Influences on the outcome of early treatment for Class II malocclusion

In the first phase of a randomized clinical trial of early versus late Class II treatment, statistically significant differences were observed between the treatment and observation groups. However, there were wide variations in response. The change in jaw relationship (categorized as the annualized reduction in ANB angle) was favorable or highly favorable in 76% of the headgear, 83% of the functional appliance, and 31% of control (observation only) groups. The patient's initial skeletal severity, age/maturity at the outset of treatment, growth pattern, and cooperation with treatment were examined as possible influences on early growth modification treatment. Correlations between the annualized change in the ANB angle and any of the possible influences were close to zero and not statistically significant. We conclude that there is little to be gained from precisely timing early treatment to specific age/maturity markers and that a favorable reduction in Class II skeletal problems can occur for patients in a broad range of skeletal severity and growth patterns. Cooperation, measured as the number of hours of reported wear, or the clinical assessment of compliance, explained little of the variation in treatment response. The wide variation in growth seen in the untreated patients highlights the importance of well-controlled studies if clinicians are to improve their ability to select children with the greatest chances of a favorable treatment response.