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Two basic strategies for the timing of treatment for Class II malocclusions in children are common: (1) correction achieved in two phases, one during pre-adolescence (early treatment) and the other during the teen years; and (2) correction accomplished in one phase of active treatment during the adolescent years. The issues of efficacy and cost(risk)-benefit of these strategies have not been well delineated. Most clinical studies examining these issues have suffered serious methodological deficiencies, such as being retrospective, lacking adequate controls, and evaluating only successfully treated cases. However, despite a lack of objective data, clinicians have shown considerable interest in recent years in two-phase treatment. This paper reviews major issues of two-phase Class II treatment and concludes by delineating several important clinical questions which could be resolved by a carefully controlled prospective study.

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The purpose of this study was to determine if mandibular incisors could be proclined markedly without increasing the potential for relapse of crowding. Patients with surgically treated mandibular prognathism were selected. In 29 patients the mandibular incisors were proclined more than 10 degrees during the presurgical orthodontic phase. The remaining 33 patients had only minimal change in incisor inclination. A long-term follow-up examination was performed 10.0 (SD 2.3) and 11.1 (SD 3.1) years postoperatively in 26 and 24 patients, respectively. Study casts were measured before and after treatment, three years after surgery, and long-term. Cephalograms were evaluated before and after treatment, immediately before and after surgery, and three years after surgery. Prior to therapy the patients treated with presurgical proclination had less dental arch length and more retroclined and crowded mandibular incisors than the patients in the other group. No differences in parameters were observed at later intervals. Dental arch length and intercanine width decreased and incisor irregularity increased in both groups during the follow-up periods. No intergroup differences in changes were observed. Indications for proclination of mandibular incisors are discussed.

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Two hundred and fifty-two adolescent orthodontic patients were categorized according to their general level of compliance during orthodontic treatment. Each patient completed three standardized psychological tests, (1) The Comprehensive Personal Assessment System: Self-Report Inventory, by Oliver H. Bown, (2) The Adolescent Alienation Index, by F.K. Heussenstamm, and (3) The Home Index, by Harrison Gough. The most important variable in predicting compliance was the sex of the patient. Females were more compliant than males. The psychological tests indicated that more compliant patients scored higher on self-esteem, derived self-satisfaction from personal achievement, were optimistic regarding the future, had higher socioeconomic status and had a low degree of general alienation from society. These easy-to-administer, brief psychological inventories could be helpful to clinicians in anticipating compliance problems during orthodontic treatment.

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To determine accurately the morphological characteristics specific to patients with sleep apneas syndrome (SAS), a group of 43 adult males with SAS was compared in a cephalometric evaluation with a homologous control group. In SAS patients, the soft palate was elongated; the sagittal dimensions of upper face and anterior cranial base were reduced and correlated with reduced bony pharynx opening; and the increased lower face height was associated with a retruded position of the chin and tongue, thus contributing to lower pharynx crowding. With the four variables entering the discriminant function analysis, 93 percent of the whole population was correctly classified. If anatomical rehabilitation of the pharynx is to be envisaged, the leading factors to consider should be: soft palate length, maxillary position, chin and tongue position, in that order.

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Alginate impressions of a master acrylic study model pair were made in order to assess the effect of various disinfection techniques on dimensional stability. Impressions were made using self-disinfecting alginate, traditional alginate which had been dipped or soaked in a disinfecting solution, and included wasa control group which was not disinfected. Inter- and intra-arch linear measurements of the resultant study casts were made using a Reflex Metrograph. The small differences found for the variables measured were not statistically significant.

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A two-stage endosseous implant, placed in the retromolar area of the mandible, was utilized as rigid anchorage to translate two molars 10–12 millimeters mesially into an atrophic endentulous ridge. Despite substantial anchorage demand over a three year period, the endosseous implant remained rigid (“osseointegrated”). At the end of treatment the implant and adjacent, intravitally labeled bone were recovered. Microradiographic and polarized light analyses revealed that about 80 percent of the endosseous portion of the implant was in direct contact with mature lamellar bone. Bone labels demonstrated a remarkably high remodeling rate (about 30 percent/year) for cortical bone within 0.5 millimeter of the interface. Continuous remodeling may be the long-term mechanism whereby loaded implants resist bone fatigue and maintain “osseointegration.” Clinical use of orthodontic implants, placed outside the dental arches, requires careful attention to soft tissue management.

This paper was presented at the Biennial Meeting of the Edward H. Angle Society, September 13, 1989 in Chicago, IL.

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No Abstract Available