ONLINE ONLY

Dental and skeletal changes associated

with Class II surgical-orthodontic treatment
Brittany Potts,a Shiva Shanker,b Henry W. Fields,c Katherine W. L. Vig,d and F. Michael Becke
Toledo and Columbus, Ohio

Introduction: Few published reports detail the dental changes produced by orthodontic treatment in conjunc-
tion with orthognathic surgery. Methods: Thirty-four Class II subjects who underwent surgical-orthodontic
treatment with mandibular advancement and rigid fixation were selected, and their lateral cephalograms
were digitized. Mean skeletal and dental values were calculated for pretreatment, presurgical, and final treat-
ment times. Treatment efficacy as a percentage of an ideal goal achieved also was calculated. Results: All
data showed significant positive changes in the position of the mandible. The mean changes showed that
the maxillary incisors were overretracted presurgically and then returned to a normal position postsurgically,
whereas the mandibular incisors were proclined and protruded presurgically and remained so at posttreat-
ment. The efficacy data showed that the incisors were not ideally decompensated in many patients.
Conclusions: The efficacy data show that presurgical orthodontic treatment often does not fully decompen-
sate the incisors; this then limits the surgical outcome. (Am J Orthod Dentofacial Orthop 2009;135:566.e1-566.e7)

A
spectrum of contemporary orthodontic treatment
options is available for patients with skeletal mal-
occlusions. The indicated treatment depends on
the patient’s growth status, the severity of the malocclu-
sion, and facial esthetics. For growing patients with minor
to moderate skeletal malocclusions, growth modification
appears to be a reasonable solution. For nongrowing pa-
tients with acceptable esthetics and minor to moderate
skeletal discrepancies, camouflage treatment, with the
teeth made to fit on nonideal skeletal bases is acceptable.1
When facial esthetics is a concern or there are severe skel-
etal discrepancies, orthognathic surgery combined with
orthodontic treatment provides the best results in terms
of function, stability, and esthetics. With improved surgi-
cal and orthodontic techniques and a collaborative inter-
disciplinary approach, it is possible to treat patients with
skeletal and dental problems in all planes of space.2
Improved treatment outcomes have resulted from better
understanding of which diagnostic and treatment vari-
a
Private practice, Toledo, OH.
b
Clinical associate professor and graduate program director, Division of Ortho-
dontics, College of Dentistry, Ohio State University, Columbus.
c
Professor and chair, Division of Orthodontics, College of Dentistry, Ohio State
University, Columbus.
d
Professor emeritus, Division of Orthodontics, College of Dentistry, Ohio State
University, Columbus.
e
Associate professor, Division of Oral Biology, College of Dentistry, Ohio State
University, Columbus.
The authors report no commercial, proprietary, or financial interest in the prod-
ucts or companies described in this article.
Reprint requests to: Henry W. Fields, 4088 F Postle Hall, 305 W 12th Ave,
PO Box 182357, Columbus, OH 43218-2357; e-mail, fields.31@osu.edu.
Submitted, April 2007; revised and accepted, August 2007.
0889-5406/$36.00
Copyright Ó 2009 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.08.020
ables contribute to success and failure. Rigid internal fix-
ation is a good example of a treatment variable that
contributes to increased surgical success.3 For maximum
impact with a surgical orthodontic approach, the goals are
to decompensate the dentition to ideal, surgically move
the skeletal units to ideal, and postsurgically detail the
occlusion. Little information is available about how suc-
cessful the orthodontic clinician is in achieving the ortho-
dontic goals. The extent of dental decompensation during
the presurgical orthodontic phase directly determines the
extent of the surgical correction possible because the
occlusion is used as the template for the surgical moves.4
Final postsurgical dental changes detail the occlusion and
compensate for a less-than-ideal surgical outcome.
There are few reports about presurgical and postsur-
gical orthodontic tooth movements during surgical-or-
thodontic treatment. Moreover, when mean changes
are reported, the true dynamics of the changes during
each treatment stage are lost. The measures of central
tendency and summary statistics of data that have sim-
ilar values on either side of zero cancel each other out
and provide little evidence of the true nature of the un-
derlying changes. This is especially and uniquely true
with Class II patients and the 2 variants (Divisions 1
and 2), which have proclined and retroclined maxillary
incisors, respectively.
In a pilot study, Potts et al5 evaluated orthognathic sur-
gical patients to determine dental decompensation during
presurgical orthodontic treatment. When incisor position
was evaluated, only 56% of the upper incisors and 36% of
the lower incisors were decompensated appropriately.
The upper incisor position was associated with the pa-
tient’s sex, and slot size to archwire size differential,
566.e1
566.e2 Potts et al American Journal of Orthodontics and Dentofacial Orthopedics
May 2009

and lower incisor position was associated with patient Table I. Skeletal and dental cephalometric measures and
compliance scores and the use of intermaxillary elastics. their normative standards
Proffit et al6 evaluated incisor decompensation in Variable and type Male Female
a sample of surgical patients. They found acceptable fi- of measurement norm norm Reference
nal positions for 60% of the upper incisor (U1) to NA an-
Anteroposterior skeletal
gles, 72% of the U1 to NA distances, 58% of the lower
measurements
incisor (L1) to NB angles, and 90% of the L1 to NB dis- SNA ( ) 82 82 Steiner8-10
tances based on an incisal position of 61 SD of ideal. A-point to N perp (mm) 1 1 McNamara11
They also determined treatment efficacy as the percent- SNB ( ) 80 80 Steiner8-10
age of the ideal achieved during treatment. For this eval- Pg to N perp (mm) 0.3 1.8 McNamara11
ANB ( ) 2 2 Steiner8-10
uation, 61% of the U1 to NA angles, 20% of the U1 to NA
Wits appraisal (mm) 1 0 Jacobson12,13
distances, –3% of the L1 to NB angles, and 15% of the Overjet (mm) 2 2 ABO standards14
L1 to NB distances of the ideal were achieved.6 Vertical skeletal measurements
Burden et al7 investigated a sample of Class II sur- SN to GoGn ( ) 32 32 Steiner8-10
gical-orthodontic patients to determine predictors of Mandibular plane angle ( ) 26 26 Ricketts15-17
Face height ratio 0.54 0.54 Isaacson18
success using multiple logistic regression. They defined
Dental measurements
success as outcomes within approximately 61 SD of U1 to Na ( ) 22 22 Steiner8-10
ideal relationships. They found that successful overjets U1 to NA (mm) 4 4 Steiner8-10
(1-4 mm) were obtained in 72% of the patients and more U1 to SN ( ) 104 104 Bell et al19
likely in patients with large pretreatment overjets. Ideal L1 to NB ( ) 25 25 Steiner8-10
L1 to NB (mm) 4 4 Steiner8-10
posttreatment ANB angles were achieved in 42% of the
L1 to MP ( ) 95 95 Bell et al19
patients and typically in those with larger pretreatment
angles. Mandibular decompensation was incomplete
in 28% of the patients, especially in those with increased
vertebrae maturation of stage 4 or 5 before treatment,
pretreatment proclination. The soft-tissue profile as
indicating minimal growth potential; they had received
judged by the Holdaway angle was worse in patients
orthognathic surgery of which at least 1 component was
with large pretreatment SNA angles, increased final
mandibular advancement with rigid fixation. Thedr
lower incisor proclination, and reduced upper incisor in-
34 subjects had complete records, high-quality lateral
clination, when dental decompensation was incomplete.
cephalometric radiographs, including pretreatment
These studies contributed to a more critical appraisal of
(T1), presurgical (T2), and postsurgical or final (T3),
the outcomes of orthodontic presurgical decompensa-
and complete dental charts. The final records were
tion and the overall dental changes that accompany
obtained within 3 months of debanding.
orthognathic surgery.5-7
The subjects’ cephalometric radiographs were
The purpose of this study was to evaluate in further
traced, and 122 landmarks (25 soft tissue, 95 hard tissue,
detail the incisor and skeletal changes og presurgical
and 2 points on the true vertical plane) were identified
and postsurgical orthodontic treatment.
and digitized by a trained person (B.P.) using a Nu-
monics Accugrid (Numonics Corp, Philadelphia, Pa)
MATERIAL AND METHODS and DFP Plus software (Dentofacial Software Inc, Tor-
onto, Canada) on the radiographs at T1, T2, and T3. All
In this retrospective study, we evaluated digitized
linear measurements were corrected for magnification.
lateral cephalograms from a sample of Class II subjects
Certain cephalometric measurements were chosen to
who had received combined surgical-orthodontic treat-
show anteroposterior and vertical skeletal and dental
ment at the Orthodontic Graduate Clinic at The Ohio
characteristics. All measurements are shown with their
State University College of Dentistry. Approval to con-
referenced normative standards in Table I.8-19
duct this study was obtained from The Institutional
To verify intraexaminer reliability, 20 cephalomet-
Review Board of The Ohio State University.
ric radiographs were randomly selected, redigitized
Thirty-four subjects satisfied the inclusion criteria
and remeasured a minimum of 3 weeks later.
from an available sample of 97 patients with Class II
malocclusion treated by orthognathic surgery. Eighteen
of them were classified as Class II Division 1, with pro- Statistical analysis
clined maxillary incisors, and 16 were Class II Division Intraclass correlation coefficient and 95% confi-
2, with retroclined maxillary incisors. All subjects were dence interval statistics were used to test the reliability
white with Class II molar relationships and at cervical of the linear and angular cephalometric measurements.
American Journal of Orthodontics and Dentofacial Orthopedics Potts et al 566.e3
Volume 135, Number 5

Table II. Means and standard deviations for skeletal Table III. Means and standard deviations for dental
measurements at T1, T2, and T3, including confidence measurements at T1, T2, and T3, including confidence
intervals and ANOVA comparisons intervals and ANOVA comparisons
Mean and Lower Upper Mean and Lower Upper
ANOVA SD 95% CI 95% CI ANOVA SD 95% CI 95% CI

T1 SNA ( ) 81.856 A 3.701 80.565 83.147 T1 U1 to NA ( ) 21.371 A 11.888 17.223 25.519

T2 SNA ( ) 81.750 A 3.937 80.376 83.124 T2 U1 to NA ( ) 19.885 A 9.604 16.534 23.236
T3 SNA ( ) 81.947 A 3.552 80.708 83.186 T3 U1 to NA ( ) 21.291 A 8.982 18.157 24.425
T1 A-point to N perp (mm) 0.435 A 3.594 0.819 1.689 T1 U1 to NA (mm) 3.192 A 4.252 1.708 4.675
T2 A-point to N perp (mm) 0.163 A 3.879 1.191 1.516 T2 U1 to NA (mm) 2.388 A 3.121 1.299* 3.477*
T3 A-point to N perp (mm) 0.233 A 4.113 1.202 1.668 T3 U1 to NA (mm) 2.670 A 3.006 1.621* 3.719*
T1 SNB ( ) 74.426 A 3.673 73.145* 75.708* T1 U1 to SN ( ) 103.241 A 11.894 99.091 107.391
T2 SNB ( ) 74.321 A 3.541 73.085* 75.556* T2 U1 to SN ( ) 101. 550 A 8.522 98.577 104.523
T3 SNB ( ) 77.106 B 3.402 75.919* 78.293* T3 U1 to SN ( ) 10 3.321 A 7.806 100.597 106.044
T1 Pg to N Perp (mm) 10.682 A 7.569 13.323* 8.041* T1 L1 to NB ( ) 26.715 A 7.637 24.050 29.379
T2 Pg to N Perp (mm) 10.645 A 8.196 13.504* 7.785* T2 L1 to NB ( ) 26.450 A 6.979 24.015 28.885
T3 Pg to N Perp (mm) 4.752 B 7.354 7.318* 2.186* T3 L1 to NB ( ) 30.656 B 7.161 28.157* 33.154*
T1 ANB ( ) 7.447 A 2.237 6.667* 8.228* T1 L1 to NB (mm) 5.369 A, B 2.781 4.398* 6.339*
T2 ANB ( ) 7.424 A 2.205 6.654* 8.193* T2 L1 to NB (mm) 5.176 A 2.884 4.170* 6.183*
T3 ANB ( ) 4.835 B 3.090 3.757* 5.914* T3 L1 to NB (mm) 6.066 B 2.809 5.086* 7.047*
T1 Wits appraisal (mm) 6.821 A 3.593 5.568* 8.075* T1 L1 to MP ( ) 96.315 A 9.466 93.012 99.617
T2 Wits appraisal (mm) 5.985 A 4.199 4.520* 7.450* T2 L1 to MP ( ) 96.318 A 8.952 93.194 99.441
T3 Wits appraisal (mm) 1.153 B 2.753 0.193* 2.114* T3 L1 to MP ( ) 96.929 A 8.873 93.833 100.025
T1 overjet (mm) 7.380 A 3.782 6.060* 8.699*
T2 overjet (mm) 7.185 A 1.818 6.550* 7.819* Similar letters (A and B) indicate no significant difference at the
T3 overjet (mm) 2.995 B 0.882 2.688* 3.303* P 5 0.05 level.
T1 SN to GoGn ( ) 34.135 A 7.974 31.353 36.917 *Normative values beyond the confidence interval bounds.
T2 SN to GoGn ( ) 34.382 A 7.878 31.634 37.131
T3 SN to GoGn ( ) 34.144 A 7.652 31.474 36.814
T1 mandibular 27.335 A 8.913 24.225 30.445 retrusive teeth at T1, T2, and T3 were placed into groups.
plane angle to FH ( ) This gave the following time points: T1 to T2, T1 to T3,
T2 mandibular 27.529 A 9.550 24.197 30.861 and T2 to T3. These groups were further subdivided into
plane angle to FH ( ) those that moved in the correct direction (toward the
T3 mandibular 26.874 A 9.163 23.676 30.071
ideal) and those that moved in the opposite direction
plane angle to FH ( )
T1 face height ratio 0.568 A 0.023 0.560* 0.576* (away from the ideal). The percentages of skeletal
T2 face height ratio 0.573 A 0.025 0.565* 0.582* change were also calculated. This uniquely addressed
T3 face height ratio 0.570 A 0.023 0.562* 0.578* the well-demonstrated problems of having the summary
Similar letters (A and B) indicate no significant difference at the
statistics of the central tendency mask changes for the
P 5 0.05 level. Division 1 and Division 2 patients (or initially proclined
*Normative values beyond the confidence interval bounds. vs retroclined incisor groups) and reassessed for each
stage of treatment for a comprehensive appraisal.
For each mean dental measure, the 95% confidence
interval was calculated to determine whether the means RESULTS
differed significantly from the normative standards as Twenty lateral cephalograms were retraced and
a comparison method to typify the sample groups and measured to assess intrarater reliability. The intraclass
the changes (Tables II and III). correlation coefficients and their upper and lower 95
An efficacy analysis was completed by using a mod- percentile confidence boundary for the linear and angu-
ification of the method described by Proffit et al.6 For lar cephalometric measures were 0.995 (0.989, 0.998)
this analysis, the actual change in a measurement was and 1.00 (0.999, 1.00), respectively.
expressed as a percentage of the change needed to give The means and standard deviations for the skeletal and
an ideal posttreatment value. The closer the value was dental measures at T1, T2, and T3 are shown in Tables II
to 100%, the more successful the treatment. To evaluate and III with the 95% upper and lower confidence bounds
potential differences between Class II Division 1 and Di- and the analysis of variance (ANOVA) comparisons. The
vision 2 subjects, the modified analysis treated proclined following descriptions are based on the confidence inter-
and retroclined or protrusive and retrusive incisors inde- vals for the mean values and their relationships to norms
pendently. The proclined or retroclined and protrusive or and the mean changes during treatment.
566.e4 Potts et al American Journal of Orthodontics and Dentofacial Orthopedics
May 2009

Fig 1. Alternative treatment efficacy: dynamic representation of upper and lower incisor inclinations.
The percentages of ideal position (upper and lower incisor to NA and NB, respectively) accomplished
are noted for initially retroclined and proclined incisors. Percentages over 100% overshot the goal,
and negative percentages indicate movement in the wrong direction.

In our sample, the Class II surgical patients had nor-
mal skeletal maxillary cephalometric values and sagittal
mandibular deficiency with slightly increased lower
facial height before treatment. There was essentially
no change in the position of the maxilla in any direction
and no vertical skeletal change during treatment, but
there was a statistically significant advancement of the
mandible. This change in mandibular position also sig-
nificantly changed the maxillomandibular relationships
as noted by the ANB angle and the Wits measurements.
Despite the surgical mandibular advancement, the sub-
jects remained slightly Class II and mandibular retru-
sive by cephalometric measurements.
On average, the upper incisors started near ideal and
were reclined and retracted presurgically. After surgery,
they returned to their near pretreatment position but
were still retrusive relative to the norm. No changes
were statistically significant.
The lower incisors also started with near normal in-
clination but were in a slightly protrusive position and
did not significantly change during the presurgical pe-
riod. After surgery, the lower incisors proclined signifi-
cantly and became more protrusive relative to the NB
line. No significant changes were measured relative to
the mandibular plane. Regardless of the outcome mea-
surement, they were more prominent than at T1.
The efficacy analysis (Figs 1-3) showed that the pa-
tients who started with a given incisor inclination (Fig 1)
had the following.
1. Proclined maxillary incisors (18 subjects in the
Class II Division 1 tendency group): 88% were ret-
roclined, but they often were overcorrected beyond
ideal to 140%.
2. Retroclined upper incisors (16 subjects in the Class
II Division 2 tendency group): 75% were proclined,
American Journal of Orthodontics and Dentofacial Orthopedics Potts et al 566.e5
Volume 135, Number 5

Fig 2. Alternative treatment efficacy: dynamic representation of upper and lower incisor bodily
positions. The percentages of ideal position (upper and lower incisor to NA and NB, respectively)
accomplished are noted for initially retroclined and proclined incisors. Percentages over 100%
overshot the goal, and negative percentages indicate movement in the wrong direction.

but they often were overcorrected beyond ideal to
139%.
3. Proclined lower incisors (58% of the subjects): 42%
were retroclined, but they achieved only 51% of
ideal, and 58% moved farther from the ideal; they
were proclined an additional 35% beyond the ideal.
4. Retroclined lower incisors (42% of the subjects):
93% were proclined, but they were overcorrected
beyond ideal to 150%.
The bodily position of the incisors (Fig 2) of these
patients was assessed as follows.
1. Protrusive maxillary incisors (47% of the subjects):
94% were retracted, but they were overcorrected
beyond ideal to 190%.
2. Retrusive upper incisors (53% of the subjects): 73%
achieved about 82% of ideal when they were moved
toward the ideal, but 28% were retracted even far-
ther from the ideal to end 76% farther from ideal.
3. Protruded mandibular incisors (66% of the sub-
jects): 36% reached 66% of the ideal, but 64% of
this group were protracted even farther from the
ideal to end 57% farther from the ideal.
4. Retrusive lower incisors (33% of the subjects): 73%
were protracted and slightly overcorrected to 107%
beyond the ideal.
For skeletal change (Fig 3), 51.4% of ideal position
was reached from T1 to T3.
DISCUSSION
Conventional cephalometric evaluation techniques
were used in this study to examine the dental and skel-
etal outcomes. Newer tools such as cone-beam radiogra-
phy might improve the scope of such studies in the
future. Because this was a retrospective study design,
we used available records. Cone-beam radiography,
however, is still in the developmental stage and usually
extracts a 2-dimensional reconstructed cephalogram for
dental analysis. Finally, the standard of care and the
method used by most practitioners for evaluating dental
566.e6 Potts et al
Fig 3. Alternative treatment efficacy: skeletal position.
The percentages of ideal position (ANB) accomplished
are noted. Percentages over 100% overshot the goal,
and negative percentages indicate movement in the
wrong direction.
and skeletal outcomes are still lateral cephalometric
analysis, as used in this study.
The subjects in this study were Class II patients se-
lected from a surgical-orthodontic treated convenience
sample. The selection criterion for Class II malocclu-
sion was based on molar relationships, increased over-
jet, and a skeletal Class II relationship as established
by lateral cephalometric evaluation. The initial overjet
averaged 7.4 mm, and the ANB angle was 7.4 . Nearly
equal numbers of patients had proclined and retroclined
incisors. Comparable studies used pretreatment samples
with mean overjets, ANB angle, and percentages of Di-
vision 2 patients of 9 mm, 5.8 , and 29%6 and 10.7 mm,
4. 2 , and 2%, respectively.7 Our sample clearly had
many dental and skeletal values indicating skeletal
Class II malocclusion.20
The patients also exhibited changes during and after
treatment that were consistent with orthognathic-surgi-
cal Class II correction; 41% had a 1 to 5 ANB angle,
and 88% had an overjet of 1 to 4 mm. Comparable stud-
ies achieved percentages of 81% and 95%6 and 42% and
72%,7 respectively.
The efficacy data further amplify the shortcomings
of presurgical decompensation (Figs 1-3). Certainly,
the patients in this study had bona fide Class II maloc-
clusions worthy of surgical-orthodontic treatment. A
previous report by Proffit et al6 noted that only a portion
of the Class II surgical-orthodontic subjects they exam-
ined after treatment achieved acceptable results when
they used a method that considered the result acceptable
if the incisors were within 61 SD of the ideal.
Proffit et al6 extended their evaluation to introduce
the concept of the efficacy analysis for the dentition
American Journal of Orthodontics and Dentofacial Orthopedics
May 2009
and found that incisor positions varied from –3% to
61% of ideal. Our modification of their analysis, which
separated Class II Division 1 and Division 2 subjects,
also confirmed that the presurgical orthodontic objec-
tives were not achieved. Some incisors were not decom-
pensated, and others were overcorrected. Generally, it
appears that patients with retrusive incisors at the begin-
ning of a stage of treatment were more adequately
treated than those with protrusive incisors (Figs 1 and 2).
The goals of orthodontic treatment are typically
highly individualized to accommodate variability;
thus, an argument could be made that not all patients
with proclined or retroclined incisors need uprighting.
However, in this group of patients who had treatment
plans for surgical skeletal correction, a strong case can
be made for the singular goal of uprighting and decom-
pensating incisors. The entire premise of surgical treat-
ment planning is to maximize skeletal correction, which
requires optimal decompenstion. If this is not achieved,
the patient could have been effectively managed by
growth modification or camouflage treatment.
Although Burden et al7 could not discriminate be-
tween the presurgical and postsurgical incisor changes
or the angular vs bodily components, they similarly
found that mandibular incisor decompensation was in-
complete in 28% of the patients after treatment, espe-
cially those with pretreatment proclination. They also
found fewer esthetic soft-tissue results with increased fi-
nal lower incisor proclination and reduced upper incisor
proclination.
Jang et al,1 evaluating surgical orthodontic patients
from 2 institutions, also found, when using mean values,
that subjects frequently did not achieve ideal presurgical
decompensation. This finding with patients from 2 cen-
ters indicates that our finding in this study is not a chance
or strictly local finding. But one could argue that, with
many faculty members in an academic setting, the var-
iability of the results might have been greater than those
of 1 practitioner. However, our results might better rep-
resent the variety of treatment in the community.
Given these findings, it is apparent that the surgical
moves were limited by the position of the dentition;
this would explain why the skeletal improvement was
only 51.4% of the ideal. Since the scope of skeletal cor-
rection depends on dental decompensation during pre-
surgical orthodontic treatment, this finding was not
surprising. For example, if the upper incisors were over-
retracted and retroclined, and the lower incisors were
proclined, the surgical movements would be limited as
previously reported by Burden et al.7
One could view the overall outcomes as a failure of
surgical-orthodontic treatment, except that, in most sub-
jects, according to the more rigorous dynamic analysis,
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 135, Number 5
the position of the mandible improved with the advance-
ment surgery. Mihalik et al21 compared orthodontic
camouflage with surgical-orthodontic treatment of
Class II malocclusions in adults. They found 2 major
differences between the surgical and the orthodontic
camouflage patients: the surgical patients had more
ideal skeletal relationships, and the position of the inci-
sors ended in a more ideal position relative to their bony
bases. They concluded that, for a patient with a severe
mandibular deficiency with increased overjet and com-
promised facial esthetics, surgery provides enough ben-
efit to make it worthwhile. Jang et al1 compared Class II
camouflage and surgery patients and found that the inci-
sors in the surgery group were closer to the ideal than in
the camouflage group. The surgical group achieved the
greatest skeletal change by advancement of the mandi-
ble. Our study also supports the concept that improved,
but not ideal, mandibular position can be achieved by
surgical advancement; this was also reported by Burden
et al.7
Although this retrospective study demonstrated that
ideal incisor position and inclination were not neces-
sarily achieved with orthognathic surgery treatment,
compensation is not limited to only this group and
camouflage patients. Similar results were reported
for patients treated with growth modification. Growth
modification patients had modest skeletal changes but
were compensated by the dentoalveolar change. The up-
per incisors were retracted, and the mandibular incisors
tended to procline and protrude to compensate for the
limited skeletal change.1
Ideal orthodontic presurgical decompensation and
postsurgery finishing were not achieved. Without total
decompensation, the surgical advancement was limited
by incisor position and amount of overjet so that the
postsurgical phase of orthodontic treatment camou-
flaged the less-than-ideal surgical outcome by dental
compensation.
CONCLUSIONS
1. Presurgically, the incisors were not decompensated
adequately in most patients.
2. The surgical outcomes were limited by the presur-
gical orthodontic outcomes.
3. Postsurgically, it was necessary to compensate the
incisors to obtain acceptable occlusion.
4. The efficacy analyses showed otherwise unforeseen
issues related to dental and skeletal changes during
treatment.
Potts et al 566.e7
REFERENCES
1. Jang JC, Fields HW, Vig KWL, Beck FM. Controversies in timing
of orthodontic treatment. Semin Orthod 2005;11:112-8.
2. Proffit WR, Fields HW. Contemporary orthodontics. 4th ed. St
Louis: Mosby; 2007.
3. Berger JL, Pangrazio-Kulbersh V, Bacchus SN, Kaczynski R. Sta-
bility of bilateral sagittal split ramus osteotomy: rigid fixation ver-
sus transosseous wiring. J Adult Orthod Orthognath Surg 2000;
118:397-403.
4. Capelozza Filho L, Martins A, Mazzotini R, da Silva Filho. Ef-
fects of dental decompensation on the surgical treatment of man-
dibular prognathism. Int J Adult Orthod Orthognath Surg 1996;11:
165-80.
5. Potts B, Shanker S, Beck FM, Vig KW. Predictors of dentoalveo-
lar outcome of presurgical orthodontic change [abstract 128].
J Dent Res 2004;83(Spec Iss A).
6. Proffit WR, Phillips C, Douvartzidis N. A comparison of out-
comes of orthodontic and surgical-orthodontic treatment of Class
II malocclusion in adults. Am J Orthod Dentofacial Orthop 1992;
101:556-65.
7. Burden D, Johnston C, Kennedy D, Harradine N, Stevenson M. A
cephalometric study of Class II malocclusion treated with mandib-
ular surgery. Am J Orthod Dentofacial Orthop 2007;131:7.e1-8.
8. Steiner CC. Cephalometrics for you and me. Am J Orthod 1953;
39:729-55.
9. Steiner CC. Cephalometrics in clinical practice. Angle Orthod
1959;29:8-29.
10. Steiner CC. The use of cephalometrics as an aid the planning and
assessing orthodontic treatment: report of a case. Am J Orthod
1960;46:721-35.
11. McNamara JA Jr. A method of cephalometric evaluation. Am J
Orthod 1984;86:449-69.
12. Jacobson A. The ‘‘Wits’’ appraisal of jaw disharmony. Am J
Orthod 1975;67:125-38.
13. Jacobson A. Application of the ‘‘Wits’’ appraisal. Am J Orthod
1976;70:179-89.
14. Cangialosi TJ, Riolo ML, Owens SE, Dykhouse VJ, Moffitt AH,
Grubb JE, et al. The ABO discrepancy index: a measure of case
complexity. Am J Orthod Dentofacial Orthop 2004;125:270-8.
15. Tweed CH. Was the development of the diagnostic facial triangle
as an accurate analysis based on fact or fiction? Am J Orthod
1962;48:823-40.
16. Ricketts RM, Bench RW, Hilgers JJ, Schulhof R. An overview of
computerized cephalometrics. Am J Orthod 1972;61:1-28.
17. Ricketts RM. The value of cephalometrics and computerized tech-
nology. Angle Orthod 1972;42:179-99.
18. Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme
variation in vertical facial growth and association in skeletal and
dental relations. Angle Orthod 1971;41:219-29.
19. Bell WH, Proffit WR, White RP. Surgical correction of dentofa-
cial deformities. Volume 1. Philadelphia: W.B. Saunders; 1980.
p. 137-50.
20. Kelson DA, Fields HW, Beck FM, Shanker S. Concordance of
multiple A-P cephalometric measurement methods in long-, nor-
mal-, and short-faced individuals at various treatment stages
[abstract 1490]. J Dent Res 2003;82(Spec Iss A).
21. Mihalik CA, Proffit WR, Phillips C. Long-term follow-up of Class
II adults treated with orthodontic camouflage: a comparison with
orthognathic surgery outcomes. Am J Orthod Dentofacial Orthop
2003;123:266-78.