Protruding front teeth in children mean an important and potentially harmful orthodontic issue. This condition develops when children’s permanent teeth erupt and it is related to a little mandible with a retracted position, something which is called, class II.
Class II treatment
If the child turns to us at an early age to correct class II condition the orthodontist faces a dilemma, i.e. acting early or waiting for the child to grow up and acting as a teenager. Based on evidences we can see that children with protruding upper front teeth treated in two stages, that is, an early treatment, do not show any advantage over those treated in one single stage in their teens. That’s why, in Ortodoncia Friedländer prefer dealing with classes II as late as possible, since this treatment protocol shows two main advantages;
1. Our treatment are more efficient (shorter in time, cheaper and less unpleasant for the patient)
2. We find less class II recurrence (relapse after the treatment)
However, there are some conditions when we decide to act immediately to avoid tooth trauma, psychosocial problems (the child is the butt of everyone’s jokes at school, bullying), periodontal problems (gingiva conditions), etc…
Interesting information about class II with overjet
To be able to make decisions as a patient and as an orthodontist you need to know certain key features:
- You should consider an early treatment if the overjet is greater than 6mm (Index of Treatment Need, IOTN criteria). The treatment should be very brief and focused on overjet reduction.
- There is a greater risk of trauma of upper incisors, specially if lips are unfit. Most of trauma happen before the orthodontic treatment.
- Early treatment for class II as a part of a two stages therapy is rarely advised. It has not shown to be more efficient and it represents a greater expense and treatment time as compared to one single stage therapy at patient’s adolescence.
- When children undergo an early treatment they show 40% less probability to suffer a tooth trauma (of upper incisors).
- The early treatment improves face aesthetics and self-esteem, however these benefits are balanced at the adolescence with the late treatment.
- Functional appliances are quite efficient solving class II at incisal level (they reduce front overjet).
- Functional appliances do not change face pattern significantly.
- Upper extractions are a right solution to correct incisors relation. However there are different and very efficient methods to avoid extractions, as the distalization therapy using microscrews.
- There are no differences for the output between late fixed orthodontics and removable (early) appliances orthodontics.
- Treatments perform better with fixed appliances than with removable ones (fixed appliances do not require any patient’s collaboration).
- The average distalization distance with extraoral appliances is 1.6mm, with microscrews we already get 6 or 7mm, so there is no justification to use extraoral appliances, but in same cases with a specific indication (it requires a great deal of collaboration and it works worse.)
- The most important etiologic feature of class II is a little and retrusive mandible.
- Class II etiology is familial with a very reduced environmental component.
- No orthodontist nor dentist can make the mandible grow, for the time being.
- There are many mandibular advance appliances. One of the most efficient ones to correct class II is the Herbst’s appliance (it is the appliance we use the most for class II in teenagers).