Treatment of class II, division 1 (angle). I. Occipital anchorage

This paper has dealt with the use of occipital force for the correction of the anteroposterior malrelationship of Class II, Division 1 malocclusion.

Six treated cases of Class II, Division 1 were reported. At no time has mandibular anchorage with Class II intermaxillary elastics been used during active treatment. The correction of the anteroposterior malrelationship of the dental arches was accomplished by means of occipital force applied directly to the maxillary arch. Of the six cases presented, three were treated in the mixed dentition and three in the permanent dentition. An appraisal of the results showed: (1) In all of the cases the maxillary arch was moved posteriorly except the one in which the occipital force was applied in the intercanine area. (2) This posterior movement of the maxillary arch brought about a correct occlusal relationship between the maxillary and mandibular teeth without any expansion in the dental arches except in the one case in which the occipital force was applied in the intercanine area. (3) The marked improvement in facial balance that resulted from this method of treatment seems to have been due to a readjustment of the various component parts of the dentofacial complex. (4) Several factors may be operative either individually or jointly to produce this change in the dentofacial complex. In some cases the posterior movement of the maxillary arch produced a compensatory adjustment of the surrounding parts to the mandible. In other cases, there was little posterior movement of the maxillary arch. The entire change was due to a repositioning of the entire mandible to the changed occlusal plane of the maxillary arch. Again in other cases the corrected occlusion and facial change was the result of a combined posterior movement of the maxillary arch and a repositioning of the mandible. Rotations of the entire mandible were not unusual.

In closing, I wish to emphasize that the application of occipital force as presented in this paper was designed to test the efficacy of this force and to evaluate the changes produced by it in the dentofacial complex. This made it essential to omit the use of mandibular appliances wherever feasible. In my usual method of treatment of Class II, Division 1, while occipital force replaces intermaxillary force for the correction of the anteroposterior malrelationship of the dental arches, a mandibular appliance is part of the assemblage.