A comparison of one-stage and two-stage nonextraction alternatives in matched Class II samples

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In the treatment of Class II malocclusion, an early phase of functional appliance treatment is commonly used to simplify subsequent fixed appliance therapy and to optimize the development of the facial skeleton. Unfortunately, these expectations enjoy little support in the refereed literature. The present study therefore was undertaken to examine the benefits of a two-stage bionator/edgewise regimen in comparison to the more conventional one-stage edgewise alternative. To minimize proficiency bias, we examined the records of the one- and two-stage Class II nonextraction patients who received treatment between 1980 and 1990 by a single experienced clinician. On the basis of descriptive data from 96 sets of initial study models and lateral cephalograms, discriminant analysis was used to identify two subsamples of 36 patients who were relatively similar before treatment and thus equally susceptible to the two treatments. Of these 72 “borderline” patients, 19 subsequently underwent a change in treatment plan (to extraction or surgery), leaving 25 two-stage and 28 single-stage nonextraction patients on whom to base a comparison of treatment effects. Except for a slight posttreatment difference in age (and, hence, size), the two groups underwent skeletal changes that left them essentially indistinguishable at the end of treatment. In both groups, these skeletal changes were largely responsible for molar and overjet corrections that were nearly identical in the two groups. The rates of change, however, differed significantly. As a result, the two-stage treatments started earlier and finished later. Although the present data do not address the relative impact of the two strategies on the 10% to 15% at each tail of the distribution, the early phase of functional appliance treatment conferred no obvious, measurable benefits on the central 75%. Therefore for most nonextraction Class II patients, the choice of treatments may well constitute a practice management, rather than a biologic, decision. (A M J O RTHOD D ENTOFAC O RTHOP 1995;108:118-31.)