Classification and treatment of Class II subdivision malocclusions.
BACKGROUND
Patients with Class II subdivision malocclusions are a challenge for clinicians because reestablishing symmetry in 1 arch or both arches is often a treatment goal. In patients with mandibular skeletal asymmetry, surgery is often a treatment option. However, patients may be unwilling to undergo surgery, and other options might have to be considered. The aim of this study was to evaluate the etiologies and outcomes of Class II subdivision patients treated at the University of Washington graduate orthodontic clinic in Seattle from 1995 through 2011.


METHODS
A search of patients treated between 1995 and 2011 resulted in the identification of 110 consecutively treated Class II subdivision subjects with complete records. Ninety-eight subjects could be classified into 1 of 3 groups, based on midline position and dental or skeletal etiology. Initial and final models were used to measure the peer assessment rating scores, midlines, overjet, overbite, and molar positions. Initial and final cephalograms were traced and measured. Charts were reviewed for information regarding treatment.


RESULTS
Twenty-five percent of the 98 subjects had their maxillary and mandibular midlines coincident with the facial midline; their asymmetries were due to a maxillary posterior dental asymmetry. Another 15% had maxillary midlines deviated from their facial midlines, caused by maxillary anterior and posterior dental asymmetry. About 50% of the subjects had mandibular midlines that were not coincident with their facial midlines, and most of them exhibited some degree of mandibular skeletal asymmetry. Over the past 15 years, treatment strategies used at the University of Washington indicated trends toward less surgery, fewer extractions, less use of headgear, and more reliance on fixed functional appliances. Ideal correction of midlines was not always achieved, especially in patients with mandibular skeletal asymmetry, with undercorrection occurring more commonly than overcorrection. Final peer assessment rating scores were comparable, regardless of the origin of the asymmetry or the extractions status. Mandibular incisor proclination was increased when fixed functional appliances were used, as well as when a Class I molar relationship was the target for the Class II side.


CONCLUSIONS
Class II subdivision malocclusions were grouped into 3 main categories; the largest category was mandibular asymmetry. Interesting trends were noted with regard to treatment strategies, midline and molar corrections, and mandibular incisor proclination.
Private practice, Seattle, Wash. Electronic address: sara@greenlakeorthodontics.com.
Sara E
SE
Cassidy
US Army graduate orthodontic resident, Tri-Service Residency Program, Lackland Air Force Base, San Antonio, Tex.
Stona R
SR
Jackson
Moore-Riedel Professor, Department of Orthodontics, University of Washington, Seattle, Wash.
David L
DL
Turpin
Professor and chair, Department of Oral Health Sciences, University of Washington, Seattle, Wash; professor, Department of Orthodontics and Pediatric Dentistry, University of Washington, Seattle, Wash.
Douglas S
DS
Ramsay
Research scientist, Department of Oral Health Sciences, University of Washington, Seattle, Wash.
Charles
C
Spiekerman
Professor and chair, Department of Orthodontics, University of Washington, Seattle, Wash.
Greg J
GJ
Huang
D000293:Adolescent; D002508:Cephalometry / Q000379:methods; D002985:Clinical Protocols; D003724:Dental Arch / Q000473:pathology; D005115:Extraoral Traction Appliances; D005146:Facial Asymmetry / Q000145:classification / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D008312:Malocclusion, Angle Class II / Q000145:classification* / Q000628:therapy; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D008963:Molar / Q000473:pathology; D017289:Orthodontic Appliances, Functional; D056948:Orthognathic Surgical Procedures; D057887:Overbite / Q000145:classification; D010347:Patient Care Planning; D018024:Peer Review, Health Care; D012189:Retrospective Studies; D014081:Tooth Extraction; D016896:Treatment Outcome; D055815:Young Adult