Building the Class II Treatment Foundation

 

Foundation Rules

1. Treat the biggest problem first.

2. Sequence treatment based on euption.

3. Begin with primary maxillary expansion if there is a posterior crossbite or if the maxillary lateral

incisors are impacted. These teeth erupt at 8 to 9 years old on average.

4. Time first phase treatment when the first bicuspids are erupting at 10 to 12 years old to make

room for the erupting maxillary canines at 11 to 12 years old. This will reduce the incidence of

impacted maxillary canines.

5. Don't place full edgewise appliances until the second molars have erupted or you will prolong

your second phase treatment and increase decalcification and root resorption.

6. Save cooperation with Class II elastics in deep overbite cases until you are in full size

stainless steel arch wires and the overjet is reduced enough to place a bite turbo.

7. Try to postpone IPR (interproximal reduction) of the incisors until all spaces are closed,

the buccal occlusion is Class I, and the overbite and overjet is where you want it.

The goal is to create long, flat interproximal contacts without black triangles keeping in mind

not to create a tooth mass discrepancy. This is impossible to do with early IPR.

This is one of the main reasons why I do not like clear aligner treatment. I believe you need to

align the teeth and close space first which is easier to do with fixed appliances, niti arch wires

and open coil niti springs.

8. Always go back to the foundation base during treatment to make sure the patient can breathe

through the nose, keep the tongue on the anterior palate, swallow without a tongue thrust,

and keep the lips together at rest, if posible.

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Dr. Michael Wainwright was my mentor and taught me this in 1981. He had Dennis Akey,

a speech pathologist, come to the office to help patients.

Dr. Wainwright was doing "sagittal and transverse first" treatment before I became his associate.

Instead of Xbow he used a Hawley/headgear combination and later Twin Blocks.

We both graduated from the orthodontic program at Indiana University and were taught about

appliance side effects, especially the over-use of Class II elastics.