Class II – detailed

➤ Bullying or psychosocial issues due to Class II features

• A child may experience bullying or teasing due to their protrusive incisors or Class II facial appearance. This is a significant indication for early treatment.

➤ Lower lip trap

• A lower lip trap will cause upper incisors to procline without the ability to correct itself.
• Early treatment is indicated to eliminate the lip trap, reduce the protrusive upper incisors and reduce the risk of dental and lip injury.

➤ Habits-induced overjet

• Habits such as thumb or digit sucking can cause proclination of the upper incisors and retroclination of the lower incisors leading to an increased incisor overjet Class II appearance.
• Habit cessation should be sufficient to correct the Class II incisors, however sometimes early treatment is required to assist the correction.

➤ Deep bite with palatal mucosa injury

• A deep overbite with a Class II malocclusion can cause the lower incisors to occlude the palatal mucosa. This will lead to pathologic mucosa stripping and early loss of incisors.

➤ Risk of dental or lip injury

• Approximately 30% chance of young children with a Class II malocclusion will have dental trauma. This injury is often minor and orthodontic treatment lessens the risk but does not eliminate it.
• Soft tissue irritation from a lower lip trap can cause lip abrasion.

Aesthetic concerns of protrusive incisors

• Aesthetic concerns are not necessarily linked to the severity of the problem however they can be a significant social handicap. (Jolley et al. 2010, Meyer-Marcotty et al. 2010)

Increased incisor overjet

• Whilst there is no strict overjet threshold for treatment, the IOTN (Brook and Shaw 1989) has defined a mild need at > 3.5mm, moderate need at > 6mm and severe need at > 9mm.

Deep bite with palatal mucosa injury

• A deep overbite with a Class II malocclusion can cause the lower incisors to occlude the palatal mucosa. This will lead to pathologic mucosa stripping and early loss of incisors.

Aesthetic concerns of the facial appearance

• A moderate to severe skeletal Class II can result in a reduced mandible and chin appearance that can be a psychological concern to the patient.

Any associated problems requiring treatment

• Crowding, crossbite, anterior open bite, deep bite etc.
• Obstructive sleep apnea, Condylar resorption, Pierre Robin Syndrome etc.

Risk of dental or lip injury

• Approximately 30% chance of young children with a Class II malocclusion will have dental trauma. This injury is often minor and orthodontic treatment lessens the risk but does not eliminate it.
• Soft tissue irritation from a lower lip trap can cause lip abrasion.