Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 62

Presentation Summary

Class II Functional Orthopedics:
Evidence-Based or Practice Management?
Dr. Christine Hong
PCSO Bulletin Contributing Editor

Presented by Dr. Peter Ngan at the PCSO Spring
Training, March 4, 2017.
Objectives
 Learn the rationale for early orthopedic treatment of Class II problems.
 Learn the timing and current protocol in managing developing Class II problems with fixed
and removable appliances.
 Learn what works and what does not work for
Class II correctors.
Dr. Peter Ngan is professor and head of the
department of orthodontics at West Virginia
University School of Dentistry. He maintains an
intramural faculty practice at the WVU School
of Dentistry Faculty practice clinic.

Dr. Peter Ngan
West Virginia University
School of Dentistry

Introduction
Class II malocclusion affects one-third of the U.S.
population, with 8%-10% of the overall population experiencing an overjet of > 6 mm. Among
the wide variety of appliances used for Class II
correction, fixed appliances such as the Herbst
and Forsus are most widely used in the U.S.
Headgears have been considered a gold standard
of Class II treatment because they are effective in
restraining forward and downward growth of the
maxilla. However, in the majority of Class II
patients the A-P position of the maxilla is normal
or retrusive. Therefore, using headgear alone to
treat Class II malocclusions may not be the most
appropriate option.

Case #1: 8-Year-Old Female
 Diagnosis: maxillary protrusion, full step Class
II malocclusion.
 Treatment considerations: Cephalometric
analysis showed a combination of maxillary
protrusion and mandibular retrusion. Diagnostic cast analysis showed a 3 mm skeletal
deficiency in maxillary width. Maxillary
expansion in combination with early A-P correction was recommended to improve lip
competency and prevent trauma to maxillary
incisors.
 Treatment rendered: Maxillary expansion with
RPE, 2*4 fixed appliance, high pull headgear,
retention with removable functional appliance in combination with nighttime headgear.
 Tips: Dr. Ngan recommended expansion in
conjunction with high-pull headgear; the
expander serves as a good anchor for restraining forward maxillary growth and preventing
buccal tipping of maxillary first molars. The
appliance was debonded after six months to
prevent oral hygiene issues. For retention,
headgear tubes were incorporated into the
removable functional appliance. The patient
was asked to wear the headgear at night,
in conjunction with the removable retainer,
to continue the orthopedic A-P corrections.
The retraction of maxillary incisors and headgear effects enabled the patient to gain lip
competence.

Case 1

62

PCSO Bulletin  Summer 2017



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