This document provides a summary of the clinical diagnosis of Class II malocclusion. It describes the extraoral and intraoral features, diagnostic process including case history, photos, radiographs and casts. It analyzes features of Class II division 1 and 2 malocclusions. Key aspects of cephalometric analysis are outlined including measurements of cranial bases, facial heights, angles between cranial structures, jaw bases and dentoalveolar structures. Growth patterns and effects of functional appliances are discussed.

1. clinical diagnosis of
CLASS – II
MALOCCLUSION
Dr.Cyan Chacko
1st year pg
Dept of orthodontics and dentofacial orthopedics

2. Diagnosis
• Diagnosis is the process of attempting to determine or
identify a possible disease or disorder
 (Extra oral and Intra oral features)
CLINICAL EVALUATION
 Case history , Photographic analysis ,
 Radiographic analysis , Cast analysis ,
DIAGNOSTIC AIDS
 Examination of postural rest position and maximum intercuspation
 Examination of the tempromandibular joint
 Examination of orofacial dysfunction
FUNCTIONAL ANALYSIS

3. Extra oral features
Class II divison 1
profile: convex
Shape of head : dolicocephalic
Mento labial sulcus : shallow/deep
Hyper active mentalis: present
Hypo active upper lip :present
Class II divison 2
Profile : straight / convex
Shape of head : mesocephalic
/dolichocephalic
Hyper active mentalis: absent
Mento labial sulcus : normal
Hypo active upper lip :present/
absent

4. Clinical features of
class II -division 1
o classII molar relation,
that may vary from end on
molar to fully fledged class II
o proclined maxillary anteriors
with resultant increased overjet
o Flaring and spaced dentition

5. V – shaped palatal arch
Excessive curve of spee
Deep palate
Increased over bite

6. o Patient may have a short
hypotonic upperlip
o Lip trap may be present(placing
lower lip against the palatal
surface of upper incisor)
o Abnormal buccinator activity
leading to a constricted , narrow
upper arch. Which predispose
to posterior cross bite
o Hyper active mentalis muscle
(retrognathic mandible)

7. Class II divison 2 malocclusion
 Excessive lingual
inclination of
the maxillary central incisors
overlapped on the labial by
the maxillary lateral incisors.
 In some Cases ,
 both the central and the
lateral incisors are lingualy
inclined and the canines
overlap the lateral incisors on
the labial.

8. o The Class II Division 2
malocclusion is often accompanied
by
o U – shaped palatal arch
o A deep overbite and minimal
over jet
o with extreme overbite, the
incisal edges of the lower
incisors may contact the soft
tissues of the palate
o In the absence of over jet)
mandibular labial gingiva get
traumatised by lingually
inclined maxillary incisors

9. Case history
 Most hereditary dysgnathias are already evident in
Deciduous dentition .
 Dominantly inherited anomalies Include
 mandibular prognathism ,
 class II division 2
 Some cases of distoclussion
 skeletal open bite ,
 and bimaxillary protrusion

10. Photographic analysis
For the analysis of the relationship
between the craniofacial skeleton
the soft tissue facial contures ,profile and
frontal photographs are
taken under stantardized condition.
 Patient sitting up straight
 in habitual Occlusion
 with relaxed lips and mentalis
muscle
Facial profile
Profile convexity or concavity results from
a disproportion in the size of jaw.
Convex profile indicate class II jaw
relationship , ie maxilla projected too
forward or mandible too backward
in concave profile : classIII relationship
Which can be result from either maxilla
Is backward or a mandible protrudes
forward
 The line joining the forhead and
the border Of the upper lip
 The line joining the border of
upper lip and soft tissue
pogonion

11. Recommended frontal images
 Frontal at rest
 Frontal view with teeth in maximal intercuspation
 Frontal dynamic (smile)
 A close up image of posed smile

12. Frontal at rest Frontal view with teeth in maximal intercuspation
Frontal dynamic (smile)
A close up image of posed smile

13. Facial symmetry in frontal plane
From the frontal view it is particularly important to examine the face
for bilateral symmetry
The normal asymmetry which usually result s from a small size
difference Between the two side s ,should be distinguished from a
chin or nose .That deviates to one side .
Facial proportion
Well proportioned face can be divided into
Three equal thirds using four horizontal planes
 At hair line
 Supra orbital ridge
 Base of nose
 Inferior border of chin
Within the lower face upper lip occupies a third of distance
while chin occupies The rest of the space
The rule of fifth.
From midsagittal plane ideal face is composed
Of equal fifths ,all approximately equal to one eye width
Comissure width should also be coincident with medial limbus
Of eye alar width should coincident with intercanthal distance

14. Lateral cephalometrics

16. CEPHALOMETRIC ANALYSIS
Four linear measurements
 Anterior and posterior cranial base length
 Anterior and Posterior face height ,
The first cephalometric analysis includes three angular
measurements
(saddle angle ,articular angle ,gonial angle )
 Analysis of facial skeleton
 Analysis of mandibular and maxillary base
 Dento alveolar analysis

17. ANTERIOR CRANIAL BASE LENGTH (Se_N)
The measurement of anteriorcranial base
the center of the Superior enterance to the sella
trucica as a reference point to nasion
The corelation of this criterion with length of jaw base
enables the propotional averages of the bases
Growth direction 9 years Incremental changes from
9-15years
horizontal 68.8 mm 4.46mm
vertical 63.8mm 3.52mm
Mean value: N – S (72-75)mm

18. Posterior (lateral) cranial base length (S-Ar)
The magnitude of posterior cranial base length depends on
Posterior face height and position of the fossa. Short posterior cranial base
occur in vertical growth pattern and skeletal open bite
Growth
direction
9 years Incrimental changes from
9-15years
horizontal 32.2mm 9.16mm
vertical 30mm 4.47mm
Mean value S –Ar (32-35)mm

19. The measurement of anterior and posterior face
height is a linear millimeteric assessment.
The posterior face height (S-Go) and
anterior face height (N-Me) are measured on
lateral cephalograms with the teeth in habitual
occlussion
ANTERIOR AND POSTERIOR FACE HEIGHT
Anterior and posterior face height and setup ratios
To estimate growth direction according to recommendation of jaraback
Posterior face height x 100
anterior face height
Mean value is 62-65% Higher the % means greater posterior face height and horizontal growth
A small % denotes shorter posterior facial height and vertical growth

20. For early mixed dentition the treatment with an activator should be done
By comparing angular and linear measurements and morphologic characteristic of
the mandible .
The assessment of growth direction Is important in functional appliance therapy .
It helps determine whether
Functional appliance should be used and influence construction details, type
Of construction bite and other factors .periodic growth assessment during
Treatment is equally important for the plotting of mid course correction s
And alteration
Growth
direction
9 years 15years
Horizontal 67% 69%
Vertical 60.1% 62.7%

21. CEPHALOMETRIC ANALYSIS
SADDLE ANGLE : (N-S-Ar) .
The angle formed by joining these three points
provides a parameter for assessment of the
relationship between
Anterior and posteriolateral cranial bases
Saddle angle usually signifies the position of
fossa
Mean value 123+/-5
Thus a large saddle angle usually signifies a
posterior condylar position and a mandible
That is posteriorly positioned with respect to
cranial base and maxilla – that is unless the
deviation in the position of the fossa is
compensated By articular angle and ramal length
relationship.
A noncompensated posterior positioning of the
mandible Caused by a large saddle angle is very
difficult to influence With functional appliance
therapy

22. ARTICULAR ANGLE: (S-Ar-Go)
The angle is a constructed angle between
the upper and lower Part of the posterior
part of facial skeleton .
Its size depend on position of the mandible ;
 Angle is Large if mandible is retrognathic
 Angle is Small if mandible is prognathic
 Mean value(143+_6)
It can be influenced during the orthodontic or
Orthopedic therapy . It decreases with anterior
positioning of the mandible , closing of the bite ,
And mesial migration of the posterior segment teeth
And increase with posterior relocation of the mandible
Opening of the bite , distal driving of the posterior
teeth
Growth direction 9 years 15years
Horizontal 139.5* 2.89*
vertical 142.4* 2.49*

23. The angle is formed by tangents of the body of the mandible
and posterior border Of ramus
It gives information on mandibular growth Direction
Upper and lower gonial angles of jarabak
Gonial angle divided by line drawn from nasion to gonion ,
this gives upper and lower gonial Angle
If the lower gonial angle is small ,
the direction of growth is horizontal .if lower angle is larger
the direction of growth is vertical
Mean value(128+/-7)
Upper gonial angle(52 to55)
Lower gonial angle (70 to 75)
GONIAL ANGLE: (Ar- Go-Me)
Growth direction 9 years 11years
Horizontal 125.5* 2.89*
vertical 133.4* 2.42*

24. SUM OF POSTERIOR ANGLES
The sum of (saddle angle, articular angle, gonial angle is 396 +/_6 *
The sum is significant for the interpretation of analysis .
If it is greater than 396*,direction of growth is vertical
If it is lesser than 396 * direction of growth is horizontal

25. ANALYSIS OF JAWBASE
The angles between vertical
reference lines represent
the saggital relation of parts
eg (SNA –SNB)
Angle between horizontal lines
assist in the evaluation
Of vertical relationship eg
(basal plane angle , inclination
angle)
linear measurement indicate
the length of maxillary and
mandibular
Bases and ascending ramus

26. S-N-A
The angle S-N-A expresses the sagittal
relationship of the anterior limit of
The maxillary apical base to the anterior
cranial base
 It is large in prognathic maxillas
 small in retruded maxillas .
 Mean value ( 81*)
Growth
direction
SNA angle
9 years
SNA angle
15years
Average 79.5* 81.28*
horizontal 79.73* 81.57*
vertical 79.0* 80.57*
A moderate decrease of SNA angle is possible through the use of conventional activator
therapy. Larger decrease in angle is possible by special activator (clark twin block appliance)

27. S-N-B
The angle S-N-B expresses the sagittal relationship
between the
Anterior extent of the mandibular apical base and
anterior cranial Base
prognathic mandible it is large ,and with a retrognathic
mandible It is small .
Functional appliance treatment is indicated if the
mandible Is retrognathic and has a small S-N-B .
A posteriorly located mandible can be large or small .if it is small
The prognosis for anterior posturing in the mixed dentition is good
Because a larger growth increament can usually be expected
Growth direction SNB angle
9 years
SNB angle
15years
Horizontal 77.9* 80.5*
vertical 74.3* 75.9*
Mean value (79*)

28. THE Wit’s METHOD
 In normal occlusion BO is 1 mm anterior to point
AO
 In skeletal classII point BO is located posterior to
 point AO
 In skeletal classIII point BO is forward of pointAO
Jacobson described the wits appraisal of jaw dis
harmony , which is a
Measure of the extent to which the jaw are related to
each other Anteroposteriorly
 Drawing perpendicular on a lateral cephalometric
head film tracing from
Point A and point B on maxilla and mandible
respectively .
 On to the occlussal plane which is drawn through
maximum cuspal Interdigitation
 The point of contact on the occlusal plane from A
and B are labelled AO and BO respectively
A
B
AO
BO

29. BASE PLANE ANGLE (PaL-MP)
The base plane angle .Angle between the
maxillary and mandibular jaw base
Also is used to determine the inclination of
mandibular plane
 In horizontal growth patterns this angle
is small
 In vertical growth patterns it is larger
Growth
direction
9 years 15years
horizontal 23.4* 20.5*
vertical 32.9* 30.9*

30. INCLINATION ANGLE
 A large angle expreses upward and
forward inclination
 Small angle indicate down and back
tipping of the anterior end Of the
palatal plane and maxillary base
 This angle doesn't Correlate with
growth pattern or facial type.
 Functional and therapeutic influences
can alter the inclination of maxillary
bases .
The inclination angle gives an assessment of
the inclination of maxillary base .
It is the angle formed by the Pan Line
( a perpendicular line dropped from N-Se at N )
and palatal plane (mean value:85*)

31. ROTATION OF JAW BASE
Basal plane angle and inclination angle ) are
used to evaluate the rotation of upper and
lower jaw base
The rotation of the mandible is growth
conditioned and depend on Direction and mutual
relation of growth increments in the posterior
(condylar) and anterior ( sutural and alveolar )
facial skeleton.if condylar growth proceed at
greater rate horizontal rotation occur
 Convergent rotation of jaw base ,rotation
Creates a severe ,deep bite
 Divergent rotation of jaw base – this rotation
can cause marked open bite problem
Cranial rotation of both bases-horizontal growth pattern a relatively harmonious rotation of
Both jaws occurs. in upward and forward direction ,Maxilla compensates for upward and
forward Mandibular rotation .off setting deep bite.
down and back rotation of both bases – rotation occurs in a relative harmonious manner
The down and back maxillary rotation offset the openbite created by down and back
mandibular rotation

32. Linear measurement of the jaw base
The length of maxillary , mandibular base and ascending ramus is measured
Relative to (S-N) ANTERIOR CRANIAL BASE
The ideal dimension relative to S-N is calculated using the following ratio
N-S : MANDIBULAR BASE 20 : 21
ASCENDING RAMUS :
MANDIBULAR BASE
5 : 7
MAXILLARY BASE :
MANDIBULAR BASE
2 : 3

33. Extent of mandibular base
Extent of mandibular base is determine by measuring the distance gonion-
pogonion
Ideally mandibular base should be 3 mm long than S – N Until 25 years.
3.5 mm long after 25 years.
5 mm or less than this average considered within normal limit until 7 years
5 mm or more is normal until 15 years
Extent of maxillary base
The extend of maxillary base is determined by measuring the distance between
Posterior nasal spine and point A projected perpendicular onto palatal plane.
The evaluation of this has two ideal measurements one relate to nasion -sella
And other to the length of mandibular base
A Deviation from the mandibular base –related norm indicates that
maxillary base is too long or too short .
Growth direction 9 years 15years
horizontal 67.59mm 77.35mm
Vertical 65.23mm 73.5mm

34. Ascending ramus
Ascending ramus is calculated by measuring distance between gonion and condylion
The length of ramus is important in determination of posterior facial height
And subsequent relation to anterior face height
Ramus tend to be longer in horizontal grower and shorter in vertical patterns
Growth
direction
9 years 15years
horizontal 48.9mm 58.6mm
vertical 44.47mm 51.7mm
Growth direction 9 years 15years
horizontal 44.56mm 48.6mm
vertical 44.0mm 47.16mm

35. Mc Namara Analysis
Cranio facial complex is divided into 5 major sections.
 Maxilla to cranial base
 Maxilla to mandible
 Mandible to cranial base
 Dentition
 airway
Maxilla to cranial base
Soft tissue evaluation
 Nasolabial angle
 Ideal angle is 102=/-8*
 Small angle indicate dento alveolar protrusion

36. Cant of upper lip
ideal value in woman is 14 +/-8*
For men the value is 8+/-8*
Hard tissue evaluation
Anteroposterior orientation of maxilla relative
to cranial base
Linear measurement between nasion
perpendicular and point A
Anterior position of point A is a positive value ,
Posterior position of point a is a negative value

37. Maxilla to mandible
Anterior posterior relationship
Mid facial length is measured from condylion to point A.
Mandibular length from condylion to gnathion
ideally (co-point A)is 91 mm
(co –Gn)115-119 mm
Vertical relationship
Vertical maxillary excess cause a downward and backward rotation
of the mandible ,result in increase anterior lower face height
Vertical maxillary dento alveolar deficiency cause mandible rotate
upward and forward
Mandibular plane angle
Mandibular plane angle is the angle between anatomic frankfort
Horizontal and the line drawn along the line drawn along the
lower
Border of mandible through constructed gonion and menton
On average mandibular plane angle is 22+/-4 *
Higher measurement is suggestive of excessive lower face height

38. Facial axis angle
Facial axis is the angle formed by line constructed from
posterosuperior aspect
Of the pterygomaxillary fissure to gnathion relative to the
cranial base
Which is represented by line joining basion to nasion . In a
balanced face facial axis angle is perpendicular. Or 90* to
basion- nasion line
negative value excessive vertical development of face
Positive value deficient development of face
Mandible to cranial base
Relationship of mandible to cranial base is determined by
measuring the distance from
Pogonion to nasion perpendicular
In adult men chin position extends from about 2mm behind to 2
mm forward
In adult female pogonion is positioned 4 to 0 mm behind the
nasion perpendicular line

39. dentition
Maxillary incisor position
Vertical line is drawn through point A parallel to nasion
perpendicular
The distance between point a to facial surface of upper
incisor is 4 to 6 mm
Mandibular incisor position
To determine anterior posterior position of lower incisor
the distance is measured
Between the edge of mandibular incisor and a line drawn
from point A to pogonion
in a well balanced face the distance should be 1 to 3 mm

40. Airway Analysis
Upper pharynx
Upper pharyngeal width is measured from a point on the posterior outline
Of soft palate to the closest point on pharyngeal wall
Average naso pharynx is approximately 15 to 20 mm width.
Width of less than 2mm in this region may indicate airway impairment
Lower pharynx
Lower pharynx width is measured from point of interaction of posterior
Border of tongue and inferior border of mandible to closest point on
the posterior pharyngeal wall. Average measurement is 11 to14 mm
Anterior positioning of tongue ,either as a result of habitual posture or tonsillar
enlargement

41. ANALYSIS OF DENTOALVEOLAR RELATIONSHIP
Construction and management of functional appliance is assessment
Of the inclination and position of incisors with respect to anterior
cranial base ,their apical bases
Axial inclination of the incisors
Upper incisors:
The long axis of the maxillary incisors is extended
to intersect the S-N line Larger angle indicate
labial crown tipping (mean value:102*)
Lower incisor :
measurement of the posterior angle between
The long axis of the lower incisors and mandibular
plane Is the class method of assessing the axial
inclination The ideal angle is 90 *
Small angle indicate lingual tipping of the incisors

42. Position of incisors
Linear measurements are the best assessors of the position of the incisors
with respect to the profile.
Most common assessment method is to measure the distance of the incisal edges
To the line N-Pog (FACIAL PLANE)
 The average position of the maxillary incisor is
 2 -4mm anterior to N – Pog line
 The lower incisor vary from 2mm posterior to
 2 mm anterior of this line
 Relationship of lower incisors to the N –Pog line
also help to determine the sagittal discrepancy

43. LIP ANALYSIS
METRIC DETERMINATION
Length of upper lip
 Average value in boys and girls
 (22.5mm in boys and 20 mm in girls In class II (22mm),
 A positive correlation
 Exists between length of upper lip and
 Facial height (N-Gn104mm on average with Class II
 Length of lower lip 50 mm on average in boys and 46.5 mm in
girls
 Lip gradually increases with age With classII by 1.5 mm on
average
 During treatment lower lip shows a slightly increase in length
With mesiocclussion than with distocclusion
 During classII treatment the lower lip curls up and moves
forward

44. Thickness of red part of upper lip
 Measured from most labial surface of the most labial
incisor
 to the most anterior point on the red part of upperlip
 The average thickness is 11.5mm
 With class II malocclusion the red upper lip is relatively
thin (10.8)mm
 Thinner upper lip is seen with class II is due to
angulation of the upper incisor
 Upper lip grows thicker as the incisors retract.
 Elimination of the lip tension, due to3 mm retraction of
the incisor Upper lip thickness increases by 1mm
 lip profile will change until the tension is eliminated

45. THICKNESS OF RED PART OF LOWER LIP
Measured from the labial surface of the lower incisors to the most anterior
Point of the red part of lower lip the average thickness is 12.5mm
With class II malocclusion lower lip
is thicker (14 mm )
The thickness of the lip depend on
position of the mandible and on
over jet
During treatment lower lip becomes
thinner in cases of class II
Retraction of upper incisor causes
lower lip to curl back or forward

46. Reference planes for lip profile assessment
RICKETTS LIP ANALYSIS
Ricketts drawn from tip of nose to skin pogonion
 Normal relation means upper lip is 2-3 mm
 Lower lip 1-2 mm behind this line

47. STEINER’S ANALYSIS
Reference point is at centre of the
s –shaped curve between tip of nose
And sub nasale .
soft tissue pogonion represents the
lower point
Lip lying behind the line connecting
those two points are too flat
Those lying anterior to it ,
too prominent

48. HOLDAWAY’S LIP ANALYSIS
This is a quantitative analysis to assess lip configuration
Holdaway determine the angle between a tangent to the
Upper lip and the NB line the angle between these two lines is called
The H line
HOLDAWAY ‘S DEFINES PERFECT PROFILE
ANB angle 2*, H angle 7-8*
Lower lip touches the soft tissue line
(soft tissue pogonion
Upper lip Continued as far as SN)
The relative proportion of nose and upper lip are
balanced (soft tissue line bisecting the S CURVE

49. Functional analysis
Evaluation of path of closure from postural rest to occlusion in the sagittal plane
Condylar movement from postural rest to occlusion can consist of
 pure hinge movement,
 hinge and anterior translatory displacement ,
 hinge and Posterior translatory displacement
classII malocclusion without functional
distrubance
The path of closure from rest to
occlusion is straight up and forward
with a hinge movement of the condyle
and the fossa. These are true class II
malocclusion

50. This type of activity is the most common, particularly in cases of
excessive overbite class II malocclusion.
classII malocclusion with functional distrubance
A rotatory action of the condyle in the fossa from postural rest to occlusion is
evident. From initial contact to full occlusion,
condylar action is both rotatory and translatory up and backward .
thus the movement combine rotary and sliding components .

51.  In class II malocclusion with functional disturbances in which
the path of closure is Up and forward from rest to initial contact
 the mandible may be anteriorly Displaced from initial contact as
the cusps guide the mandible into a forward position ,with
translatory movement of the condyle down and forward on
the posterior slope of the articular eminence
 The path of closure appears more up and forward than
it is without tooth interference .this variation of path of closure
is least frequent for class II malocclusions
In functional class II malocclusion the elimination of
functional retrusion or protrusion leads to an
improvement is a change in the sagiattal
malrelationship

52. Examination of TMJ and condylar movement
The objective of this aspect of functional examination is to assess
whether incipient symptoms of TMJ dysfunction are present
The early examination of functional disturbances,some incipient TMJ
problem can be prevented or eleminated
During activator therapy the condyle is displaced or dislocated to achieve
a remodeling of the TMJ structure and a change in muscle function
If TMJ problems are present in deciduous dentition , forward posturing may
Be better achieved in a staged progression
Early symptoms of TMJ problems
 Clicking and crepitus
 Sensitivity in the condylar region and masticatory muscles
 Functional distrubances
 (hyermobility, limitation of movements, deviation)
 Radiographic evidence of morphologic and positional abnormalities

53. Clinical functional examination for temporomandibular joint area
 Auscultation
 Palpation
 Functional analysis
 classII malocclusion with excessive overjet , horizontal growth
 Pattern ,and lower lip cushioning to the lingual of the upper incisors
(lip trap)
 Deep over bite problems
 Anterior open bite with associated abnormal lip , tongue, and finger habits
 Cross bite condition
If incipient TMJ signs already exist at the first examination of the patient
Early orthodontic treatment is recommended

54. Examination of orofacial dysfunction
Dysfunction can be primary etiologic factor in malocclusion
Many disfunction are acquired in the early stage of birth
Neonates are capable of performing some vital function s
 Sucking
 Swallowing
 Breathing
Many functions learned during the first month or year of life
 Chewing
 Phonation
 Mimicry
Unconditional reflex
conditional reflex

55. EXAMINATION OF TONGUE
 Tongue function
 Tongue posture
 Tongue size

56. TONGUE FUNCTION
Abnormal tongue posture and function can be primary factors as
consequences of retained infantile deglutitional patterns or other abnormal
oral habits , but they also may be strictly secondary or adaptive to
unfavourable morphologic patterns.
TONGUE POSTURE
Cephalometric evaluation of tongue posture –
• Assessment of tongue posture is made from a lateral cephalogram taken in
postural rest and habitual occlusion .
•Successful analysis will depend on the proper reference line

58. Preconditions for reference lines
 The greatest possible area should lie above the line
 The line should be independent of variation in skeletal
structures
 Its relation to the tongue should not change with changes
with the mandible .
 It should remain constant in relation to changes in tongue
position .
 It should relate to the anatomical and functional properties of
the tongue
 Determination should be as simple as possible .

59. For assessment of tongue position In the radiograph

60. ASSESSMENT OF TONGUE POSITION
Measurement along 1 gives the distance between soft
palate and the root of the tongue
•Average – 0.9 – 2.1 mm
•Less- with anomalies in nasal breathing.
•Large – class III and mouth breathing

61. Measurement along 2 – 6 gives the relationship of
the dorsum of the tongue to the floor of the mouth .
 Class II – high
 Deep overbite – dorsum is high at the back . Low at front
 Other cases – low
Measurement along 7 gives the position of the
tip of the tongue relative to the lower incisors
 Open bite – lies forwards- 2.4mm
 classII with nasal breathing - 6.3mm
 classII and mouth breathing – 10mm
 Class III and mouth breathing – 5.2mm

62. ASSESSMENT OF TONGUE MOBILTY-
To assess the mobility of the tongue ,
the difference between the position of the tongue at rest
and occlusal is calculated
The occlusal position is taken as zero, with changes in rest
position is expressed as positive or negative .
In rest position the tip of the tongue is retracted in class II,
but shows forward displacement in class III

63. TONGUE SIZE
Microglossia
Macroglossia

64. SIGNIFICANCE OF FUNCTIONAL ANALYSIS IN TREATMENT PLANING WITH
REMOVABLE APPLIANCE
CLASSII MALOCCLUSIONS
 The postural rest position of the mandible can be
anterior or posterior to habitual occlusal position .
 If a large free way space ,Mandibular over closure,
and deep bite are present
 Prognosis with functional appliances is good
Early TMJ symptom can frequently be seen in class II malocclusion
Especially in cases of deep overbite , horiontal growth pattern , and
Abnormal perioral muscle function .
The disfunction of the tongue should be Evaluated as should the lips ,
mentalis muscle , facial musculature Suprahyoid and infrahyoid musculature
localized effect on dento alveolar growth should be noted .
Respiratory distrubance have potential interfering role
In the accomplishment of normal growth and developmental pattern
and should be eliminated

65. Thank you