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Class II division 1 malocclusion with increased overjet — ORE Part 1 MCQ

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ModerateOrthodonticsClass II division 1 malocclusion with increased overjetORE Part 1

A 12-year-old patient has a 9 mm overjet, competent lips only with effort, and a Class II division 1 incisor relationship. He is in the pubertal growth spurt and has good oral hygiene. There is no anterior open bite. What is the most appropriate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Referral for orthodontic assessment for functional appliance treatment

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

D is correct. A 12-year-old with 9 mm overjet and Class II division 1 in active pubertal growth spurt is an ideal candidate for specialist orthodontic assessment and functional appliance treatment. Evidence shows functional appliances reduce overjet significantly during this growth phase and can modify underlying skeletal discrepancy better than waiting or using only fixed appliances. The patient's good oral hygiene and absence of contraindications make immediate referral appropriate. A is wrong: lower incisor extraction is not standard for Class II overjet and inappropriate in primary care. B is wrong: delaying referral past the pubertal growth spurt reduces the skeletal benefits of functional treatment. C is wrong: occlusal grinding does not address the underlying malocclusion and causes irreversible damage. E is wrong: veneers are cosmetic-only, irreversible, and do not correct the Class II relationship or lip incompetence in a growing patient.

Reference: Cochrane Oral Health Group (2015), 'Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma' (353 RCT participants); supported by 3D prospective study (Perinetti et al., PMC10932136, 2024) and UK-based RCT (NCT00957489, University of Manchester). https://pubmed.ncbi.nlm.nih.gov/26124027/