Resident: Derek Nobrega
Title: Orthodontists’ Perceptions of the Impact of Phase 1 Treatment for Class II Malocclusion on Phase 2 Needs
Authors: GJ King, TT Wheeler, SP McGorray, LS Aiosa, RM Bloom, MG Taylor
Journal: Journal of Dental Research 78(11): 1745-1753, November, 1999
Main Purpose: To examine how orthodontists, blinded to treatment approach, perceive the impact of phase 1 treatment on phase 2 needs.
Background: Almost 23% of malocclusions in children aged 10-12 are Class II. The most appropriate timing for the treatment of Class II malocclusions is controversial. Some clinicians advocate starting a first phase in the mixed dentition, followed by a phase 2 in the permanent dentition. Others see no clear advantage to that approach and recommend that the entire treatment be done in the late mixed or early permanent dentition.
Methods: 242 class II subjects aged 10-15 were included in the randomized clinical trial. For each subject, video orthodontic records, a questionnaire, a fact sheet, and a ceph tracing were sent to five randomly selected reviewing orthodontists blinded to the subject group and study purpose. Reviewing orthodontists were asked to assess treatment need, general approach, need for extractions, priority, difficulty, and determinants.
- 95% of orthodontists agreed on treatment need.
- 84% agreed on treatment approach.
- 80% agreed on extraction need
- Previously treated patients were judged as less difficult and to have a lower treatment priority.
- The most highly ranked problems ranked by orthodontists for treating class II patients are overbite, dental class II relationship, overjet, skeletal, and crowding.
- The most common reasons for not selecting treatment are no need for treatment (45.7%), no cooperation expected (24.3%), and too early to begin treatment (15.7%).
- Orthodontists do not perceive phase 1 treatment as preventing the need for a second phase or as offering any particular advantage with respect to preventing the need for extractionss or other skeletal treatments in the second phase
- Orthodontists do view early class II treatment as an effective means of reducing the difficulty and priority for phase 2
This article presents a situation we see frequently. This study seems to indicate that phase 1 treatment doesn’t prevent the need for phase 2 treatment. Therefore, if we see an older patient for the first time with a class II that hasn’t had phase 1 treatment, there is still time to correct their malocclusion. Conversely, if we initiate phase 1 treatment on a younger patient, it is important to let the parents know that phase 2 therapy will also be required. There are many factors that can indicate phase 1 including orthodontist preference, severity of class II, and behavior.