Two - Phase Therapy of a Severe Skeletal Class Ii Malocclusion
Arif Yezdani1Professor in Dept. of Orthodontics and Dentofacial Orthopaedics,Bharath University, Sree Balaji Dental College and Hospital, Narayanapuram, Pallikaranai,Chennai-600100.
Abstract: To evaluate the efficiency of a two-phase treatment of a preadolescent girl with a severe skeletal Class II malocclusion with an orthognathic maxilla and a retrognathic mandible with bi-maxillary dento-alveolar protrusion. Treatment involved an orthopedic phase of 2 years with a high-pull headgear and a maxillary intrusion splint followed by orthodontic treatment with pre-adjusted edgewise appliance, Roth’s prescription (0.022 X 0.028 - inch slot), with extraction of maxillary first premolars. The case was assessed at start of orthopedic treatment (T1), end of orthopedic treatment (T2), and end of orthodontic treatment (T3). At T2, the maxilla was restrained slightly and the overjet, deep bite and overexposure of maxillary incisors was reduced slightly with a normal mentolabial sulcus and relief of lower lip trap. The cephalometric changes at T2 revealed a slight reduction in the SNA angle with slight improvement in the sagittal position of the mandible. At T3, the inclination of the maxillary central incisors, overjet and overbite were normal and the soft-tissue profile improved dramatically. A severe skeletal Class II malocclusion with an orthognathic maxilla and retrognathic mandible was treated in two phases. In the initial orthopedic phase a high-pull head gear and maxillary intrusion splint was used to restrain the growth of maxilla and the overexposure of maxillary anteriors, and to promote normal growth of mandible. This was followed by a second phase of fixed appliance treatment with extraction of maxillary first premolars. This combination therapy resulted in good improvement of the soft tissue profile.
Keywords: Two-phase therapy; high-pull headgear; pre-adjusted edgewise appliance therapy Back to TOC