Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 49

Presentation Summary

Class II Management
A new paradigm- quality of life- enters into
the consideration of early treatment for Class II
malocclusions in the mixed dentition. Managing
potential psychological problems, reducing the
risk of increased trauma, and managing skeletal
hyperdivergence are likely the main reasons to
indicate a two-phase Class II treatment. Research
shows that over 200 million injuries to anterior
teeth per year are attributed to large overjet.
Headgear with a biteplate can be the appliance
of choice for Class II management. High-pull
headgears are indicated in cases of hyperdivergence. In hyperdivergent cases, functional
(MARA or Herbst type) appliances might best be
avoided, as the mandibular plane tends to open
more. A vertical chin cup and posterior dental
intrusion can also be utilized in addition to highpull headgear and a maxillary plastic splint
(Thurow appliance). TADs in the center of the
palate, with TPA and high-pull headgear, can also
aid in the improvement of these challenging
cases.
Class III Early Treatment
Whenever possible, we try to correct Class III
problems as early as they are detected. Class IIIs
can be treated nonsurgically with success and

Doctors

finished before the completion of skeletal
growth. However, it is important to recognize the
varying degrees of stability in Class III. Growth-
a partner in the correction of Class II malocclusions- is definitely the worst enemy in cases of
Class III. The most difficult Class III cases involve
obtuse gonial and chin angles. The odds of surgical intervention later becoming necessary are 3.5
times greater in the absence of early intervention
with reverse headgear according to recent studies.
Class III malocclusions can, of course, worsen
with time. Advise the family of the young patient
especially the amount thereof. We can probably
produce some growth redirection to a limited
extent in the more difficult cases. After Phase 1,
Dr. Araüjo likes to retain with a Velcro chin cup
and a "smart" Hawley in the upper arch, while
preserving the lower leeway space, which may
be very useful later. Early Class III management
often involves expansion of the upper arch,
wearing a facemask and a splint on the lower
arch, and Class III elastics to a hook on the upper
appliance. If possible, try to finish a Class III case
in a slight Class II relationship in the first phase
of management. 

Myths, Dogma, Untruths, and Unpredictability. . .
type of retainer can also be used in the maxillary
dental arch. The process utilizes scanned images
of the lingual surfaces of the teeth to be retained.

Acknowledgements
I would like to thank Drs. Jessica Stromme, Jung
Joo Park, and Dawn Pruzansky for their help with
the preparation of this summary. - Dr. Park
References
1. Bowman SJ. A quick fix for pseudo-Class III correction. J Clin Orthod 2008;42:691-697.

Spring 2018  PCSO Bulletin

continued from page 45

2. Huang GJ, Richmond S, Vig KW. Evidence-Based
Orthodontics. Oxford: Wiley-Blackwell, 2011.
3. Varrela J. Masticatory Function and Malocclusion:
A Clinical Perspective. Semin Orthod 2006;12:102-109.
4. Tollaro I, Baccetti T, Franchi L, Tanasescu CD. Role of
posterior transverse interarch discrepancy in Class II,
Division 1 malocclusion during the mixed dentition
phase. Am J Orthod Dentofacial Orthop 1996;110:417-422.
5. Premkumar S. Textbook of Orthodontics. New Delhi:
Elsevier, 2016.
6. Moskowitz EM, Park MB, Maestre, ME. Direct bonding of Ortho Flextech lingual retainers. J Clin Orthod
2004;38:554-556.

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018