Early management of class II division 2 malocclusion. Literature review
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This paper presents the most relevant information about the class II division 2 malocclusion (II / 2) described in the literature and different treatment options based on orthopedics. Class II malocclusion is characterized by mandibular retrognathism and / or prognathic maxillary which could affect the molar relationship and considering the dental component is subdivided into Type 1, characterized by vestibular inclination of all upper incisors and Type 2 with upper central incisors retroclined and vestibularized lateral incisors. It presents multifactorial etiology. As reported by the literature, the incidence of malocclusion Class II / 2 ranges from 3-12%. It is characterized by different vertical, transverse, facial, skeletal and dental features that differentiate it from other malocclusions, and thus make decisions on time. Therefore, early treatment of this type of malocclusion, can reduce the possibility of surgery, minimizec the severity of the alteration in stomatological system functions and improve the overall appearance of the patient. The goals of treatment are directed transversely performing maxillary expansion to allow correction in alteration of the axial inclination of the upper incisors and solve dental crowding, leading to a malocclusion class II / 1, for further mandibular advancement.
Keywords: Malocclusion, Class II Division 2, mixed dentition, functional orthopedics of the jaws.
Rodríguez-Manjarrés, C., & Padilla-Tello, M.-R. (2017). Early management of class II division 2 malocclusion. Literature review. Revista Estomatología, 23(2). https://doi.org/10.25100/re.v23i2.5788
1. Valencia A-M, Hurtado A-M, Hernández J-A. Tratamiento temprano de la mordida abierta anterior con aparatología ortopédica funcional. Reporte de caso. Rev. estomatol. 2014; 22:20-6.
2. Dolce C, Mansour DA, McGorray SP, Wheeler TT. Intrarater agreement about the etiology of Class II malocclusion and treatment approach. Am J Orthod Dentofacial Orthop 2012; 141:17-23.
3. Ghafari J-G, Haddad R-V. Cephalometric and dental analys is of Class II , Division 2 reveals various subtypes of the malocclusion and the primacy of dentoalveolar components. Semin Orthod
2014; 20:272-86.
4. Saldarriaga-Valencia JA, Alvarez-Varela E, Botero-Mariaca PM. Tratamientospara la maloclusión Clase II esquelética combinada. Rev CES Odont 2013; 26:145-59.
5. Silva-Esteves Raffo JF, Amez-Atapoma J, Bustinza-Gómez P. Tratamiento temprano de maloclusión II división 2: Reporte de un caso. Rev Estomatol Herediana. 2008; 18(2):118-22.
6. Pinos Luzuriaga A, Siguencia V, Bravo Calderón M. Tratamiento de Maloclusiones de clase II división 2. Revisión de la literatura. Revista Latinoamericana de Ortodoncia y Odontopediatría. FUENTE: http://www.ortodoncia.ws/ publicaciones/2015/art3.asp
7. Bishara SE. Class II Malocclusions: Diagnostic and clinical considerations with and without treatment. Semin Orthod 2006;12:11-24.
8. Hartsfield JK Jr. Genetics and orthodontics. In: Graber LW, Vanarsdall RL, Vig KWL, eds. Orthodontics: Current Principles and Techniques. 5th ed. Saint Louis: Elsevier Mosby; 2011: 139-56.
9. Isman E, Isman O, Aktan AM, Ciftci E, Topcuoglu T. Multiple tooth anomalies in a nonsyndromic patient with class II division 2 malocclusions: A case report and a literature review. Niger J Clin Pract 2015;18:563-8.
10. Lapatki BG, Klatt A, Schulte-Mönting J, Jonas IE. Dentofacial parameters explaining variability in retroclination of the maxillary central incisors. J Orofac Orthop 2007; 68:109-23.
11. Strang RHW. Class II Division 2 malocclusion. Angle Orthod 1958; 28:210-14.
12. Lapatki BG, Mager AS, Schulte-Moenting J, Jonas IE. The importance of the level of the lip line and resting lip pressure in Class II, Division 2 malocclusion. J Dent Res 2002; 8:323-8.
13. Peck S, Peck L, Kataja M. Class II Division 2 malocclusion: a heritable pattern of small teeth in well-developed jaws. Angle Orthod 1998; 68:9-20.
14. Ota K, Araj K. Prevalence and patterns of tooth agenesis in Angle Class II Division 2 malocclusion in Japan. Am J Orthod Dentofacial Orthop 2015; 148:123-9.
15. Basdra EK, Kiokpasoglou M, Stellzig A. The Class II Division 2 craniofacial type is associated with numerous congenital tooth anomalies. Eur J Orthod 2000; 22:529-35.
16. Pereira PM, Ferreira AP, Tavares P, Braga AC. Different manifestations of class II division 2 incisor retroclination and their association with dental anomalies. J Orthod 2013; 40:299-306.
17. Millett DT, Cunningham SJ, O’Brien KD, Benson PE, de Oliveira CM. Treatment and stability of class II division 2 malocclusion in children and adolescents: A systematic review. Am J Orthod Dentofacial Orthop 2012; 142:159-69.
18. Foster TD, Day AJ. A survey of malocclusion and the need for orthodontic treatment in a Shropshire school
population. Br J Orthod 1974; 1:73-8.
19. Markovic M. A genetic study of Class II Division 2 malocclusions. Eur J Orthod 2000; 22:453-4.
20. Myllärniemi S. Malocclusion in Finnish rural children An epidemiological study of different stages of dental development. Suom Hammaslaak Toim 1970; 66(5):219-64.
21. Massler M, Frankel JM. Prevalence of malocclusion in children aged 14 to 18 years. Am J Orthod 1951; 37: 751-68.
22. Katsavrias EG. Morphology of the temporomandibular joint in subjects with Class II Division 2 malocclusions. Am J Orthod Dentofacial Orthop 2006; 129:470-8.
23. Brezniak N, Arad A, Heller M, Dinbar A, Dinte A, Wasserstein A. Pathognomonic cephalometric characteristics of Angle Class II Division 2 malocclusion. Angle Orthod 2002; 72(3):251-7.
24. Bratu DC, Bălan RA, Szuhanek CA, Pop SI, Bratu EA, Popa G. Craniofacial morphology in patients with Angle Class II division 2 malocclusion. Rom J Morphol Embryol 2014; 55:909-13.
25. Reyes-Ramírez D, Etcheverry-Doger E, Antón-Sarabia J, Muñoz-Quintana G. Asociación de maloclusiones clase I, II y III y su tratamiento en población infantil en la ciudad de Puebla, México. Rev Tamé 2014; 2:175-9.
26. Al-Khateeb EA, Al-Khateeb SN. Anteroposterior and vertical components of class II division 1 and division 2 malocclusion. Angle Orthod 2009; 79(5):859-66.
27. Basciftci FA, Uysal T, Büyükerkmen A, Sari Z. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod 2003; 25:87-93.
28. Isik F, Nalbantgil D, Sayinsu K, Arun T. A comparative study of cephalometric and arch width characteristics of Class II division 1 and division 2 malocclusions. Eur J Orthod 2006; 28:179-83.
29. Bălan RA, Popa G, Biţă R, Fabricky M, Jivănescu A, Bratu DC. Alveolar and dental arch morphology in Angle Class II division 2 malocclusion: a comparative study. Rom J Morphol Embryol 2014; 55:1093-7.
30. Coskuner HG, Ciger S. Three-dimensional assessment of the temporomandibular joint and mandibular dimensions after early correction of the maxillary arch form in patients with Class II division 1 or division 2 malocclusion. Korean J Orthod 2015; 45:121-9.
31. Oltramari-Navarro PV, Janson G, de Oliveira RB, Quaglio CL, Castanha Henriques JF, de Carvalho Sales-Peres SH, McNamara JA Jr. Tooth-wear patterns in adolescents with normal occlusion and Class II Division 2 malocclusion. Am J Orthod Dentofacial Orthop 2010;137:730. e1-5; discussion 730-1.
32. Walkow TM, Peck S. Dental arch width in Class II Division 2 deep-bite malocclusion. Am J Orthod Dentofacial Orthop 2002; 122:608-13.
33. Palomino-Gómez SP, Almeida KM, de Mello PB, Restrepo M, Raveli DB. Efectos de los aparatos propulsores mandibulares fijos en la articulación temporomandibular. Rev CES Odont 2014; 27:82-92.
34. Chen JY, Will LA, Niederman R. Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 2002; 122(5):470-6.
35. Lorenzo Franchi; Tiziano Baccetti. Prediction of Individual Mandibular Changes Induced by Functional Jaw Orthopedics Followed by Fixed Appliances in Class II Patients. Angle Orthod. 2006;76:950-4.
36. Singh MG, Vashisth P, Chaudhary S, Sinha A. Early treatment outcomes of class II malocclusion with twin-block facial profile and cephalometric changes. J Oral Biol Craniofac Res 2012;2:61-6.
37. Bock NC, Ruf. S. Class II division 2 treatment – does skeletal maturity influence success and stability?. J Orofac Orthop 2013;74:187-204.
38. Sabri R. Treatment of a Class II Division 2 malocclusion with space reopening for a single-tooth implant. Am J Orthod Dentofacial Orthop 2001;119:135-42.
39. Gómez Ávila R, Arias Araluce M, López Méndez Y, González Valdés D. Disyunción Maxilar Rápida con Tornillo Hyrax Modificado. Rev Cubana Ortod 1999;14:27-31.
40. Mata J, Zambrano F, Quirós O, Farias, M, Rondón, S, Lerner H. Expansión Rápida de Maxilar en Maloclusiones Transversales: Revisión Bibliográfica. Revista Latinoamericana de Ortodoncia y Odontopediatría. Ortodoncia.ws edición electrónica Septiembre 2007. Obtenible en: www.ortodoncia.ws. Consultada 19/11/2015. 41. Arias Araluce M, González Fernández M, García González B. Consideraciones prácticas para la construcción de pistas planas. Rev Cubana Ortod 2000;15:61-5.
42. Petrović D, Vujkov S, Petronijević B, Šarčev I, Stojanac I. Examination of the bioelectrical activity of the masticatory muscles during Angle’s Class II division 2 therapy with an activator. Vojnosanit Pregl. 2014;71:1116-22.
43. Bedoya A, Chacón A. Tratamiento temprano de maloclusiones clase II tratado con Activador Abierto Elástico de Klammt (AAEK). Reporte de caso. Rev Estomat 2009; 17:23-29.
44. Simoes WA. Ortopedia Funcional de los Maxilares. A través de la Rehabilitación Neuro - Oclusal. Tercera edición. Artes Médicas Latinoamérica: São Paulo; 2004.
45. Tedaldi J, Calderón R., Mayora L, Quirós O, Farias M, Rondón S, Lerner H. Tratamiento de Maloclusiones según el estadio de maduración carpal - Revisión Bibliográfica. Revista Latinoamericana de Ortodoncia y Odontopediatría. Ortodoncia. ws edición electrónica 2007. Obtenible en: www.ortodoncia.ws. Consultada 19/11/2015.
46. Pancherz H, Ruf S, Kohlhas P. “Effective condylar growth” and chin position changes
in Herbst treatment. A cephalometric roentgenographic long-term study. Am J Orthod 1998;114:437-46.
47. Eberhard H, Hirschfelder U. Treatment of Class II, division 2 in the late growth period. J Orofac Orthop 1998; 59:352-61.
48. Obijou C, Pancherz H. Herbst appliance treatment of Class II division 2 malocclusions. Am J Orthod Dentofacial Orthop 1997;112:287-91.
49. Schweitzer M, Pancherz H. The incisorlip relationship in Herbst/Multibracket appliance treatment of Class II division 2 ma loc c lus ions . Angl e Or thod 2001;71:358-63.
50. Ferrazzini G. Class II/2 malocclusion: early treatment with removable appliances and stability after 20 years. Schweiz Monatsschr Zahnmed 2008;118:814-9.
51. Julia Von Bremen, Pancherz. H. Efficiency of Class II Division 1 and Class II Division 2 Treatment in Relation to Different Treatment Approaches. Semin Orthod 2003;9: 87-92.
52. Yousefian J, Trimble D, Folkman G. A new look at the treatment of Class II Division 2 malocclusions. Am J Orthod Dentofacial Orthop 2006;130:771-8.
2. Dolce C, Mansour DA, McGorray SP, Wheeler TT. Intrarater agreement about the etiology of Class II malocclusion and treatment approach. Am J Orthod Dentofacial Orthop 2012; 141:17-23.
3. Ghafari J-G, Haddad R-V. Cephalometric and dental analys is of Class II , Division 2 reveals various subtypes of the malocclusion and the primacy of dentoalveolar components. Semin Orthod
2014; 20:272-86.
4. Saldarriaga-Valencia JA, Alvarez-Varela E, Botero-Mariaca PM. Tratamientospara la maloclusión Clase II esquelética combinada. Rev CES Odont 2013; 26:145-59.
5. Silva-Esteves Raffo JF, Amez-Atapoma J, Bustinza-Gómez P. Tratamiento temprano de maloclusión II división 2: Reporte de un caso. Rev Estomatol Herediana. 2008; 18(2):118-22.
6. Pinos Luzuriaga A, Siguencia V, Bravo Calderón M. Tratamiento de Maloclusiones de clase II división 2. Revisión de la literatura. Revista Latinoamericana de Ortodoncia y Odontopediatría. FUENTE: http://www.ortodoncia.ws/ publicaciones/2015/art3.asp
7. Bishara SE. Class II Malocclusions: Diagnostic and clinical considerations with and without treatment. Semin Orthod 2006;12:11-24.
8. Hartsfield JK Jr. Genetics and orthodontics. In: Graber LW, Vanarsdall RL, Vig KWL, eds. Orthodontics: Current Principles and Techniques. 5th ed. Saint Louis: Elsevier Mosby; 2011: 139-56.
9. Isman E, Isman O, Aktan AM, Ciftci E, Topcuoglu T. Multiple tooth anomalies in a nonsyndromic patient with class II division 2 malocclusions: A case report and a literature review. Niger J Clin Pract 2015;18:563-8.
10. Lapatki BG, Klatt A, Schulte-Mönting J, Jonas IE. Dentofacial parameters explaining variability in retroclination of the maxillary central incisors. J Orofac Orthop 2007; 68:109-23.
11. Strang RHW. Class II Division 2 malocclusion. Angle Orthod 1958; 28:210-14.
12. Lapatki BG, Mager AS, Schulte-Moenting J, Jonas IE. The importance of the level of the lip line and resting lip pressure in Class II, Division 2 malocclusion. J Dent Res 2002; 8:323-8.
13. Peck S, Peck L, Kataja M. Class II Division 2 malocclusion: a heritable pattern of small teeth in well-developed jaws. Angle Orthod 1998; 68:9-20.
14. Ota K, Araj K. Prevalence and patterns of tooth agenesis in Angle Class II Division 2 malocclusion in Japan. Am J Orthod Dentofacial Orthop 2015; 148:123-9.
15. Basdra EK, Kiokpasoglou M, Stellzig A. The Class II Division 2 craniofacial type is associated with numerous congenital tooth anomalies. Eur J Orthod 2000; 22:529-35.
16. Pereira PM, Ferreira AP, Tavares P, Braga AC. Different manifestations of class II division 2 incisor retroclination and their association with dental anomalies. J Orthod 2013; 40:299-306.
17. Millett DT, Cunningham SJ, O’Brien KD, Benson PE, de Oliveira CM. Treatment and stability of class II division 2 malocclusion in children and adolescents: A systematic review. Am J Orthod Dentofacial Orthop 2012; 142:159-69.
18. Foster TD, Day AJ. A survey of malocclusion and the need for orthodontic treatment in a Shropshire school
population. Br J Orthod 1974; 1:73-8.
19. Markovic M. A genetic study of Class II Division 2 malocclusions. Eur J Orthod 2000; 22:453-4.
20. Myllärniemi S. Malocclusion in Finnish rural children An epidemiological study of different stages of dental development. Suom Hammaslaak Toim 1970; 66(5):219-64.
21. Massler M, Frankel JM. Prevalence of malocclusion in children aged 14 to 18 years. Am J Orthod 1951; 37: 751-68.
22. Katsavrias EG. Morphology of the temporomandibular joint in subjects with Class II Division 2 malocclusions. Am J Orthod Dentofacial Orthop 2006; 129:470-8.
23. Brezniak N, Arad A, Heller M, Dinbar A, Dinte A, Wasserstein A. Pathognomonic cephalometric characteristics of Angle Class II Division 2 malocclusion. Angle Orthod 2002; 72(3):251-7.
24. Bratu DC, Bălan RA, Szuhanek CA, Pop SI, Bratu EA, Popa G. Craniofacial morphology in patients with Angle Class II division 2 malocclusion. Rom J Morphol Embryol 2014; 55:909-13.
25. Reyes-Ramírez D, Etcheverry-Doger E, Antón-Sarabia J, Muñoz-Quintana G. Asociación de maloclusiones clase I, II y III y su tratamiento en población infantil en la ciudad de Puebla, México. Rev Tamé 2014; 2:175-9.
26. Al-Khateeb EA, Al-Khateeb SN. Anteroposterior and vertical components of class II division 1 and division 2 malocclusion. Angle Orthod 2009; 79(5):859-66.
27. Basciftci FA, Uysal T, Büyükerkmen A, Sari Z. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod 2003; 25:87-93.
28. Isik F, Nalbantgil D, Sayinsu K, Arun T. A comparative study of cephalometric and arch width characteristics of Class II division 1 and division 2 malocclusions. Eur J Orthod 2006; 28:179-83.
29. Bălan RA, Popa G, Biţă R, Fabricky M, Jivănescu A, Bratu DC. Alveolar and dental arch morphology in Angle Class II division 2 malocclusion: a comparative study. Rom J Morphol Embryol 2014; 55:1093-7.
30. Coskuner HG, Ciger S. Three-dimensional assessment of the temporomandibular joint and mandibular dimensions after early correction of the maxillary arch form in patients with Class II division 1 or division 2 malocclusion. Korean J Orthod 2015; 45:121-9.
31. Oltramari-Navarro PV, Janson G, de Oliveira RB, Quaglio CL, Castanha Henriques JF, de Carvalho Sales-Peres SH, McNamara JA Jr. Tooth-wear patterns in adolescents with normal occlusion and Class II Division 2 malocclusion. Am J Orthod Dentofacial Orthop 2010;137:730. e1-5; discussion 730-1.
32. Walkow TM, Peck S. Dental arch width in Class II Division 2 deep-bite malocclusion. Am J Orthod Dentofacial Orthop 2002; 122:608-13.
33. Palomino-Gómez SP, Almeida KM, de Mello PB, Restrepo M, Raveli DB. Efectos de los aparatos propulsores mandibulares fijos en la articulación temporomandibular. Rev CES Odont 2014; 27:82-92.
34. Chen JY, Will LA, Niederman R. Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 2002; 122(5):470-6.
35. Lorenzo Franchi; Tiziano Baccetti. Prediction of Individual Mandibular Changes Induced by Functional Jaw Orthopedics Followed by Fixed Appliances in Class II Patients. Angle Orthod. 2006;76:950-4.
36. Singh MG, Vashisth P, Chaudhary S, Sinha A. Early treatment outcomes of class II malocclusion with twin-block facial profile and cephalometric changes. J Oral Biol Craniofac Res 2012;2:61-6.
37. Bock NC, Ruf. S. Class II division 2 treatment – does skeletal maturity influence success and stability?. J Orofac Orthop 2013;74:187-204.
38. Sabri R. Treatment of a Class II Division 2 malocclusion with space reopening for a single-tooth implant. Am J Orthod Dentofacial Orthop 2001;119:135-42.
39. Gómez Ávila R, Arias Araluce M, López Méndez Y, González Valdés D. Disyunción Maxilar Rápida con Tornillo Hyrax Modificado. Rev Cubana Ortod 1999;14:27-31.
40. Mata J, Zambrano F, Quirós O, Farias, M, Rondón, S, Lerner H. Expansión Rápida de Maxilar en Maloclusiones Transversales: Revisión Bibliográfica. Revista Latinoamericana de Ortodoncia y Odontopediatría. Ortodoncia.ws edición electrónica Septiembre 2007. Obtenible en: www.ortodoncia.ws. Consultada 19/11/2015. 41. Arias Araluce M, González Fernández M, García González B. Consideraciones prácticas para la construcción de pistas planas. Rev Cubana Ortod 2000;15:61-5.
42. Petrović D, Vujkov S, Petronijević B, Šarčev I, Stojanac I. Examination of the bioelectrical activity of the masticatory muscles during Angle’s Class II division 2 therapy with an activator. Vojnosanit Pregl. 2014;71:1116-22.
43. Bedoya A, Chacón A. Tratamiento temprano de maloclusiones clase II tratado con Activador Abierto Elástico de Klammt (AAEK). Reporte de caso. Rev Estomat 2009; 17:23-29.
44. Simoes WA. Ortopedia Funcional de los Maxilares. A través de la Rehabilitación Neuro - Oclusal. Tercera edición. Artes Médicas Latinoamérica: São Paulo; 2004.
45. Tedaldi J, Calderón R., Mayora L, Quirós O, Farias M, Rondón S, Lerner H. Tratamiento de Maloclusiones según el estadio de maduración carpal - Revisión Bibliográfica. Revista Latinoamericana de Ortodoncia y Odontopediatría. Ortodoncia. ws edición electrónica 2007. Obtenible en: www.ortodoncia.ws. Consultada 19/11/2015.
46. Pancherz H, Ruf S, Kohlhas P. “Effective condylar growth” and chin position changes
in Herbst treatment. A cephalometric roentgenographic long-term study. Am J Orthod 1998;114:437-46.
47. Eberhard H, Hirschfelder U. Treatment of Class II, division 2 in the late growth period. J Orofac Orthop 1998; 59:352-61.
48. Obijou C, Pancherz H. Herbst appliance treatment of Class II division 2 malocclusions. Am J Orthod Dentofacial Orthop 1997;112:287-91.
49. Schweitzer M, Pancherz H. The incisorlip relationship in Herbst/Multibracket appliance treatment of Class II division 2 ma loc c lus ions . Angl e Or thod 2001;71:358-63.
50. Ferrazzini G. Class II/2 malocclusion: early treatment with removable appliances and stability after 20 years. Schweiz Monatsschr Zahnmed 2008;118:814-9.
51. Julia Von Bremen, Pancherz. H. Efficiency of Class II Division 1 and Class II Division 2 Treatment in Relation to Different Treatment Approaches. Semin Orthod 2003;9: 87-92.
52. Yousefian J, Trimble D, Folkman G. A new look at the treatment of Class II Division 2 malocclusions. Am J Orthod Dentofacial Orthop 2006;130:771-8.
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