Orthodontics in the Vertical Dimension

Long term patient and orthodontist satisfaction with non surgical correction of severe class II division 1 malocclusions

“…Class II malocclusion is usually the result of an underlying skeletal problem in the basal bones, yielding an apical base discrepancy of either a prognathtic maxilla, a retrognathic mandible, or a combination of both; however, there is inherently a dental component as well (Southard, Marshall, & Bonner, 2015). The complexity of the clinical manifestation of this malocclusion allows for a variety of different treatment modalities.…”

“…Masking, or camouflage, treatment involves treatment that is aimed to solely correct the dental relationship without addressing the underlying skeletal problems and is considered when patients are done growing and have a mild to moderate discrepancy. Surgical treatment involves the surgical skeletal movement of the maxilla and/or the mandible and is considered when the discrepancy is too severe to be adequately corrected by orthopedics or masking (English et al, 2014;Southard et al, 2015).…”

Long lower anterior face height

“…Apposition at the maxillary tuberosity and sutural growth toward the palatine bone increase maxillary length, and while previously debated, the anterior aspect of the maxilla is believed to be resorptive (Enlow 1982). The role of the nasal cartilage growth in the translation of the nasomaxillary complex remains uncertain (Southard 2015). Compensatory growth, most pronounced in the alveolar process, can accommodate for different facial patterns (Moyers 1988).…”

“…When vertical condylar growth exceeds maxillary descent and dentoalveolar growth, hypodivergence and skeletal deep bite patterns occur (Schudy 1964). While hyperdivergent individuals may exhibit less true forward rotation, studies show that most individuals with a hyperdivergent growth pattern still have net forward rotation of the jaw during growth (Southard 2015).…”

“…Orthopedic treatment aims to modify growth by reducing the descent of the maxilla, as well as reducing the eruption of both maxillary and mandibular posterior teeth. Orthopedic treatment options include high pull headgear, vertical pull chin cup, modified Herbst appliance, posterior occlusal coverage bite plates, transpalatal arch with acrylic button, lower lingual holding arch, and temporary anchorage devices (TADs) (Southard 2015).…”