Thoughts on the early treatment of Class II malocclusion

The timing of Class II, division 1 malocclusion treatment is discussed in the context of the development of the dentition within the craniofacial environment. The occlusion of the dentition actually serves as the key that controls and maintains the exact position of the mandible vis-à-vis the maxilla during childhood, pubescence and throughout adulthood. Research and clinical evidence suggest that treatment which 'disturbs' the interdigitation of teeth in the Class II malocclusion can lead to correction of the distocclusion. This correction can theoretically be undertaken throughout childhood and adolescence, and even thereafter. Treatment at a very young age was thought to normalize the occlusion, and consequently the growth process, leading to more stable results. Re-examination of this concept shows that, for practical purposes, the presence of the first premolars signals an early indication for treatment of Class II, division 1 malocclusion. The mobility of the deciduous second mandibular molars provides the last opportunity to prevent, whenever possible, a four premolar extraction approach.