Treatment Timing in the Management of Class II Malocclusion

Treatment timing for class II malocclusion has been debated for almost as long as the specialty of orthodontics has existed. Initial retrospective investigation of early intervention suggested that significant dental and orthopedic change could be achieved with headgear and activator-based treatment in the early mixed dentition. However, longer-term follow-up and more latterly, large-scale randomized clinical trials have shown that most of the changes achieved with early treatment are lost and a single phase of treatment in the late mixed or early permanent dentition will yield similar results. Orthodontists have also preoccupied themselves with coinciding their later treatment with the adolescent growth spurt to maximize the effect of functional appliance treatment on condylar growth. However, our ability to accurately predict onset of the adolescent growth spurt is questionable, correlation between this growth spurt and maximal condylar growth is poorly understood, and evidence that timing functional appliance treatment specifically to coincide with this growth spurt yields better treatment results is poor.