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Purpose <p>To compare two non-extraction approaches for treating Class II Division 1 malocclusion in hypodivergent growing patients: clear aligners (CAs) with high-pull headgear (HP-HG) versus CAs with TAD-supported molar distalization.</p> Methods <p>Two 11-year-old girls with similar diagnostic features were treated using different non-extraction protocols. Case 1 received HP-HG, CAs and Class II elastics for en masse distalization; Case 2 underwent TAD-supported molar distalization followed by aligner-based retraction of the remaining maxillary dentition.</p> Results <p>Both patients achieved Class I molar and canine relationships, correction of incisor proclination and normalization of overjet and overbite. Case 1 showed sagittal skeletal improvement and stable vertical dimension, consistent with the orthopedic headgear effect during growth. Case 2 maintained the sagittal skeletal relationship with a slight increase in vertical dimension, reflecting the purely dentoalveolar nature of TAD-supported distalization. These skeletal differences did not result in clinically appreciable profile changes. Case 1 required less treatment time (18 vs. 26 months), fewer visits and approximately 35% lower cost in our clinical setting.</p> Conclusions <p>Although the two protocols produced different cephalometric effects, the esthetic impact on the facial profile was limited. The main differences concerned biomechanics, treatment duration, visit burden and cost. These observations should be interpreted within the limits of a descriptive two-case comparison.</p>

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Comparison of Class II Division 1 treatment in similar growing patients with clear aligners: headgear-assisted versus TAD-supported distalization

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Giuseppe Manti,
  • Marco Rosa

摘要

Purpose

To compare two non-extraction approaches for treating Class II Division 1 malocclusion in hypodivergent growing patients: clear aligners (CAs) with high-pull headgear (HP-HG) versus CAs with TAD-supported molar distalization.

Methods

Two 11-year-old girls with similar diagnostic features were treated using different non-extraction protocols. Case 1 received HP-HG, CAs and Class II elastics for en masse distalization; Case 2 underwent TAD-supported molar distalization followed by aligner-based retraction of the remaining maxillary dentition.

Results

Both patients achieved Class I molar and canine relationships, correction of incisor proclination and normalization of overjet and overbite. Case 1 showed sagittal skeletal improvement and stable vertical dimension, consistent with the orthopedic headgear effect during growth. Case 2 maintained the sagittal skeletal relationship with a slight increase in vertical dimension, reflecting the purely dentoalveolar nature of TAD-supported distalization. These skeletal differences did not result in clinically appreciable profile changes. Case 1 required less treatment time (18 vs. 26 months), fewer visits and approximately 35% lower cost in our clinical setting.

Conclusions

Although the two protocols produced different cephalometric effects, the esthetic impact on the facial profile was limited. The main differences concerned biomechanics, treatment duration, visit burden and cost. These observations should be interpreted within the limits of a descriptive two-case comparison.