Seminar Dr. Derek Mahony – Control of the High Angle Malocclusion

18 mei 2016

10th June at the Hilton Royal Parc Hotel, Soestduinen.

If we think of a high angle patient as a Class II skeletal, we tend to think, because of the Class II paradigm, of retracting the maxilla. This normally leads to extraction of premolars as the typical approach. Alternatively, the Class II high angle case can be considered as an underlying Class III disguised by the vertical posterior excess.
By removing the posterior occlusion the mandible has no choice but to rotate upwards and forward. This means the treatment paradigm for high angle Class II malocclusions should be intrusion of the first permanent molars, 1-2mm out of the occlusion.
If we think of the high angle vertical growth pattern as really being a disguised Class III we would also treat it by expansion of the upper arch. To allow the mandible to rotate we need to remove the posterior vertical occlusion via some method e.g. using a bite block or extractions or intrusion with micro implants.
Removal of second molars allows the first permanent molars to be intruded 1mm out of the occlusion so that the patient has to bite forward on the bicuspids.

Thus the treatment paradigms for the vertical facial growth pattern should be:

Palatal expansion, with occlusal coverage, to develop the arch width
Improve the nasal airway/breathing and promote an anterior lip seal.
Removal of the posterior vertical occlusion by various methods
Encourage auto rotation of the mandible.
Change the tongue posture

Outcomes
Following the conclusion of this session each attendee will be able to:

Differentiate between a true vertical growth patient as opposed to a patient whose vertical dimensions are increased due to environmental factors.
There will be a review of the process of facial growth, and dento-alveolar compensation, that leads to increased vertical proportions with or without an anterior open bite.
Understand the effect of proper diagnosis and treatment planning in a long face patient,
Understand intrusion biomechanics and its effect on facial balance.

Topics to be covered