Paradigm Shift in the treatment of Class-II malocclusions in children and adolescents

Abstract

In 1975, M. Chateau, wrote that only a first stage of treatment, by rigid bimaxillary hyperpropulsion, could correct mandibular retrognathism. Since then, we have witnessed a double paradigm shift. The first has seen the replacement of traditional sources of information, and their limitations, by access to the best published data, using an evidence-based approach. It has shed light on the debate about the treatment of Class-II malocclusions in children and adolescents, particularly on one-phase or two-phase treatments. Can a two-phase treatment increase the amount of mandibular growth in the long term? Can it increase the volume of the airways? Can it help prevent maxillary incisor trauma or root resorptions? The second paradigm shift concerns the treatment of Class-II malocclusions in children and adolescents. To discover that the long-term skeletal effects of an initial phase of treatment are weak and clinically insignificant at best has been a bitter disappointment for our profession. But this new data also led to developments in treatment. The treatment of mandibular retrognathism has given way to an effective correction of Class-II malocclusions, which best suits the particular case of the patient, child, or adolescent.