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Treatment of Class II in permanent dentition (the Bioprogressive approach) Sergio Sambataro Italy. Episode 16 June 22nd 2020

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Farooq Ahmed

Dr Sergio Sambataro describes the bioprogressive approach to managing the class 2 case

Class 2 aetiology: Sato 2008

  • Upper molars less erupted 
  • Lower molars more erupted

 

Occlusal objective for class 2 in bioprogressive technique:

  • Lower the posterior occlusal plane

 

Unlocking of growth:

  • Decompression theory
  •  Increased interarticular space = vertical growth at the condyle
  •     = mandible grows forward
  • counterclockwise rotation of mandbile

 

 

Principles of treatment:

  •  Extrude upper molars – correct steep posterior occlusal plane
  • Decompress condyle through creating interarticular space
  • Correct overbite
  • = if not anterior interference prevents forward growth of mandible

 

Distalise

  1. Utility arch with tip back bend   
    1. distally tip upper molars
  2. Utility arch with activation:
    1.  By obtuse bend (instead of perpendicular band) – activate by compressing wire on insertion
    2.  distalisation force on posterior teeth
      1. advance anterior teeth  – Counter affects by class 2 elastics

 

Utility arch: 16×16 Elgiloy =  low forces

 

Overall treatment entails the following:

·      Diagnosis 75%

·      Unlocking 20%

·      Mechanics 5%

 

 

 

 

 

 

References

 

Occlusal plane and aetiology

Tanaka, E.M. and Sato, S., 2008. Longitudinal alteration of the occlusal plane and development of different dentoskeletal frames during growth. American Journal of Orthodontics and Dentofacial Orthopedics134(5), pp.602-e1.

 

Ricketts textbook

Ricketts, R.M., 1998. Orthodontic treatment in the growing patient. Vol. I, pp.16-21.

 

Cervial headgear = greater AP change in class 2

Zervas, E.D., Galang-Boquiren, M.T.S., Obrez, A., Viana, M.G.C., Oppermann, N., Sanchez, F., Romero, E.G. and Kusnoto, B., 2016. Change in the vertical dimension of Class II Division 1 patients after use of cervical or high-pull headgear. American Journal of Orthodontics and Dentofacial Orthopedics150(5), pp.771-781.

 

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