A Report On Clinical Orthodontic Treatment Of Angle Class Ⅱ And Skeletal Class Ⅱ Malocclusion

Objective: By compiling and summarizing the cases of various types of Angle malocclusion that I was responsible for treating throughout my training and postgraduate studies under the guidance of my teachers,I select 3 cases of patients with Angle Class Ⅱ and skeletal Class Ⅱ malocclusion to report.The clinical examination,model and X-ray cephalometric analysis,diagnosis,design,treatment process and results of these three cases are comprehensively reviewed and analyzed,and I report my personal experience of orthodontic treatment of adolescents and adult patients with Angle Class Ⅱ and skeletal Class Ⅱ malocclusion and its shortcomings,in order to better treat such patients in the future.Methods: From December 2020 to December 2022,among the 17 cases of various types of Angle malocclusion that I was responsible for the whole consultation under the guidance of First Affiliated Yiji Shan Hospital of Wannan Medical College orthodontic training base teachers,three patients with Angle Class Ⅱ and skeletal Class Ⅱ malocclusion were selected for summary report.Clinical examination was performed before treatment,photographs were taken before and after treatment,oral panoramic films and lateral cranial films were taken,and memory models were taken.Before treatment,according to clinical examination,model and X-ray cephalometric analysis,problems are listed,correct diagnosis is made,treatment goals are determined,reasonable treatment plan is given,and informed consent for orthodontic treatment is signed after fully communication with the patients.Case 1 An Angle Class Ⅱ and skeletal Class Ⅱ malocclusion in a female,13 years old,with late growth spurt.Normal maxillary position relative to cranial base,mandibular position relative to cranial base and maxillary recession,ANB angle 5.9 degrees,wits 2.4.cuspids and molars in distal-medial relationship,anterior teeth ⅡI degree deep and ovebite about 3 mm,moderate maxillary crowding,mild mandibular crowding,average growth pattern.Case 2 An Angle Class Ⅱ division2,skeletal Class Ⅱ malocclusion,male,21 years old,growth completion stage.Underdeveloped maxilla and mandible,mandibular recession,ANB 5.8 degrees,wits 5.9.Long development of mandibular ascending and mandibular body,deep chin-labial groove,distal-medial relationship of cuspids and molars,inwardly inclined anterior teeth with ⅡI degree deep overbite mild crowding of maxillary and mandibular dentition,severe low angle,mother with similar malocclusion.Case 3 An Angle Class Ⅱ division1,skeletal Class Ⅱ malocclusion,female,11 years old,pre-growth peak.The maxillary development was basically normal,the mandible was underdeveloped,and the lower jaw was receding.Open lips and teeth,ⅡI° deep overbite in the anterior,overjet about 9.5 mm,distal-medial relationship of the cuspid molars.ANB 6.1 degrees,wits 2.6,cervical bone analysis showed that the patient was in the CS2-CS3 stage,pre-growth peak,average growth type.Results: Case 1 Extraction of 14,24,35,45,MBT straight wire arch orthodontic technique,14 months of treatment.At the end of the orthodontic treatment,the relationship of the molars and tinea was normal,the upper and lower anterior teeth are aligned with the midline and in line with the facial midline,and the lateral appearance is significantly improved compared to before the orthodontic treatment.Case 2 MBT straight arch orthodontic technique without tooth extraction for 17 months.After treatment,the overbite and overjet were normal,shallow coverage,posterior teeth with neutral relationship,upper and lower anterior teeth were basically aligned with the midline,chin-labial sulcus became shallow,and the lateral appearance was improved compared with that before treatment.Case 3 Two-phase treatments,the first phase using functional orthodontic appliances to guide the lower jaw forward,the second phase proposed to use fixed orthodontic techniques.In the first phase,the Twin-Block functional appliance was used to guide the lower jaw forward in conjunction with functional training of the labial muscles for about 11 months.However,the increased labial inclination and protrusion of the upper central incisors after treatment may be due to the absence of an anterior labial arch for the maxillary portion of the Twin-Block aligner and the absence of simultaneous maxillary expansion.Conclusion: When designing the orthodontic treatment plan for patients with An’s class Ⅱ and skeletal class Ⅱ malocclusion,the orthodontist can take into account the patient’s stage of growth and development,the functional state of the jaw,and the growth type,and consider the three aspects of function,health and aesthetics according to the specific conditions of different patients,making full use of the characteristics and advantages of orthodontic treatment and the patient’s own developmental advantages to provide conditions and guarantee the best oral clinical treatment results for such patients.