Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 33

PCSO Program Talk

Special Section: Class II Correction

Class II Correction

Dr. Sohyon (Michelle) Kim
Department of Orthodontics,
School of Dentistry
Oregon Health &
Science University
Portland, OR

Class II malocclusion is a common chief complaint of orthodontic patients, affecting nearly
15% of 12- to 15-year-olds in the United States.1
There has been a lot of debate over timing and
treatment modalities for Class II malocclusion,
especially during the past two decades.2 One of
the questions that revolve around the debate is
whether two-phase Class II treatment protocols
are more efficient and effective than one-phase
Class II treatment protocols.2 Another question is
whether any specific Class II treatment modalities
are more efficient and effective than others.
In the two-phase Class II treatment protocols, the
treatment begins with a Phase I treatment in the
mixed dentition. During Phase I of this approach,
patients usually receive either headgear, functional appliances, or a combination of fixed 2 × 4
appliances and Class II elastics. The main goal of
Phase I treatment is to intercept or prevent orthodontic issues that are associated with patients'
skeletal and dental Class II malocclusions.3,4 Phase
I treatment is followed by Phase II treatment with
full fixed appliances after the eruption of permanent teeth to achieve comprehensive treatment
goals.5 The one-phase Class II treatment approach
starts in the late mixed to permanent dentition with full fixed appliances. The treatment
modalities for the one-phase treatment protocol
may include Class II elastics, headgear, traditional
fixed functional appliances, orthognathic surgery,
and "Class II correctors," which are commercially
available and were recently introduced, such as
the ForsusTM Fatigue Resistant Device (3M Unitek,
Monrovia, Calif).
Survey of 12 Orthodontic Programs: Class II Correction
The chairpersons and program directors of all
PCSO postgraduate orthodontic programs were
emailed a questionnaire regarding the prevalence
of Class II malocclusion in their orthodontic clinic,
the ratio between one-phase and two-phase treatment protocols, and types of Class II treatment
modalities. The following summarizes the results
of the survey; responses are shown in Table 1.

Summer 2020    PCSO Bulletin	

In the PCSO postgraduate orthodontic programs
that responded to our survey (N = 5), approximately 50% to 75% of their patient population is
growing patients and 25% to 50% of their patient
population is nongrowing patients. These results
are in line with the results of the AAO's "Economics of Orthodontics" survey of 2014, which
reported that about 27% of all US and Canadian
orthodontic patients are adults.6 Programs reported that approximately 35% to 80% of the growing
patients presents with Class II malocclusion. For
the nongrowing patients, programs responded
that about 30% to 40% of the population presents with Class II malocclusion.
One-Phase Versus Two-Phase Class II Treatment
Protocols for Growing Patients
It was reported that the ratio between one-phase
and two-phase Class II treatment protocols for
growing patients ranges from 1:1 to 6:1. When
asked if there is a general treatment philosophy
(one-phase vs two-phase treatment protocols) for
treating Class II malocclusion in growing patients
in their clinic, most of the programs described
that, ultimately, the assigned faculty determines
which treatment protocol is indicated for the
case. To make a decision on which treatment
would be appropriate for each case, the programs
use the evidence-based approach (i.e., a combination of the best-quality scientific evidence,
patient needs and preferences, and the orthodontist's expertise).7 In the five PCSO postgraduate
orthodontic programs, the treatment protocol
choice is based on the effectiveness and efficiency
of the treatment, the patient's estimated motivation/compliance level, the potential psychosocial
benefits of the treatment, and the risk of incisal
trauma.1,2 Most of the programs have not noticed
any change in the trend (one-phase vs two-phase
treatment protocols) in their clinic over the past
decade.
Phase I Class II Treatment Modalities for Growing
Patients
Programs outlined multiple different approaches as the Phase I Class II treatment modalities

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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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