Abstract
Treatment of skeletal Cl II includes functional orthopedic treatment, head-gears, extraction of the upper premolars and orthognathic surgery. To treat any patient with functional appliances (bite jumping) an adequate overjet is necessary. In this case an 11 years old female patient has skeletal CLII due to mandibular deficiency with ANB angle 8 degrees, overbite: 3 mm, overjet: 1 mm, extremely convex profile and underdeveloped chin due to the hyper muscle contraction of the lower lip to obtain oral seal. To obtain an adequate overjet lower first premolars were extracted and maximum retraction using mini screws (for maximum anchorage) was applied. Afterwards Rahhal functional appliance was used by the patient 16 hours a day for 6 months and 10 hours a day for another 6 months for retention. After that fixed orthodontic treatment was completed. Lateral cephalometrics were taken, traced and analyzed. In the result Skeletal CLI was obtained (ANB 4 degree), straight facial profile, normal over bite overjet and particular chin development were noticed. As a conclusion, in skeletal CLII malocclusions, lower incisor protrusion will cause a contraindication for functional treatment. Extraction of the lower premolars and retraction of the lower incisors followed by functional orthopedic treatment is an efficient method to treat these cases instead of waiting for orthognathic surgery, also reducing the muscle pressure on the chin will change the development characteristics of it.
Highlights
Functional appliances have been used for over a century in the treatment of Class II patients [1]
In skeletal CLII malocclusions, lower incisor protrusion will cause a contraindication for functional treatment
Extraction of the lower premolars and retraction of the lower incisors followed by functional orthopedic treatment is an efficient method to treat these cases instead of waiting for orthognathic surgery, reducing the muscle pressure on the chin will change the development characteristics of it
Summary
Functional appliances have been used for over a century in the treatment of Class II patients [1]. Functional appliances can be removable or fixed [2]. The main objective of therapy with functional appliances is to induce supplementary lengthening of the mandible by stimulating increased growth at the condylar cartilage [2]. It has been demonstrated that the effectiveness of the functional treatment of mandibular growth deficiencies strongly depends on the biological responsiveness of the condylar cartilage, which in turn is associated with the growth rate of the mandible [3]. The stimulation of mandibular growth, distal movement of the upper dentition, and mesial movement of the lower dentition contribute to the correction of Class II malocclusion with the use of fixed functional appliances. Protruded lower incisors might cause contraindication for functional orthopedic treatment [4]
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