Clinical Assessment & Presentations
Extra-oral Features
Start your assessment by looking at the patient’s extra-oral features.
Retrusive mandible and chin
The facial profile should be one of the first assessments for an orthodontic patient as it highlights the skeletal base and soft tissue relationships on which a dental malocclusion may be present. A convex facial profile is indicative of a skeletal Class II relationship.
A clinical profile view of a patient with a retrognathic mandible and chin. There is pronounced facial convexity highlighting the underlying skeletal Class II pattern. (Adapted from Posnick 2015)
The lateral cephalograph of the same patient confirming a significant Class II skeletal base with a hypoplastic mandible and reduced hard tissue pogonion (chin) prominence. (Adapted from Posnick 2015)
Lower lip trap, everted lower lip and/or facially protrusive upper incisors
Adverse lip patterns can often be present with severe Class II incisors and they may also prevent its correction. Facially protrusive incisors are indicative of severely protrusive upper incisors or a very retrusive mandible. If these are present, they are often a patient’s chief concern because of their significant impact to the facial and dental aesthetics.
Intra-oral Features
Class II incisors relationship
The incisor relationship is a key intra-oral feature as it often the most prominent component of a Class II malocclusion and will often be part of the patient’s chief concerns. The incisor relationship should be addressed in its entirety during orthodontic treatment.
Incisor overjet
Not all dental Class II malocclusions are associated with an increased incisor overjet. A Class II div 2 incisor relationship has minimal overjet due to crowding and retroclined incisors. Orthodontic treatment will usually convert Class II div 2 incisors into Class II div 1 incisors and hence an incisor overjet will develop that needs to be addressed.
Class II canine relationship
The canine relationships are indicative of the incisor relationships. Left and right canine relationships may be asymmetric due to dental or skeletal displacement. Correction of the canine relationship is often required to enable incisors correction.
Class II molar relationship
Angle’s molar classification is the original method of assessing a Class II malocclusion and still acts as a cornerstone of dental malocclusion classifications. The molar positions are however variable and may not be reflective of the overall malocclusion. Molar drifting can occur due to crowded or missing teeth. Asymmetric left and right molar relationships are often present as well.
