Surgical versus orthodontic correction for class II patients: age and severity in treatment planning and treatment outcome

Abstract

Treatment options for Class II malocclusion include orthognathic surgery. Treatment choices are particularly difficult for young patients because of the uncertainty regarding future growth. Surgical treatment has generally been considered necessary for older patients with more severe Class II problems. The treatment records of more than 500 patients with Class II malocclusion were reviewed. Patients were grouped according to their initial treatment plan (surgery or orthodontics) and treatment outcome (overjet [OJ] reduced to <4 mm or not). Discriminant function analyses using data from the patient's pretreatment cephalogram were used to determine whether age, in combination with malocclusion severity, could predict the choice of treatment, and whether a simple set of pretreatment variables could predict the success or failure of OJ reduction. The derived equations were tested in a similar group of growing Class II children. Although the data showed clinicians use patient's age in determining treatment choice, age did not seem to be associated with treatment outcome. The majority of the variability that determined the success or failure of OJ reduction was not explained by patient's age or malocclusion severity. These findings suggest other factors, including psychosocial variables, need to be explored if we are to gain a better understanding of why treatments succeed or fail.

Comparison of surgical and non-surgical orthodontic treatment approaches on occlusal and cephalometric outcomes in patients with Class II Division I malocclusions

“…This study emphasized that in severe cases, surgical treatment is most likely the best option [35]. They examined 500 patients in a study with similar inclusion criteria as ours.…”

“…Patients were treated non-surgically or surgically and end-of-treatment outcomes were reviewed based on division into three categories: orthodontic success, orthodontic failure, and surgical success. This study assessed success of treatment through reduction in overjet to less than 4 mm [35]. Cephalometric radiographs were reviewed and patients were placed into two sub-groups based on gender.…”

“…Initial ANB in this study was about 6°, similar to that in our study, but the initial overjet measurement is that both groups were significantly more (7.8 and 8.6 mm) when compared to our population (2.9 versus 3.1 mm). This study found that 98% of patients in their entire population did not meet their criteria for correction of overjet [35]. Since our study evaluated ANB change as a measure of AP correction, we were able to focus exclusively on skeletal position instead of tooth position.…”

Necrotic Pulp With Crown Discoloration Associated With Orthodontic Treatment: A Case Report

“…It has been reported in the literature that orthognathic surgery is often necessary for successful correction of malocclusion when the overjet exceeds 10 mm [ 44 ]. Additionally, older patients with more severe class II problems typically require surgical treatment [ 45 ]. The extraction of all first premolars was performed to alleviate crowding and normalize incisor proclination.…”

Effective and Efficient Correction of Severe Skeletal Class II Division 1 Malocclusion with Intermaxillary Elastics

“…Treatment approach and modality for Class II division 1 with an underlying skeletal problem depend on several factors that should be considered by the clinicians such as chronological age, growth potential, skeletal maturity, severity of the condition, and patient motivation and cooperation [10,11]. The treatment options for growing patients with such malocclusion mainly based on growth modification on an exact time-frame taking advantage of the adolescent growth spurt.…”