Long term patient and orthodontist satisfaction with non surgical correction of severe class II division 1 malocclusions

The correction of Class II malocclusions is one of the most common treatments performed in the United States. Despite Class II malocclusions being one the most commonly presented problems for orthodontists, there is no consensus of which non-surgical treatment modality best impacts a patient’s quality of life long term.

This study examines the different non-surgical treatment approaches for patients with severe Class II division 1 and the impact of treatment outcomes on patient’s quality of life long term.

This study retrospectively analyzed the different treatment approaches and outcomes of class II division 1 with severe overjet, while prospectively assessing patient satisfaction and quality of life long term. Initial and final cephalometric and clinical variables for 83 patients (38 at Harvard School of Dental Medicine, 30 at the University of Iowa, and 15 in private practice in Iowa) treated non-surgically were recorded and analyzed. A retention clinical exam, at least 6 months post-debond, was done for final measurements, assessment for practitioner and patient satisfaction, and patient quality of life questionnaires.

Non-surgical treatment of severe Class II division 1 malocclusions yielded 5.54 mm overjet reduction and 0.51 mm of relapse in retention on average. Patients with more overjet at their long term retention check demonstrated significantly poorer satisfaction scores with the appearance of their bite (p<0.001), the appearance of their face (p<0.001), and with their overall orthodontic treatment (p<0.001). Extraction treatment was associated with significantly lower patient satisfaction scores of overall orthodontic treatment (p=0.023) and appearance of bite (p=0.018) but not facial appearance. Patients treated with extractions also showed higher QOL scores on the OHIP-14 (p=0.022) and CPQ (p=0.002) surveys, indicating that extraction therapy of severe Class II division 1 patients led to a significantly poorer quality of life.

Non-surgical treatment of severe Class II division 1 malocclusions can yield excellent results and stability long term. Overjet can be dramatically reduced with non-surgical treatment but there is a tendency for overjet to relapse in retention. While treatment outcomes yielded high results of patient satisfaction, patients with more overjet in retention displayed significantly less satisfaction of the appearance of their bite, appearance of their face, and with their overall orthodontic treatment. Extraction treatment was associated with significantly lower patient satisfaction scores of overall orthodontic treatment and appearance of bite but not facial appearance. Patients treated with extractions showed poorer quality of life scores in retention compared to those treated nonextraction.