# Heavy Palatal Contact Causing the bite to be more class II than the starting position

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Class 2 div 2 tendency teen boy 13, started with 6mm ob 1 year ago. 

# Question:

I have proclined anterior and worked on opening bite and guiding teeth in. Canines are now erupted and ready to start finalizing things. left is slight class 3, right end to end class 2 (actually worse than where i started?), upper midline on with face, lower 2mm to right


1. would you use class 2 right elastic alone or left class 3 maybe at night?
2. Where did I go wrong to get a worse class 2 on right? Maybe too much retraction and not enough proclination in first clincheck? Loss of anchorage while proclining? Not enough levelling? 


# Answer:


[https://www.loom.com/share/35accbaedeed490499a6f0a88809ad4a?sid=efb82115-9e2b-483d-8d74-be48e23a04c3](https://www.loom.com/share/35accbaedeed490499a6f0a88809ad4a?sid=efb82115-9e2b-483d-8d74-be48e23a04c3)


This is a growing patient, 13 years old, with a class 2 division 2 malocclusion. The anterior teeth are proclined, and treatment focuses on opening the bite. The patient presents with a slightly class 3 occlusion on the left side, and an end-to-end class 2 on the right, which is worse.


The primary issue on the right is premature contact from the palatal cusp of the upper right first molar, causing a more pronounced class 2 relationship. The palatal cusp is hitting too heavily, propping the jaw open, which forces the lower jaw into a class 2 position. To address this, I would recommend reducing the interfering cusp, which would allow the mandible to rotate forward naturally.


In addition, some class 2 elastics would be helpful, but more importantly, intruding the palatal cusps is necessary. By doing so, you will create an open bite, leading to autorotation of the mandible. In treatment plan 12, elastics are being used, but there is still extrusion of the buccal cusps instead of intrusion of the palatal cusps, which is the primary goal.


We need to ensure there is no palatal cusp contact by increasing buccal root torque and reducing expansion if needed. The ideal outcome is visible space between the palatal cusps and lower teeth, allowing for mandibular autorotation. If needed, an equilibration procedure could adjust the palatal cusps to facilitate this forward movement.


The simulation may not immediately show the class 1 occlusion result, but autorotation will occur as the bite opens. For the ClinCheck plan, we can manually move the teeth into a class 1 position and lock them in place. This would give a better approximation of the final result.


Finally, there’s no need for class 3 elastics in this case. The key is to eliminate palatal cusp contact and ensure proper occlusion on the buccal cusps. At the end of treatment, if necessary, extrusion can be easily managed with elastics or attachments. The main goal is to prevent any heavy contact on the palatal cusps.