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

o Increased interarticular space = vertical growth at the condyle

· = mandible grows forwards

· = counterclockwise rotation of mandbile

Principles of treatment:

· Extrude upper molars – correct steep posterior occlusal plane

o = Decompress condyle through creating interarticular space

· Correct overbite

o = if not anterior interference prevents forward growth of mandible

Distalise

1. Utility arch with tip back bend

a. =  distally tip upper molars

2. Utility arch with activation:

a. By obtuse bend (instead of perpendicular band) – activate by compressing wire on insertion

i. distalisation force on posterior teeth

ii.  advance anterior teeth  - Counter affects by class 2 elastics

Utility arch: 16x16 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 Orthopedics, 134(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 Orthopedics, 150(5), pp.771-781.