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Class II division 1 treatment using a two-phase approach – a case report: part 1

In the first of a two-part article, JOHAN CHRISTIAN JULYAN and MARIUS COETSEE describes how they treated a patient using a functional removable appliance


Figure 1 (a-h): Pre-treatment photographs

The improvement of facial aesthetics is one of the main reasons why patients with a class II division 1 malocclusion seek orthodontic treatment. There are various techniques available to treat class II malocclusions, one of which is a twophase approach that includes functional jaw orthopaedics as well as fixed orthodontic treatment. The following case report describes a young growing female patient with a severe class II division 1 malocclusion. The patient was treated using the functional removable appliance called the Twin Block, for growth modiication and correction of her overjet and proifle, in the first phase. Thereafter, a fixed pre-adjusted self-ligating Damon orthodontic appliance was utilised in the second phase, to ensure well aligned arches and improved aesthetics and function


Dr Johan Christian Julyan BChD

(Pretoria), PDD (UWC), MSc (UWC) is a dentist who practices in Cape Town, South Africa. Email:


Dr Marius Coetsee BChD (Stell), MChD (Medunsa) qualiied from the University of Stellenbosch in 1986 and is an orthodontist who practices in Table View, South Africa.


Class II division 1 malocclusion cases are often complicated due to a skeletal discrepancy involving the maxilla and mandible. It can be as a result of a retrusive mandible and/or a protrusive maxilla (Pachori et al, 2012). The most prevalent feature of this malocclusion in growing patients is mandibular retrusion (McNamara, 1981). Treatment of skeletal class II cases depends on growth, age, compliance and the severity of the malocclusion (Tulloch et al, 1997).

There are various ways to treat an angle class II division 1 malocclusion, with treatment options including both removable and fixed appliances. Removable appliances can be removed by the patient and require good compliance, whereas fixed appliances are bonded onto the teeth and do not require patient compliance for placement and removal.

Removable treatment options include functional appliances and, more recently, clear aligners. There are more fixed options available and include fixed class II correctors and fixed orthodontic treatment in conjunction with inter-arch elastics and/or extractions and/ or skeletal anchorage and/or orthognathic surgery, depending on the severity of the case.

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About Orthodontic Practice

The May/June 2019 edition