A comparison of outcomes of orthodontic and surgical-orthodontic treatment of Class II malocclusion in adults.

The treatment outcome for skeletal Class II malocclusion was reviewed in 33 nongrowing patients who were treated with orthodontics alone (by premolar extraction and tooth movement to camouflage the skeletal problem) and in 57 patients treated for similar problems with surgery and orthodontics (with mandibular advancement and with tooth movement to reduce rather than increase dental compensation for the skeletal deformity). Cephalometric and dental cast changes were scored to quantitate treatment effects. Two approaches were used to determine the treatment efficacy (the relative success of treatment): (1) whether the final value for a measurement criterion (such as an overjet and an ANB angle) fell within the normal range, and (2) the quantitative amount of correction produced relative to an "ideal" value. In addition, a panel of judges was used to rate esthetic changes from pretreatment and posttreatment facial slides. Both orthodontic treatment and surgical-orthodontic treatment improved the malocclusion as judged from dental casts. Surgery resulted in greater reduction of overjet and greater improvement in most cephalometric skeletal, dental, and soft tissue criteria. Before treatment, the surgical patients had lower esthetic ratings than the orthodontics-only patients. After treatment, the esthetic ratings for the orthodontic patients were unchanged. The surgical patients had improved but not to the pretreatment level of the orthodontics patients.