Class II treatment in orthodontics

Abstract

T he diagnosis, treatment, and retention of Class II malocclusions have been a constant source of study and discussion since they comprise a large segment of an orthodontist’s practice. Treatment results may range from successes to improvements to failures. Patient motivation is a prime factor in the successful treatment of any malocclusion, but it is particularly essential when one is working with severe Class II malocclusions. It is convenient to learn at an early date whether the patient desires to have the work done or whether it is being done in compliance with the parents’ wishes. Is the child cooperative at school and at home. Will there be cooperation during treatment, or only occasionally and then under pressure? These are some nonchemical factors that spell success or failure in the treatment of Class II cases. Changing the occlusion from Class II to normal by means of extraoral traction is a gratifying procedure. If it is done at an advantageous age when malocclusion and skeletal relations are not too severe, excellent results can often be achieved. When the mixed-dentition age is past and the Class II malocclusion is severe, when maxillary second molars have erupted or are in the process of erupting, more realistic measures must be taken for correction if treatment and retention are to be successful. The banding of all erupted teeth in both arches is not only advocated but, is necessary in many cases and has proved to be a time saver in practically every complicated Class II case. In most cases, banding of mandibular second molars is generally accepted as necessary for adequate leveling ; however, the banding of maxillary second molars is viewed differently and, when proposed, often causes mixed reactions. It is not easy to rotate, torque, and move distally, lingually, or buccally erupting maxillary second molars without banding them (Fig. I). Roth’ reports that the lingual cusps of many maxillary unbanded second permanent molars are frequently the main cause of the balancing contacts that are sometimes associated with a painful temporomandibular joint (TMJ) syn-