A comparison of surgery and orthodontics in "borderline" adults with Class II, division 1 malocclusions

From a pool of 108 former patients, discriminant analysis was used to identify a homogeneous borderline prognostic subgroup of 27 adult orthodontic and 26 adult surgical Class II patients who, before treatment, were similar with respect to the characteristics on which the orthodontic/surgical decision appears to have been based. The fact that some had been treated orthodontically, whereas others had been treated surgically, was taken as empirical evidence that the patients in this stratum were equally susceptible to the two treatments and that the actual choice was largely a function of whose office they happened to contact. The former orthodontic patients were recalled an average of 7.1 years after treatment, the former surgical patients, 4.7 years after surgery. Each subject was evaluated with respect to skeletal and dental stability, profile esthetics, and temporomandibular function. Although there were dramatic differences in the nature of the correction (dental versus skeletal), both groups of patients generally thought that their profiles had been improved by treatment. As judged by data generated from visual analogue scales, the mean difference between the orthodontic and surgical patients' evaluations of their treatments was small and nonsignificant. Moreover, the "borderline" Class II orthodontic and surgical patients showed no significant differences in craniomandibular function and incisor stability. There was, however, one profound difference between treatments: 3 of the 26 surgical patients underwent extensive relapse, probably as a result of condylar resorption. From the standpoint of estimated probabilities and utilities for the various outcomes, the present results imply that orthodontics would be the better choice for the borderline adult Class II patient, whereas surgery would be appropriate for the more severely affected patient.