Too extract or not to Extract, Part 2: camouflage?
Camouflage (reducing or increasing incisor prominence) vs surgery in treatment of Class II and Class III Problems
Treatment Possibilities for incorrect jaw relationship
- Guide growth so the deficient jaw catches up, and a normal jaw relationship is produced
- This is the ideal treatment approach
- Orthodontic camouflage (making teeth fit even if jaws dont)
- When growth guidance fails, extraction of upper premolars can help
- Orthognathic surgery to place the jaws in the correct position
Timing
The type of treatment chosen will obviously differ by age
- Growth modification needs to happen when pt is still growing
- Extraction / repositioning for camouflage needs to happen in late adolescence when we have a clear predication of the final relationship
- surgical correction is only when growth is complete / nearly complete i.e. at the end of adolescent growth
Orthodontic Camouflage
Class II malocclusion is the major indication for orthodontic camouflage
Possible Extraction patterns:
- Maxillary first premolars
- Maxillary first and mandibular second premolars
- Maxillary and mandibular first premolars
Maxillary ad mandibular premolar extraction
Done in cases where Class II elastics are used to to pull the upper incisors back and the lower molars forward! often the second mandibular premolars are done to protect the lower incisors from retraction
[STOPPED AT L4 UB (Typicall Class II Camou)]