I summarise Cesare's lecture looking at Class 2 subdivision cases with treatment options

classification:

· Type 1: Mandibular midline deviated from facial midline, Maxillary correct: 56-62%

· Type 2: Maxillary midline deviated facial midline, Mandibular correct 29% Cassidy 2014

Aetiology

· Type 1 subdivision: shorter mandible on affected side: Sanders 2010

Interceptive management

· RME = improved mandibular asymmetry by a mandibular rotation: Evangelista 2020:

Non extraction:

o Type 1 case (mandibular asymmetry)

o Single sided class 2 corrector, e.g. Monoscope

· Address aetiology: of a shorter mandible

· Type 2 case (maxillary asymmetry)

· Palatal finger spring active on the  1stmolar to distalise

· Pendulum appliance with occlusal rest on U4s

· TADs

o Placed:   buccal 5-6

o Ligation: Indirectly ligated to premolars

3. 1 premolar extraction

· Type 1 and type 2 cases

· Extract on the unaffected side

o Distalisation, Unilaterally activated TPA

o No cant Janson 2004

4. 3 premolar extractions

· Type 1  (mandibular asymmetry)

· 3 units:

o 2 upper units to manage class 2,

o 1 unit in the lower arch on unaffected side

· Outcome: Coincident CL and predicable Turpin 2005

References

Distalisation of intra-oral appliances + TADs

da Costa Grec, R.H., Janson, G., Branco, N.C., Moura-Grec, P.G., Patel, M.P. and Henriques, J.F.C., 2013. Intraoral distalizer effects with conventional and skeletal anchorage: a meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 143(5), pp.602-615.

Class 2 subdivision CBCT

Sanders, D.A., Rigali, P.H., Neace, W.P., Uribe, F. and Nanda, R., 2010. Skeletal and dental asymmetries in Class II subdivision malocclusions using cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics, 138(5), pp.542-e1.

Class 2 subdivision classification

Cassidy, S.E., Jackson, S.R., Turpin, D.L., Ramsay, D.S., Spiekerman, C. and Huang, G.J., 2014. Classification and treatment of Class II subdivision malocclusions. American Journal of Orthodontics and Dentofacial Orthopedics, 145(4), pp.443-451.

Extraction of 2 units Vs 1 for class 2 subdivision

Janson, G., Cruz, K.S., Woodside, D.G., Metaxas, A., de Freitas, M.R. and Henriques, J.F.C., 2004. Dentoskeletal treatment changes in Class II subdivision malocclusions in submentovertex and posteroanterior radiographs. American journal of orthodontics and dentofacial orthopedics, 126(4), pp.450-462.