Growth and the Class II patient: rendering unto Caesar

Abstract

In the context of Class II treatment, most probably would agree that an excess of mandibular growth would be helpful, both to the patient and to the orthodontist. The literature features a smattering of evidence that this is precisely the sort of pattern one sees in many Class II patients, quite independent of treatment strategy. There is, however, a tendency to expect (and perhaps to see) favorable growth only in functional-appliance patients. As a result, growth modification therapy may receive more credit than it deserves in the world of optimistic, albeit uncontrolled, clinical observations and impressions. In the present study, the pattern of sagittal maxillo-mandibular growth and/or displacement ("apical base change") was examined in 120 Class II patients treated with the edgewise appliance. Regardless of treatment (extraction or nonextraction), 9 out of 10 showed a pattern of change in which the mandible advanced relative to the maxilla. It is concluded that an assessment of treatment alternatives, especially those designed to modify growth, must employ this favorable pattern as the baseline from which the effects of growth modification are judged. Methods of factoring out the "good growth" that commonly accompanies fixed-appliance therapy are discussed within the context of evaluating the effects of functional appliances.