary and mandibular
implant lines, respectively. The growth period shown
is a six-year span around puberty, the most active
growth period of the jaws. The superimposition
on the cranial base shows downward and forward
Figure 1. Six years of general
facial, maxillary and mandibular growth in a young female
patient. The occlusion in this
subject remained unchanged
despite pronounced mandibular rotation. From Björk and
Skieller, 1972.1
FALL 2013
•
PCSO BuLLetin
11
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2013
An Editor's Journey
A Sense of Belonging
To Meet Member Needs, You Have to Know Members
Stronger, More Efficient, More Focused
Service Behavior
Class II, Division 2 Malocclusions, Part II
Dr. Terry McDonald Interviews Dr. Douglas Klein
Mark Douglas, DDS
Vincent G. Kokich, Sr., DDS, MSD
Elastic Wear Tips
AAOF
PCSO Business
Component
PCSO at a Glance
Case Report Pre-Treatment
Case Report Post-Treatment
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