PDF: Relevant variables of Class II malocclusion treatment

Success rate in Class II malocclusion treatment can be significantly influenced by factors such as treatment protocol, malocclusion severity, patient age and degree of patient compliance.


Since malocclusion severity and age are inherent patient characteristics which are, therefore, defined ahead of time, these variables are beyond professional control. It has been shown that patient compliance is hard to predict by means of simple anamnestic methods of psychiatric or behavioral evaluation. Although unpredictable, degree of compliance is one of the key variables affecting orthodontic treatment success, notably when the treatment plan involves the use of removable appliances, whose effectiveness relies considerably on patient compliance.

In light of the treatment protocols currently available, Class II malocclusion can be treated with or without extractions. The extraction protocol consists basically in extracting either four or two premolars in the upper arch whereas nonextraction treatment can be performed using extraoral anchorage, functional orthopedic appliances, Class II elastics combined with fixed appliances or, more recently, intraoral distalizing appliances.

Recent studies, however, have shown that given the same age and degree of severity a Class II malocclusion treatment protocol with the extraction of two upper premolars provides superior efficiency than the protocols involving extraction of four premolars or nonextraction. Therefore, it is safe to assert that the choice of a treatment protocol to correct Class II malocclusion constitutes one of the few approaches – if not the only one – professionals can resort to in order to influence the success rate of treatments.

Although the treatment protocol involving the extraction of two upper premolars is more efficient than the Class II malocclusion protocol entailing four premolar extraction or no extractions, it is a known fact that the mechanism of malocclusion correction involves predominantly dentoalveolar changes, irrespective of the treatment protocol or the orthodontic appliance used. Nevertheless, it has been speculated that patient skeletal features – such as facial pattern and jaw-to-jaw relationship – can impact orthodontic treatment success. Thus, this review article aims to establish evidence regarding the impact of cephalometric features on the success rate of Class II malocclusion treatment.

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