Settling the Score with Class IIs Using Miniscrews
Class IIs have been one of the most prevalent malocclusions treated in orthodontic practice. Throughout the history of the specialty, all manner of methods and devices have been employed to resolve these bad bites. Yet, after decades, there is still no co
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Settling the Score with Class IIs Using Miniscrews S. Jay Bowman
Abstract
Class IIs have been one of the most prevalent malocclusions treated in orthodontic practice. Throughout the history of the specialty, all manner of methods and devices have been employed to resolve these bad bites. Yet, after decades, there is still no consensus on the best technique or approach. In fact, we seemingly cannot even agree on the etiology nor the correct jaw to address with our mechanics. It does appear that we might find common ground regarding the most common issues with any of our treatment approaches, namely, that we are constrained by two major limitations: the requirements of patient compliance and anchorage control. It is this interminable battle for compliance and anchorage that has led us to employ skeletal anchorage for the management of Class IIs.
4.1
How Are Class IIs Corrected?
Despite the fact that Class IIs have presumably been the second most common malocclusion sign that patients present with to orthodontic practices, there has been no consensus over the past century as to when and how to correct them. In fact, there is still misunderstanding in regard to how the correction actually occurs. As a result, the multitude of philosophies and associated devices for the resolution of Class IIs remain staggering, even though substantial amounts of research have been published on the effects and effectiveness of nearly all approaches. S.J. Bowman, DMD, MSD Kalamazoo Orthodontics, 1314 West Milham Avenue, Portage, MI 49024, USA e-mail: [email protected]
From an examination of the wide range of different types of investigations of Class II treatments, there seem to be little demonstrable differences among the results produced by the menagerie of methods [1–8]. Whether addressing maxilla or mandible [2], early or late treatment timing [8], results are virtually the same. This is especially true in terms of the magnitude of mandibular growth contributing to the overall correction: it’s also nearly identical [2]. Although some Class II mechanisms are intended to modify skeletal growth (i.e., orthopedics) or move teeth (i.e., orthodontics) or even both, the actual effects are, on average, mostly found in the midface and not so much in the mandible [1–8]. Moreover, it seems that the key to Class II correction in the growing patient is primarily due to the interruption of dentoalveolar compensation—no matter the treatment method chosen [3, 9].
K.B. Kim (ed.), Temporary Skeletal Anchorage Devices, DOI 10.1007/978-3-642-55052-2_4, © Springer-Verlag Berlin Heidelberg 2014
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Consequently, it is simple to say that the selection of an orthodontic method to correct Class II is primarily a practice management decision; however, there are some factors that may sway that selection, especially if miniscrews are added to the equation.
4.2
The Role of Miniscrews in the Battle over Patient Compliance and Anchorage Loss
The most enduring orthodontic treatment challenges have been that of (1) battling patient compli
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