I / etiology AND DEFINITION

1 / etiology [17] [4]

Cl II div1 is a multiple original dysmorphia: hereditary, congenital skeletal, functional, traumatic and
possibly thrapeutique.Elle is the result of a dysmorphosis of different functional components of the
face.
This dysmorphia may be due to a skeletal problem locates at:
- Maxillary one: either a maxillary protrusion or pro-alveolie maxilla
- Mandibular one: either a microwave or a retro-mandibulie mandibulie,
-or maxillomandibular.
As it can be due to a problem alveolar:
-by pro-alveolie maxillary
-or retro-mandibular alveolie.
functional components of the face:
1: roof and base of the skull;
2: maxilla and nasal complex maxilla;
3: mandible;
4: teeth and maxillary alveolar process;
5: teeth and mandibular alveolar process.
2 / DEFINITION [17] [4]
Cl II div1 is dysmorphosis the sagittal characterized by a lower arch disttion-position relative to the
upper arch.
Its symptomatology is characterized by:
- The molars and / or canines Cl II angle.
- Incisors exhibit proclination with over jet increases: the definition of Division 1.
Skeletal level report can be bone bases in skeletal Cl I and Cl II skeletal Ballard. This shift will be
defined by an angular measurement; this is the angle ANB .For Cl Ballard, ANB is between 0 and 4,
while for the IC II Ballard, ANB is> 4.
Furthermore, the sagittal direction can be either isolated or associated with vertical and / or transverse.
A / vertically
It will be defined by its three components:
a / skeletal component
We distinguish three typologies:
-type open bite associated with posterior growth
-type deep bite associated with a previous growth
normal-type associated with a mean increase
b / the dental-alveolar component
This component is indicated by the orientation of the occlusal plane (p.o.)
c / the skin component
This component will have a decisive influence in the appearance of the smile.
B / crosswise
This is the jaw that is most often affected:
-If the basal floor which is a key ona endo-ghnatie,
-If the alveolar stage that is key is the endo-alvolie.
The transverse problem may be unilateral or bilateral and affect the situation and the horizontality of
the occlusal plane.
It is indeed a three dimensional interrelationship that must be examined in the three spatial sense.
Therefore examining the Cl II div1 should not be limited to the antero-posterior direction but only

needs to be pushed transversely and vertically, without any time to neglect dental anomalies of
position, shape and number.
II / DIAGNOSTIC AND THERAPEUTIC APPROACH
1 / IMPORTANCE OF DIAGNOSIS [17] [4]
Therapeutic Cl II Div 1 Gugino asserts the primacy of diagnosis in the therapeutic success. Indeed for
Gugino:
75% treatment success is attributed to diagnosis.
20% treatment success, returning to the consistency of therapeutic steps.
-5% Is the fate of the manufacture, installation and activation of the mechanical system.
For Gugino, diagnosis seven steps:
A / clinical examination.
B / constitution of orthodontic folder (casts, radiographs, photographs ...).
Ray examination, we have:
a- Norma -lateralis: this item will be used for angular and linear analyzes that quantify
abnormalities in the sagittal direction while the localized architectural analysis.
Jean Delaire's analysis is based on the construction of [11] [12]:
-four cranial lines:
C1: craniofacial baseline,
C2: the cranial height,
C3: the top line of the base of the skull,
C4: the basal slope.
-and eight craniofacial lines:
CF1: line balance craniofacial anterior,
CF2: line average craniofacial balance,
CF3: line balance craniofacial later,
CF4: craniofacial cleft online
GF5: d anterior vertical facial balance online
CF6: occipital-mandibular line,
CF7: occipital-occlusal line,
CF8: line facial balance antero-posterior.
The architectural analysis of Delaire
b / Norma-maxialis: will help to objectify the cross bite, the exo-alveolies and compensation.
c / Orthopantomography: enumerates the list of dental formula, agenesis ...
d / X-ray of the hand will allow us to place the child on the growth curve and estimate its residual
growth.
C / document exploitation
D / skeletal diagnosis based on the cephalometric analysis
E / the description of the face
F / Evaluation of soft tissue, skin and mucous membrane.
G / functional diagnostics
2 / ROUTE DIFFICULTY AND CURVE Gauss [12] [17]
It s d a standardized and systematic approach .in its approach (zero-based orthodontics) or zero
baseline, Gugino calls each practitioner to develop his personal baseline ie cases where the same
diagnostic procedures are conducted in a systematic way. This is the principle approach to bioprogressive zero-based philosophy that is based on a management information system (see the
Gaussian curve).

Gauss curve illustrating the basic line 0.

3 / THE DIFFERENTIAL DIAGNOSIS [9]
The differential diagnosis of Cl II div1 must be:
-with the mesio-positions 16 and 26
-with the Cl molar I accompanied a top pro-alveolie
-between classes Angle and skeletal classes Ballard.
4 / DIAGNOSIS AND FORMS ANATOMICAL [2] [17]
There are four anatomical shapes in dysmorphia of Cl II div1.
The skeletal shapes are pro-maxillie and retro-mandibulie.
The forms are the alveolar pro-alveolie maxillary and mandibular retro alveolie.
A / pro-maxillie
In this anatomical shape is the maxillary advance or lengthens while the mandible is normal in
position and dimension:
-ANB Is significantly increased following a SNA increases.
-an upper procheilie with a nasolabial angle closes.

The pro-maxillie
B / mandibulie the retroThe maxilla is normal in position and dimension while the mandible is too short
-ANB Is reduced given that SNB is reduced
-The profile is marked by:
- A retro-cheilie lower
- A retro-engineering,
- A neck-chin distance diminished.

the retro-mandibulie

C / pro-alveolie maxillary
The convex profile is associated to a higher pro-cheilie.
The nasolabial angle is firm.
The incisors are hallways, sometimes visible with the presence of a diastema inter incisive.
The angle I / F is increased> 107.

The pro-alveolie maxillary

D / the retro-mandibular alveolie
The profile is characterized by a lower-reto cheilie.
The IMPA angle is reduced.

We also note the presence of a lower footprint.

The retro-mandibular alveolie

III / THERAPEUTIC APPROACHES

1 / OBJECTIVES [5] [6] [12] [15]
The method offers the Bioprogressive O.V.T: visual treatment objective. The fact O.V.T intergrer
future growth with the expected therapeutic effects.
In therapeutic approaches equilibrium and harmony research. The patient should be considering as a
whole taking into account its growth and maturation.
For Ricketts, the seven harmonies are sought:
-Facial,
-Functional,
-Occlusale,
-Skeletal,
-Psychological,
-Nutritionnel,
And time.
Diagram ideal proportion of Leonardo Davinci
Ricketts, took the pattern of ideal proportions by Leonardo da Vinci as emblematic of his method.
2 / THERAPEUTIC PRINCIPLES [4] [9] [10] [15] [16] [20]
* Patrick Fallus emphasizes early orthodontics. The latter has a positive psychological impact on the
child. Thus the child will avoid saillure and mockery. This approach is a subject of much speculation:
There are supporters of the concept in two stages: this is the Bioprogressive school (Ricketts, Gugino,
Hilgers ...)
Supporters of the concept in one time: it is the classical school, who claims he must wait until the
establishment of the mixed dentition.
The aggressive therapy should be avoided. The ideal age for a first evaluation is around the age of 5 or
6 years.
* All ideas agree that the therapy of Cl II div1 has an adult can not be qu'orthodontiquement and / or
orthodontic-surgical. .
* Do not neglect any time, the importance of re-evaluation and its contribution to the restoration and
preservation of a neutral functional envelope in which the teeth and arches evolve and position.
* Gugino as a therapeutic project based on the principle:
Plan, organize, direct, control, agrees with many biomcaniste, telque, Evion, Marcotte ...
* To save the therapeutic and minimize possible case of recurrence acquired, it is necessary to use
restraint.
The contention must be scalable and must take into account the age, degree and extent of dysmorphia.
* The extractions will be avoided in deciduous dentition and young mixed dentition within the limits
of the possible. treatment without extractions are then distinguished versus treatment with extractions.

* The treatment of ClIInecessite in some cases the back molars maxillaires.pour do this, we have: -the
intraoral devices telque: the palatal bar, pendulum of Hilgers ...
-the extra-oral devices telque: F.E.O, F.D
-the intra-arcade devices telque: mini-screws and screwed palques
- Inter-mechanical devices arcade telque Cl II, D.A.C, Herbest rod.
* Three-dimensional approach to evil occlusion: Boussarhal fact incorporate skin components and
dental-alveolar components in its three-dimensional approach to bad occlusion. It highlights the
importance of a clean individualized therapeutic outcome of each study patient in the three directions
of space. It starts with defining the problem and determines the objectives and why it adapts means
necessary.
* For McNamara, therapy must seek to enhance the profile and the faces of our little patients and not
flatten by a false diagnosis .In effect according McNamara 2/3 of patients examined subjects Cl II,
have a jaw position retrusive, some of them also have a retrusive mandible because of the posterior
mandibular growth. Only 10% have a protrusive maxillary .So McNamara Gugino and invite us to
rethink the concept of correction Cl II. In retroghnatie mandibular they suggest to start by reviewing
the transverse direction (locking latch) in addition to sagittal and vertical problem. Realizing the cross
unlock will release the mandible which will allow him to reposition previously. The hyper growth is
even desired because it forces the mandible to propel to allow harmony between the transverse
diameters of the two arcades; what will settle most often by class relations I.
logical sequence in Orthodontic Therapy Indivi-dualized.
IV / THE REVALUATION [12] [15]
1 / OBJECTIVES OF TREATMENT
During this review we must seek cures criteria and treatment objectives to which we must approach
and / or to which we must lead. We must seek to sustain treatment outcome:
A / clinically
a / Profile:
The profile must be standardized in relation to the initial situation, without ambition in the case of
micro mandibulie e moderate and in the case of mandible "rocking chair"
b / smile: [11]
The smile line should be closer to normality .From same smile must look front and side
c / The occlusal equilibrium:
The occlusal equilibrium must be checked static and dynamic state. Dental friction in lateral must
ensure both a physiological mastication (M.U.A) and a compression processing. In adult teeth an extra
grinding may prove to be necessary to canine level to release the mandibular body language; even in
case of interference at the second lower molars to facilitate chewing and save the temporomandibular
joints.
d / functions:
swallowing, phonation, chewing, posture and breathing must be standardized to ensure a healthy
physiology.
B / Radiologically
The architectural balance must be sought through:
a / x-rays:
* The profile tele-radiography; it must be done: before, during, and after treatment all at the end of
treatment to check the clinical improvement and the need to make any corrections.
* Panoramic radiography should be used to check the parallelism of the axes after dental leveling and

end of treatment.
b / overlays cephalometric tracings:
These overlays will be helpful at different stages:
- Before treatment to diagnosis
- In the course of treatment to see any improvements
at the end of treatment to ensure healing: orthopedic, orthodontic or orthodontic and surgical.
then distinguished and following dental age and specifically in mixed dentition and in case of correct
treatment:
-If the Cl II is related to an overall upper alveolar protrusion and / or an overall lower retroalveolie
well as in cases of maxillary protrusion return to the normal is a necessity required.
-if the world and short, it is more demanding with brachy corpies that with hyporamies.
-If the dental-alveolar compensation supperior by superior dental distoversion be tolerable and nonpathogenic with an upper and lower inter-molar angle should not exceed 180 .
Bone improvement should enable a child to be able to join the lips without difficulty or effort thus
enabling a physiological incisor contact; what will their return their vocation comparator occlusal.
2 / JUSTIFICATION OF THE RE-EVALUATION [15]
Always, keep in mind that the clinical cure does not mean healing of orthopedic or importance of the
revaluation. Indeed, the revaluation should be done for three reasons:
A / Iatrogenic compensation:
it is linked to a distoversion maxillary teeth, hardly noticeable to the naked eye made of the rate of
cell renewal that surrounds the dental organ in his alvolodentaire site, and that according to the work
of Baron.
B / Anatomical variety of Cl II skeletal:
Delaire out shows that different skeletal units of the mandible does not have the same adaptive
capacity ie the body of growing global and more suggestible than Ramus. Consequently voice if a
bone lag persists after treatment and detected during the reassessment must then continue orthopedic
treatment hoping solicit more mandibular corpus.
C / biological heterogeneity:
based on the physiological basis of growth (rate, amount and direction) and for patient with the same
variety of bad occlusion; Lavergne and Petrovic have distinguished six categories of growth was
slower fastest: it's biological heterogeneity.
V / GROWTH AND THERAPEUTIC CONSEQUENCES [19]
Maxillofacial growth and in direct relation to the growth in stature of the child.
Gugino to move teeth without knowing anything about growth is c drive a boat without worrying
about the speed and direction of the current.
For this author the basis of a successful treatment plan and precise and perfect knowledge of the
probability of the patient's growth and its future typology.
Curve of growth (Bjrk)
1 / THE MAXILLOFACIAL GROWTH
This growth is marked by facial rotation and mandibular rotation.
A / facial rotation
The facial development to classical authors (Brodie and Broadbent).
Is a way of rayon (homothetic), while Bjrk for Rickette and development is done in a process
intermediate between two extreme patterns:
-the anterior facial rotation (R.F.A).
-and the posterior facial rotation (R.F.P).

a / R.F.A:
In this type of rotation, the growth is more at the rear portion than at the anterior portion of the face.

brachy-face type Ricketts

b / R.F.P:
In this type of rotation, the growth is in range with the hinge is behind the head. Therefore the rear
portion expands more than the front part

Type dolicho - facial Ricketts

B / mandibular rotation [4] [17]

Mandibular growth is generally in harmony with facial growth. However mandibular rotation may
have some independence aggravating or mitigating facial rotation. It then distinguishes two directions:
front and rear:
a / the anterior mandibular rotation:

Diagram anterior growth rotation signs of the mandible

Such rotation may have to be central incisors or premolars.

b / posterior mandibular rotation:

Patterns of subsequent growth of rotation of signs of the mandible

This type of rotation seems to have the condyle to center.

c / Structural signs of Bjrk.
The various anatomical elements that contribute to describe a rotation, are more the effect than the
cause. They number eight elements (see table).

structural signs of Bjrk by Muller

2 / THE CHANCE OF GROWTH OF THE PATIENT [4] [17]
The timing of therapeutic intervention will be dependent on the probability of expected growth in
young children.
This growth is characterized by the rhythm and direction.
A / rhythm of growth
the amount of growth the growth rate is defined as occurring in a year we will seek to set the child on
the growth chart to get an idea about future growth. This curve is characterized by a peak pre-pubertal
growth. Exploration to peak will be by radiological means; radiograph of the hand with the appearance
of internal sesamoid.
B / The direction of growth
There are three vertical typologies following the report of the anterior vertical growth and the posterior
vertical growth.
Indeed, the front vertical growth is defined as the vertical growth and maxillary alveolar
maxillomandibular: M.A U.A + + LA while the posterior vertical growth is defined by the growth of
the glenoid fossa and condyle C. O + FO
a / anterior rotation: MA + AU + CA <+ CO FO.
This type of rotation is also called skeletal-type deep bite or hypodivergent.
b / posterior rotation: MA + AU + CA> CO + FO.
This type of rotation is also called skeletal-type open bite or hyperdivergent.
c / average speed: AU MA + = + CA + CO FO.
This type of rotation is also called normal skeletal type or normodivergent or meusofacial.
3 / THERAPEUTIC ROTATION [19]
Orthodontic treatment should be in a vision to mitigate see better still harmonize the profile and
correct its disharmony. Some therapeutic attitudes will cause a rotation: the rotation caused. We then
distinguished:
A / extractions: will cause a decrease in the vertical dimension and therefore an earlier rotation
B / displacement molar
- Distalisation their causes (R P)
- Their mesial causes (R A)
- The molar eruption causes (R P)
- The molar intrusion causes (R A)
C / the importance of the initial lag
Indeed geometry wants has caused equal rotation, will be different depending on the type: type (IVA),
Type (EVA), normal type therefore cause (RP), will manifest by the chin back along the major axis
( condyle-gnathion)
D / Some orthodontic devices will cause (R.P)
-EL I.m. (Cl II, Cl III or crosses).
-F.E.B A cervical support.
top mobile -Plate with incisive hold.
-the Molar activators with grinding areas.
-The Seats molar tubes gingival.
-The tip back molars very pronounced.
So any device that erupt, or distally pay, will induce (R.P) and chin back. For Rother, we do not seek
to permanently reverse a natural rotation, but trying to provoke him a time out and enjoy some
acquired it .Semble you when this rotation can not catch up.

VI / FACTORS STAKEHOLDERS THERAPEUTIC DECISION [11] [15] [17] [19]

The treatment of Cl II div1 is influenced by three determinants: diagnosis, personal criteria and the
limit of action of therapeutic choices.
1 / DIAGNOSIS
The diagnosis will be established a different level: differential etiological and anatomical. This will
allow us to define:
-The probability of residual growth in children
-the seat and the importance of dysmorphia, isolated or associated
dental or dental-maxillary -Fixed: DDD or DDM
-The patient adaptability functionally and neuromuscular.
Dental -l'ge, there are different stages:
- Deciduous dentition,
- Young mixed dentition
- Adult dentition
- Or adult teeth.
-The periodontal biotype: thin or thick and periodontal possible attacks.
-the para-functions and distorting practices.
2 / PERSONAL CRITERIA
-l'ge patient, degree of motivation, socio-economic, aesthetic demands and time constraints.
3 / THE EXTENT OF ACTION FOR THERAPEUTIC CHOICE [11]
The action limit therapeutic options varies from one discipline to another
It is the maximum for orthodnathique and minimal surgery to orthodontics.
The scope tends to widen with the surgical orthodontics hence the importance of corticotomy and
beneficial contribution to the adult orthodontics.
The limits of the actions of therapeutic choice.
VII / SEQUENCE THERAPY
1 / MEETING INFORMATION [9]
This session precedes any equipment and it will be with the parents in the presence of their children it
can:
-Summarize The problem to solve.
-Show Planned computers working.
-Explain The harsh treatment and its requirements:
. Good collaboration.
. Rigorous hygiene.
. A diet adopted type of equipment.
- To discuss the treatment plan with parents.
- From rependre parents' questions.
2 / PREVENTIVE TREATMENT OR Interceptive [9]
It unlocks functions it interests the deciduous dentition age in two distinct therapeutic approaches
A / without gear
-Exercise Speech
-Education Swallowing
-Support Of harmful behavior conscience
-Rehabilitation Chewing by simply grinding the occlusal interferences. Check Ca slope (according
R.N.O Planas) [12] [21].

B / With equipment
-Perle Of Tucat.
-E.L.N: Night Screen labial [9] [17].
-E.F.C Rollet: functional and behavioral Educator Rollet. [22]
-Screen Interception: If interposition of the lower lip, the E.I. will help avoid the pressures of the lip,
cheeks and tongue. [9]
3 / ORTHOPEDIC [15]
Younger the better.
A / therapeutic mechanical orthopedic
We have :
-F.E.O (A-P): anterior-posterior oral Force Extra
mobile -Plate with F.E.O (A-P)
-T.I.M.de Cl II: Traction inter maxillary Cl II
B / functional orthopedic Therapeutic
a / Therapeutic active:
a-1 / myotherapy
a-2 / Functional rehabilitation

b / passive Therapeutics [17]:

b-1 / rigid monoblock
* Activator Andresen: it is a piece of resin with a vestibular strip.
* Activator Lautrou: it is a piece of resin with lateral guide fins and an incline lower [14] [17].
b-2 / Activator has thrusters stop:
* Rod of Herbest [1] [12] [18]:
It there's different variety: Connecting Rod and Rod Herbest on gutter of Herbest on ring.
For the rod Herbest on gutter, it finds its indication:
-in case of hypo-divergent type, the contact will be located to the previous level.
-in case of normal-divergent type, the contact will be left on all of the gutter.
-in case of pseudo-hyperdivergent, contact boast locates the posterior level.
* Twin block:
Generally orthopedic phase will be followed by a multitasking fixed orthodontic time to finish the
case.
Sometimes a minor orthodontic stage like leveling can before the orthopedic treatment.
4 / THE ORTHODONTIC TREATMENT [4] [7] [10] [13] [16] [20]
A / Action
The action is limited to the dental-alveolar component
B / dental Age
We have three situations:
- Mixed dentition.
- Mixed adult.
- Adult teeth.

C / Indication
-Pro-Alveolie maxilla with normal-mandibulie
-Normo-Maxillie with retro-mandibulie
-Pro-Alveolie maxilla with retro-mandibular alveolie
-With Or without D.D.M
D / Choice extractions
We have :
Without extraction, if the light is dysmorphosis
With extraction, if the dysmorphosis is important
Then:
-extraction: 14 and 24: If the jawbone is dysmorphosis alone
-extraction: 14, 24 and 34, 44: if the dysmorphosis is maxillary anterior crowding mandibular
-extraction: 14, 24 and 35, 45: if the dysmorphosis is with maxillary posterior mandibular congestion
E / therapeutic Accessories
a / cross-cutting issue of Case; Must be used:
* If endognathie: providing a circuit breaker
* If endoalveolie: providing a quad helix
b / vertical problem case: You need recour:
* If overbite:
high -F.E.O
Basic -Arc of ingression
* If infraclusie:
Basic -Arc of eruption
-M.E.AW
F / Mecanotherapy strength and light [7]: the use of light force in biomechanics allows us to optimize
dental trips approximating e physiological tooth movement that saves the dental organ and
periodontal following is a cycle remodeling unit level basics multicellular unit (BMU) in the activation
sequence, resorption, reversal and formation (ARIF).
a / Example 1
Treatment of a case of Cl II div1 D.D.M with overbite:
* Choice of extractions: we opt for the extraction of 14, 24 and 34, 44
* Choice of anchorage: maximum Anc> and <.
Mecanotherapy * t. progressive bio Ricketts
-Appareillage: Multi-clip fixed appliance
-Information Of the clip: M.B.T
Bra (0.22x0.28)
K1:
1- Fixed space and alignment:
-U.A> (16/22) in the overlay (0.16 Niti)
-U.A <(16/16) in the overlay (0.16 Niti)
-U.A Preactive according to the anchor types, namely in this case the anchor is maximum.
2- overbite correction and alignment:
Once this is done, it happens:
- U.A> in piggy back,
- U.A <in piggy back
And continues the correction of the alignment.
3 - Canine Retraction:

- It retracts the Ca <and Ca>

- A Ca retraction sectional with loop Hilgers will be used.
- A pre-activation is required then in the sagittal and horizontal plane.
- The activation will be by 2 mm / month, but the most important is wait expression and Tip Toe in.
- U. A> and U. A <to continue the rise of the overbite.
4 - Correction de la Cl II :
K1:
1- Fixed space and alignment:
-U.A> (16/22) in the overlay (0.16 Niti)
-U.A <(16/16) in the overlay (0.16 Niti)
-U.A Preactive according to the anchor types, namely in this case the anchor is maximum.
2- overbite correction and alignment:
Once this is done, it happens:
- U.A> in piggy back,
- U.A <in piggy back
And continues the correction of the alignment.
3 - Canine Retraction:
- It retracts the Ca <and Ca>
- A Ca retraction sectional with loop Hilgers will be used.
- A pre-activation is required then in the sagittal and horizontal plane.
- The activation will be by 2 mm / month, but the most important is wait expression and Tip Toe in.
- U. A> and U. A <to continue the rise of the overbite.
The incisive control and closed spaces:
-At Maxillary with C.T.U.A> for retraction and or torque control for torque alone.
-At The mandible with C.U.A <only for retraction
- The decline in i <will be before the retreat of I>
- + El Cl II.
K3:
The finish will be achieved by:
* Arc (16/22)> and <in Niti
* Arc (16/22)> and <Steel
* E.V.I.M to refine the occlusion.
K4:
- The contention
- The removal of the apparatus.
b / Example 2
Treatment of a case of Cl II div1 D.D.M
* Choice of extractions: we opt for the extraction of: 14, 24, 34 and 44.
* Choice of anchoring, anchoring maximum mandibular jaw moderate.
* Mecanotherapy (Therapeutic Arc technical bimtrique Law):
-Appareillage: Self-ligating Smart-clip.
-Information Ties: M.B.T
Bra bimtrique:
* Maxilla: - 0.18 x 0.25 on 11, 12, 21 and 22
- 0.22 x 0.28 on 13, 15,16, 17 and 23, 25, 26,27
* A mandible: - 0.18 x 0.25 on 31, 42 32,41et

- 0.22 x 0.28 on 33, 35, 36,37 and 43, 45, 46,47)

b-1 / Line and grade:
-Arc Continuous: 0.18 Niti> with distal kinking
-Arc Continuous: 0.18 Niti <with distal kinking
b-2 / Cementation and anchor:
* Case no overbite:
- Jaw: continuous arc 0.16 x 0.22 T.M.A>.
- Mandible: continuous arc 0.16 x 0.22 T.M.A <.
- Anchorage: A.T.P (0.36 x 0.72) or steel anchoring fiber strength
- Metal Ligature eight on (15,16,17), (13,12,11,21,22,23) and (25,26,27)
* Case with overbite:
-Arc Niti with enhanced speed curve maxillary
-Arc Niti speed with reverse curve mandibular
b-3 / Mechanical Cl II:
Class II T.I.M: (3/16 4 oz)
- On the right side of (13, 46)
- On the left side of (23, 36)
b-4 / intercuspidation and finish:
- Arc Niti (16/22)> and <, + T.I.M of I.C (1/8 4 oz)
- Finish: Arc Niti (16/22)> and <,
- Optionally with T.M.A arc (17/25) and / or (17/25) steel.
b-5 / Contention and deposits
- Twisted wire 0.17 or 0.22, adapts and glue 13-23 maxillary level
- Twisted wire 0.17 or 0.22, adapts and glue from 33 to 43 in the mandible.
Once contention is stable apparatus is deposited.
5 / SURGICAL THERAPY [3]
A / extractions following the case and the selected therapeutic
B / frenotomy
- From the upper labial frenulum in case of inter incisive diastema persists
- From labial frenulum, lower in case of lower-retro alveolie
- From lingual brake to release the tongue
C / Tonsillectomy and adenoids for respiratory problems
D / The corticotomy
It is an important contribution and the increase of action and in reducing the treatment time for adults,
then we distinguish:
-the small discontinuous corticotomies, they are less effective and used in orthodontic activation
techniques.
The corticotomies per tooth may be vestibular maxillary or mandibular and / or lingual or palatal.
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l'export.
-the small discontinuous corticotomies, they are less effective and used in orthodontic activation
techniques.
The corticotomies per tooth may be vestibular maxillary or mandibular and / or lingual or palatal.
In all cases we must adapt the topography and the number of dental movements corticotomy want.
The principle of the use of and reduce corticotomy has half the forces and to receive a bone thickness
were at the outset as well as increased bone metabolism following has the inflammatory response
generated by the response .

E / osteotomies
* Total osteotomies:
-At Maxillary Lefort I recoil.
-A Mandible: O.T.T of Obwegeser.
* Segmental osteotomies:
-At Jaw: Wassmund and Schuchart.
-At The Mandible: Koele
6 / SURGICAL TREATMENT ORTHODONTICO- [3] [13] [20] [23]
A / Indication
-age In adult teeth.
severe deformities of -Cases Cl II div 1.
-Cases Of important aesthetic requirement.
B / sets up
Simulation in orthoghnatique surgery is a capital contribution in fact orthoghnatique the surgery will
lead to physiological and aesthetic changes in the operated; which will have a psychological impact on
the patient. Hence the importance of the assessment of these changes through:
-Set Up cephalometric; example: V.O.T of ricketts.
-Set Up photography.
-Set Up casts.
Similarly methods combined will help the orthodontist and maxillofacial surgeon in the selection and
order of therapeutic sequences.
C / Chronology: classic pattern
a / pretrial oral Cavite:
-Dental care.
-Palliative Periodontal.
b / choice of extractions:
The decision to extract or not does not include:
-From The importance of the sagittal offset bone bases.
-Or The vertical skeletal problem.
Only the size of the deficit and the seat that will determine:
-the decision to extract or not.
-The Siting of extractions.
Example of extraction (14, 24, 35,45).
c / orthodontic preparation:
It consists of :
- Correct dimensions: the leveling and alignment phase.
- Delete offsets; must inform the patient that orthodontic treatment will worsen the Cl II.
The decompansations go and correct:
-The Vestibular tipping of the lower incesives.
-L'accentuation Of the curve of Spee.
-L'orientation The occlusal plane:
* The p.o. schedule rocker in hyper divergent and normodivergent;
* The counter rocker p.o in the hypodivergent
-Niveler The curve of Spee: the distinction will be made for Cl II hypodivergent or leveling will be
running stairs and a gutter will be prepared for the surgical block.
-Idaliser Arcades: the preparation and adaptation of the upper and lower arches ideals.
-Prepare Surgery: surgical arcs will be crafted and put in the mouth. These surgical arcs are rependre

certain criteria:
* Arc in near full size steel (0.20 x0.25) slot (0.22 x 0.28)
* Coordination of the upper and lower arches.
* Similarly, the second order of curvature adapted to the operating protocol (Case Cl II div 1
hypodivergent)
* Interdental spurs blocking.
* Metal ligatures tightened during the appetizer.
d / Surgery:
It has a preference for total osteotomies:
* I maxillary Lefort:
-Abaissement Or elevation (S.V)
-Drogation Or expansion (S.T)
-Advance Or reverses the order of 2 mm (S.S)
* O.T.T.O a mandible:
The osteotomy transramal translagital of Obwegeser, the cleavage sagittal mandibular.
This surgery will be achieved by the establishment of the surgical occlusion map previously studied
and validated at the stage set up.
Example in the case of Cl II deep bite, we have recourse to correct the anti Schedule PO rotation by
Lefort I amended by BELL or after ingression is higher than the previous end ingression has offset the
anti Time of rotation PO this allows us to advance the i <more than the chin (beneficial for aesthetics).
Plate fixation osteosynthesis, a bi-maxillary lock will be set up to perfect the occlusion.
(E.V) will be used.
e / post surgical orthodontics:
In two months the patient will be reviewed two flexible arches will be set up to improve coordination
of arches and vertical elastic to perfect occlusion.
f / occlusal equilibration:
proves useful in case of patient with prosthesis
7 / REVALUATION
8 / CONTENTION [1] [17]
It has different features:
-the Plate Hawley
-The circumferential
-The Glued fixed contention (13-23) and (33-43) with tosade wire (0.17-0.20)
-The Elasto -finisseur
- The set tooth
- Blister gutters
VIII / PROGNOSIS
The prognosis will depend on:
-From The importance of dysmorphia
-From The patient's age
-From Patient's degree of motivation,
- From the intended therapeutic
CONCLUSION
Therapeutic Class 2 Division 1 must support the patient as a whole. So do not be limited to
anteroposterior but rather to consider the other transverse and vertical direction as well as its stage of

growth will be beneficial for therapeutic attitude any time without neglecting the interrelation of other
skin components and alveolar. So s is indeed a thoughtful therapeutic outcome of a thorough diagnosis
and applies with a suitable equipment and individualized according to each case.

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