Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 32

SPECIAL SECTION: CLASS II CORRECTION
Editorial

Class II Correction
The optimal treatment strategy for correcting a
Class II dentoalveolar relationship has been a constant topic of interest throughout the history of
contemporary orthodontics. For decades, orthodontists have sought to find a Class II correction
modality that is efficient, predictable, easy to use,
and comfortable, with good long-term stability
and minimal side effects.
Dr. Jae Hyun Park
PCSO Bulletin Editor-in-Chief

In search of the ideal Class II correction mechanism, various removable and fixed appliances
have been developed and used. Headgear has
commonly been used for holding the growth of
the maxilla or maxillary distalization, while other
removable appliances such as Bionator and Twin
Block have been used for the advancement of the
mandible. Class II elastics also have been widely
prescribed.1 Irrespective of their questionable
orthopedic effects on long-term results, they were
effective in dentoalveolar correction of Class II
dental relationships, but the effectiveness of these
removable appliances was too unpredictable, depending on the level of individual patient compliance. Thus, a variety of fixed, noncompliance appliances were developed, including the pendulum
appliance, Jones Jig, and distal jet for maxillary
molar distalization and Herbst, Forsus, and MARA
for mandibular advancement. These appliances
can efficiently correct overjet and molar occlusal
relationships, but unfortunately, they produced
some significant unfavorable movements that
caused flaring of incisors, distal tipping, and extrusion of molars, especially in maxillary distalization
appliances. On top of these side effects, effective
retention was also a concern.
Temporary skeletal anchorage devices (TSADs)
were initially used in the palatal areas in conjunction with molar distalizers.2 Through skeletal
fixation of these appliances, the incisor anchorage
was stabilized, but some of the other side effects
still existed. Some orthodontists were able to
achieve intrusive retraction of the molars or even
the entire maxillary arch by using TSADs in the
buccal interradicular bone, zygomatic buttress, or
palate, but it was not always easy for the practi-

32	

tioner to place them, nor were they comfortable
for the patient. More recently, Dr. Kook and I
collaborated on a novel palatal anchorage system
called the modified C-palatal plate, which is reportedly extremely efficient at achieving maxillary
retraction and intrusion without the side effects
of molar tipping, molar extrusion, or oropharynx
airway volume reduction. In addition, there is minimal relapse when they are used.3,4 This technique,
however, still requires further validation through
a large clinical study focused on the long-term
results, ease of use, and patient comfort.
While Class II correction methods have come a
long way, there are still some limitations with
each of the techniques to overcome. Hence, it is
essential to understand the strengths and limitations of each method and what specific benefits
they offer. To maximize the benefits of each
method, orthodontists also need to build their
treatment strategies on a solid understanding of
the biomechanical principles rather than relying
on cookbook approaches.
I hope you will enjoy our new special PCSO Bulletin issue that focuses on Class II correction. Please
contact me if there is something you would like
to see discussed in future special issues!
References
1. Janson G, Sathler R, Fernandes TM, Branco NC, Freitas
MR. Correction of Class II malocclusion with Class II
elastics: a systematic review. Am J Orthod Dentofacial
Orthop 2013;143:383-392.
2. Fudalej P, Antoszewska J. Are orthodontic distalizers
reinforced with the temporary skeletal anchorage
devices effective? Am J Orthod Dentofacial Orthop
2011;139:722-729.
3. Lee SK, Abbas NH, Bayome M, et al. A comparison
of treatment effects of total arch distalization using
modified C-palatal plate vs buccal miniscrews. Angle
Orthod 2018;88:45-51.
4. Park JH, Kim S, Lee YJ, et al. Three-dimensional
evaluation of maxillary dentoalveolar changes and
airway space after distalization in adults. Angle Orthod
2018;88:187-194.

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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