Interception of class II division malocclusions Dr.BOUKHAZANI FDI MADRID 2017

Fouzi Boukhazani (1), Abdelhak Bennara (1), Nelson Oppermann (2), Fatma Si Ahmed (3)
(1) Assistant lecturer, Department of Orthodontics & Dento-Facial Orthopedics, Mustapha Pacha University Hospital, Algiers, Algeria.
(2) Visiting Professor, Department of Orthodontics, University of Illinois at Chicago, Chicago, USA.
(3) Professor, Department of Orthodontics & Dento-Facial Orthopedics, Mustapha Pacha University Hospital, Algiers, Algeria.
Various appliances have been proposed for the interception of Class II division 1
malocclusions. In this context, orthodontic trainers are claimed to unlock mandibular
growth and to correct functional associated disorders.
In this case report of 10-year-old girl diagnosed as Class II division 1 malocclusion, an
interceptive approach was decided using an orthodontic trainer with the mandible in
protruded position. At the end of this interceptive treatment, treatment changes have
been evaluated with lateral cephalograms superimposition between T0, T1 and T2.
After 12 months application, the orthodontic trainer has shown a good dento-skeletal
results but It required a good patient and parents compliance.
We concluded that the orthodontic trainers can be very useful for interceptive
procedures if a proper case and appliance selection are made and a good patient
compliance is obtained.
Key words: interception, class II division 1 malocclusion, trainers, unlock, compliance.
Abstract
The most frequent skeletal problem in class II division 1 malocclusions, in growing
patients, is mandibular retrognathia associated to functional disorders. Several
interceptions techniques and appliances have been proposed to eliminate functional,
mechanical and psychological interferences with mandibular growth.
In this context, orthodontic trainers are used to unlock mandibular growth and to
correct functional associated disorders.
The aim of this case report is to evaluate the skeletal and dento-alveolar effect of the
orthodontic trainer in 10 year-old girl diagnosed as class II division 1 malocclusion
associated to functional disorders. These treatments effects were evaluated with
superimposition of T0, T1 and T2 Cephalograms.
I. Introduction
II. Case description
III. Discussion
The orthodontic trainer with a compliant patient induced an interesting treatment results after 12 months application. It can be a real alternative to other
techniques and appliances for the correction of the class II division 1 malocclusions in growing patients specially in low income countries.
IV. Conclusion
The appliance choice:
Orthodontic trainers (Figure 5) are functional appliances which become active through
muscular forces and bring dentoalveolar and skeletal changes. They can be used to
obtain expansion by the correction of the tongue posture. Some types are used to treat
mandibular retrognathia because they are constructed in protruded position of the
mandible (Activator).
Figure 5: Orthodontic trainer effects
3:Eruption guide
4:Protrusion
correction
1:Lip bumper
2:Tongue
elevator
5:Deep bite correction
6:Mandible propulsion 7:Indirect
maxillary
expansion
1
2
3
4 5
6
7
The application of the orthodontic trainer induced a good dento-skeletal
results after 12 months comparing to the objectives visualized (VTO) before
the treatment (Figure 7). The same results were obtained in the study of DAS
and REDDY in India after 15 months and in the study of USUMEZ and coll in
Turkey after 13 months however these results required the patient sand the
parents compliance even in our case.
At the end of the interception, the corpus axis improved from 54mm to 62mm
which can be explained by the mandibular growth forward. The occlusal plan
was successfully reoriented as shown in the superimpositions. This
reorientation is a guarantee for the treatment results long term stability.
T0
T1
T2
1. Chen JY, Leslie AW, Niederman R. Analysis of efficacy of functional
appliances on mandibular growth. Am J Orthod Dentofacial Orthop
2002;122:470-6.
2. Das U M, Reddy D. Treatment effects produced by preorthodontic
trainer appliance in patients with class II division I malocclusion. J
Indian Soc Pedod Prev Dent 2010;28:30-3.
3. Mc Namara JA. Components of Class II malocclusion in children 8-
10 years of age. Angle Orthodontist 1981;51:177-202.
4. Tallgren, A. , R. Christiansen , M. M. Ash , and R. L. Miller . Effects
of a myofunctional appliance on orofacial muscle activity and
structures. Angle Orthod 1998. 3:249–258.
5. Usumez S, Uysal T, Sari Z, Basciftci FA, Karaman AI, Guray E. The
effects of early Preorthodontic trainer treatment on class II division I
patients. Angle Orthodontist 2004;74:605-9.
S E
Pre-treatment T0 After treatment T1 6 months laterT2
S E
Fig 1: Pre-treatment photos
Figure 2: Pre-treatment X rays
Figure 3: Treatment results
Figure 4: Post treatment X rays )
Figure 7: VTO and superimpositions
T0= before the interception
T1= end of the interception
T2 = 6 months after the end
of the interception
References
In our case, we had to cut the trainer posteriorly in order to allow the upper molars
extrusion to help the deep bite correction and to reorient the occlusion plan (Figure 6)
Figure 7: The used trainer