CLASS II CAMOUFLAGE

Prepared by:

Dr. Kristel

*Orthodontic Camouflage – is the

term used to describe a treatment

procedure wherein the dental

problem is corrected therefore,

making the skeletal problem no

longer apparent.

The ff. 3 patterns of tooth movement

can be used to correct a Class II

malocclusion:

1. Nonextraction treatment with

Class II elastics.

2. Retraction of the upper incisors

into a premolar extraction space.

3. Distal movement of the upper

teeth.

Nonextraction treatment with

Class II elastics. Class II

malocclusion can be corrected with

the use of intermaxillary elastics by

means of forward movement of the

mandibular teeth relative to the

mandible and retraction of the upper

teeth. However, in a patient with a

skeletal Class II due to mandibulardeficiency, the result is both unesthetic.

and unstable due to the pressure exerted

by the lower lip creating a treatment

relapsed.

Retraction of the upper incisors

into a premolar extraction space.

A straightforward way to correct

excessive overjet is to retract the

protruding incisors into the

extraction space created by the

extraction of maxillary 1st

premolars. Without extractions on

the lower arch, the patient would

still have a Class II molar

relationship but normal canine

relationship at the end of the

treatment. Temporary skeletal

anchorage is very useful when

maximum incisor retraction is

desired or if the maxillary molars

have little anchorage value because

of bone loss.

In cases wherein the mandibular 1st

or 2nd premolars are also extracted,

Class II elastics are used to bring the

molars forward and retract the upper

incisors, correcting both the molar

relationship and the overjet. On the

other hand, although premolar

extraction can produce an excellent

occlusion and an acceptable

dentofacial appearance, potential

problem still do exists. (1) If the

patient’s Class II malocclusion is

due to mandibular deficiency,

retracting the maxillary incisors just

to go with the mandibular would

create a facial deformity. (2)

Extractions in the lower arch allow

the molars to come forward into a

Class I relationship, but it would be

important to close the lower space

without retracting the lower incisors.

If elastics are used, the upper

incisors are elongated as well as

retracted, which can produce a

“gummy smile”.

Distal movement of the upper

teeth. If the upper molars could be

moved posteriorly, this would

correct a Class II molar relationship

and would also provide space for the

other teeth to be retracted. If

maxillary molars are rotated

mesiolingually, as they often are

when Class II molar relationship

exists, correcting the rotation by

moving the buccal posteriorly would

create a small space mesial to that

molar. The difficult part is tipping

the crowns distally and bodily distal

movement. There are 2 problems

“ Mesiolingual rotation of the Maxillary 1st molar”

that exists: (1) It is difficult to

maintain the 1st molar in a distal

position while the premolars and

anterior teeth are moved back, so it

must be moved back into a

considerable distance. (2) the farther

it must be moved, the more the 2nd

and 3rd molars are in the way. From

this perspective, the most successful

way to move a maxillary 1st molar

distally is to extract the 2nd molar,

which would create a space for the

tooth movement. Also, until quiet

recently, the anchorage created by a

transpalatal lingual arch was

accepted as the best way to undertake

distalization of the maxillary

dentition. This type of treatment is

time consuming and requires

excellent patient cooperation.

Palatal anchorage for the molar

movement can be created by

splinting the maxillary premolars

and including an acrylic pad in the

splint so that it contacts the palatal

mucosa. In theory, the palatal

mucosa resists displacement; in

clinical use, tissue irritation is likely.

Even with the more elaborate

appliances of this type, only about

two-thirds of the space that opens between the molars and premolars is from distal movement of the molars, even if the molars are tipped distally. They tend to come forward again when the other maxillary teeth are retracted, so more than half-cusp molar correction cannot be expected. The ideal patient for this approach is one with minimal growth potential, a reasonably good jaw relationship, and a half cusp molar relationship.

Using temporary skeletal anchorage

greatly improves the amount of true

distal movement of the maxillary

dentition that can be achieved, and

makes it possible to distalized both 1st

and 2nd molars but still, it is necessary to

create some space in the tuberosity

region so removal of the 3rd molars is a

typical procedure, bone anchors are

placed bilaterally in the zygomatic arch

(“keyridge”) or in the palate , and a

nickel titanium spring would be the one

to generate force the force needed

for distalization. Although good data

treatment outcomes still do not exist,

In some patients, it has been

possible to produce up to 6mm of

distal movement of the 1st and 2nd

molars. In addition, the premolars

migrate distally due to the

supercrestal fiber network making

retraction less complicated and no

reaction force against the incisors to

move them facially. This approach is

compatible if a Class II

malocclusion is due to maxillary

dental protrusion with normal

mandibular growth.

In the absence of favorable growth, treating a

Class II relationship in adolescents is difficult.

Fortunately, even though growth modification cannot be

expected to totally correct an adolescent Class II

problem, some forward movement of the mandible

relative to the maxilla does contribute to successful

treatment of the average patient. When little or no

growth can be expected, orthognathic surgery to

advance the mandible may be necessary to achieve a

satisfactory result.

ENDTHANK YOU