OUTCOMES OF EARLY VERSUS LATE

TREATMENT OF SEVERE CLASS II HIGH-

ANGLE PATIENTS

AUTHORS: Jung-Yul Cha, David B. Kennedy, Patrick K.

Turley, Donald R. Joondeph, Hyung-Seon Baik, Chung-Ju
Hwang, and Peter M. Sinclaire.

PLACE OF STUDY: Seoul (Korea), Vancouver, BC

(CANADA) Seattle, Washington, Los Angeles, California
(USA).

AIMS AND OBJECTIVES: The purpose of this study

was to retrospectively compare 1-phase and 2-phase
treatment outcomes for patients who had severe Class II
malocclusions and concomitant high MP angles.

MATERIAL AND METHODS:

 A total of 4000 patient’s chart was examined in the
private offices of 3 senior clinicians in Seattle, Los
Angeles and Vancouver.
 Information such as age, sex, race, treatment start
and end date, total treatment time, extraction vs.
non extraction and appliance selection were
recorded.
 660 Class II patients were identified and a final
sample of 120 patients was selected who met the
following criteria:
1. ANB ≥ 6º
2. Either SN-Mand ≥ 37º or FMA ≥ 30º
3. Bilateral molar relationship more than half cusp
Class II.
 35, 56 and 31 patients were selected from each
clinic respectively.
 Thirty-seven angular, linear, and proportional
measurements were calculated for each patient.
  The mean ages for initiation of treatment for the
early treatment group were 9.8 years for girls and
10.5 years for boys. The mean starting ages for the
late treatment group were 11.6 years for girls and
12.3 years for boys.
 Phase 1 treatment had to involve growth
modification with the use of either headgear
(combination or high-pull) or a functional appliance
(Bionator).

RESULTS:

 The samples derived from the 3 offices were

remarkably similar before treatment, with 35 of the
37 parameters showing no significant differences
 The 2 differences were a 0.8º greater initial ANB
measurement for the patients from office A and a
1.4º greater SN-GoGn angle for the patients from
office C.

 The severity of the skeletal Class 2 malocclusion

of the early and late treatment groups showed great

pretreatment similarity; (ANB: early treatment 7.4 º,
 late treatment 7.3º; Wits: early treatment 4.0 mm,
late treatment 4.4 mm).

 The 2 groups also showed similar vertical

relationships (FMA: early treatment 31.9º, late

treatment 31.8º; SN-GoGn: early treatment 39.3º,
late treatment 39.0º).

 ANB angle was 0.70º higher and the FMA angle

1.7º higher for the late treatment group.

 In dental measurements only FMIA showed a
significant decrease and other 10 of 11
measurements showed no significant difference
 The late treatment group tended to show slightly
increased dental heights and an increased lower
facial height (ANS-Me) than the early treatment
group.
 8 of the 9 skeletal anteroposterior

measurements showed no significant differences

between the early and late treatment groups.
 7 of the 8 skeletal vertical parameters were similar
at T2
 The skeletal measurements of the early treatment
group and late treatment group were very similar to
each other.
 The results of this study, therefore, support the
conclusions of previous studies.
 Boys showed no difference in outcomes between the
2 groups for all dental and skeletal variables.
 Girls showed higher ANB value in late treatment
group as well as more upright upper incisors.
 Odds of an unfavorable change in MP angle for the
late treatment group were 3.7 times greater than early
treatment group.
CONCLUSION:

 Severe Class II high-angle patients showed very

similar anteroposterior and vertical skeletal as well
as dental outcomes whether treated early with 2-
phase therapy or later in 1 phase.
 There was a clinical tendency for patients in the late
treatment group to have a higher post-treatment
MP angle and more vertical extrusion of upper
incisors and lower molars.
 There was a clinical tendency for female patients in
the late treatment group to have a higher post
treatment ANB value, an increased FMA angle, and
more upright upper incisors.