Class 2 and growth modulation. So near yet so far. Episode 23. Nikhilesh Vaid. August 26th 2020

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Farooq Ahmed

Summary of webinar: Class 2 and growth modulation. So near yet so far. Nikhilesh Vaid.

Part 1 explores key themes around the effectiveness of class 2 correction, how they work, different times, the role of headgear and fixed functional appliances.

Q1 & 2 Do we have the evidence, and is it effective?

Phase 1

  • Phase 1 there is no advantage, no difference in clinical outcomes: Cochrane review Harrison 2007.
  • 9-10% of patients benefit from phase 1 through a reduction in trauma, Gianelly 1995.
  • “Just because we can doesn’t mean we should” Jay Bowman


  • Increased OJ greater than 3mm = 2 x risk of trauma Nguyen 1999

Questions 3 Growth can we predict it?

  • No restraining effect on Maxilla, slight growth of the mandible and increase vertical growth Mills 1991
    • 3mm growth Pg-Go
    • SNB improvement of 4o
    • NO we cannot – Unpredictable


Question 4 When to treat and which on?

  • When: CVM 3-4 is where peak growth occure, (PHV): however only 25% of patients have 1 single peak, most have ‘multiple peaks’
  • Which one: Efficiency- Herbst 0.28mm, TB 0.23mm, Herbst more efficient – fixed more efficient

Question 5 What changes take place?

Functional appliances don’t all work the same:

  • Removable:
    • Upper molar distalisation / upright
    • Upper incisor uprighting
  • Fixed
    • Upper molar distalisation / upright
    • Increase mandibular length (Po-Go)

Question 6 Do they grow mandibles?

  • AAO Council statement 2005 – “No scientific evidence of increase in mandible”
    • Lengthening of condyle and ramus does occur.
    • Glenoid fossa remodelling does occur.
    • No evidence shows:
      • Insignificant overall increase in length .
      • Condyle growth cannot be permanently increased.

Question 7 Does HG still have a role?

  • Vertical and AP changes do occur with HG after 6/12 Burke 1992, Nanda 2006,
  • Compliance however is 56% Brandao

Question 8 Effectiveness of fixed functional appliances?

  • Compliance nearly 100%
  • Phase 1 shorter 5 months
  • Forsus Vs Powerscope:
    • More AP change with Forsus Arora 2018
  • New ideas of fixed functional and TAD / miniplates


Harrison, J.E., D O’Brien, K. and Worthington, H.V., 2007. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database of Systematic Reviews, (3)

Nguyen, Q.V., Bezemer, P.D., Habets, L.L.M.H. and Prahl-Andersen, B., 1999. A systematic review of the relationship between overjet size and traumatic dental injuries. European Journal of Orthodontics21(5), pp.503-515.

Mills, J.R.E., 1991. The effect of functional appliances on the skeletal pattern. British Journal of Orthodontics18(4), pp.267-275.

Vaid, N.R., Doshi, V.M. and Vandekar, M.J., 2014, December. Class II treatment with functional appliances: A meta-analysis of short-term treatment effects. In Seminars in Orthodontics (Vol. 20, No. 4, pp. 324-338). WB Saunders.

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