Roberto Justus - Are There Any Advantages of Early Class II Treatment
Roberto Justus - Are There Any Advantages of Early Class II Treatment
Roberto Justus - Are There Any Advantages of Early Class II Treatment
717
718 Reader’s forum American Journal of Orthodontics and Dentofacial Orthopedics
December 2008
important as the benefit I wish to give to my patients, I charge patient aged 12.5 years with midface deficiency due to
the same fee for 2-phase as for 1-phase Class II treatments. In maxillary hypoplasia, facemask therapy is a successful
the 2-phase treatments, the monthly fee is reduced and modality that was not mentioned as a part of treatment
divided into longer periods. By starting treatment after the planning in the article.1-3 I agree with the author that
maxillary central incisors have erupted and following with a surgery cannot be done before midteenage, but the patient
second phase of treatment at the appropriate time, the can be given the benefit of facemask therapy for anterior
clinician can help minimize the incidence of both EARR and maxillary augmentation during the growth phase.
IT in Class II patients with large overjets. This approach Varun Kumar Gupta
ensures practicing evidence-based orthodontics by consider- Ashok Utreja
ing all recent evidence in the literature concerning EARR1-3 Chandigarh, India
and IT.4-7 Thus, the conclusion by Tulloch et al1 that 2-phase Am J Orthod Dentofacial Orthop 2008;134:718
treatment of Class II patients with excessive overjet started 0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
before adolescence in the mixed dentition might be no more doi:10.1016/j.ajodo.2008.10.013
clinically effective than 1-phase treatment in the early per-
manent dentition should be reevaluated, because it does not
take into consideration 2 clinically important variables: REFERENCES
EARR and IT! 1. Rune B, Sarnäs KV, Selvik G, Jacobsson S. Posteroanterior
Roberto Justus traction in maxillonasal dysplasia (Binder syndrome). A roentgen
Mexico City, Mexico stereometric study with the aid of metallic implants. Am J Orthod
Am J Orthod Dentofacial Orthop 2008;134:717-8 1982;81:65-70.
0889-5406/$34.00 2. Petit HP. Adaptation following accelerated facial mask therapy.
Copyright © 2008 by the American Association of Orthodontists. In: McNamara JA Jr, Ribbens KA, Howe RP, editors. Clinical
doi:10.1016/j.ajodo.2008.09.010 alterations of the growing face. Monograph 14. Craniofacial
Growth Series. Ann Arbor: Center for Human Growth and
Development; University of Michigan; 1983.
REFERENCES
3. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of
1. Tulloch JFC, Proffit WR, Phillips C. Outcomes in a 2-phase facemask/expansion therapy in Class III children: a comparison of
randomized clinical trial of early Class II treatment. Am J Orthod three age groups. Am J Orthod Dentofacial Orthop 1998;113:204-12.
Dentofacial Orthop 2004;125:657-67.
2. Brin I, Tulloch JFC, Koroluk L, Phillips C. External apical root
resorption in Class II malocclusion: a retrospective review of 1- Extraction of peg-shaped lateral
versus 2-phase treatment. Am J Orthod Dentofacial Orthop
2003;124:151-6. incisors, revisited
3. Segal GR, Schiffman PH, Tuncay OC. Meta analysis of the
I acknowledge differences of opinion when it comes to
treatment-related factors of external apical root resorption. Orthod
Craniofac Res 2004;7:71-8.
evaluating facial profile and harmony. However, are orth-
4. Nguyen QV, Bezemer PD, Habets L, Prahl-Anderesen B. A odontists supposed to push the front teeth out of the bone and
systematic review of the relationship between overjet size and way too far forward in an irrational race to outpace the front
traumatic dental injuries. Eur J Orthod 1999;21:503-15. of a nose that, like Pinocchio’s, is way too far forward itself?
5. Årtun J, Behbehani F, Al-Jame B, Kerosuo H. Incisor trauma in an This was the overriding implication I took away from the
adolescent Arab population: prevalence, severity, and occlusal letter of Sadia Naureen and Ayesha Anwar (Extraction of
risk factors. Am J Orthod Dentofacial Orthop 2005;128:347-52. peg-shaped lateral incisors. Am J Orthod Dentofacial Orthop
6. Koroluk L, Tulloch JFC, Phillips C. Incisor trauma and early 2008;134:332), in response to a previously published case
treatment for Class II Division 1 malocclusion. Am J Orthod report by Eve Tausche and Winfried Harzer (Treatment of a
Dentofacial Orthop 2003;123:117-26.
patient with Class II malocclusion, impacted maxillary canine
7. Kaste LM, Gift HC, Bhat M, Swango PA. Prevalence of incisor
trauma in persons 6 to 50 years of age: United States, 1988-1991.
with a dilacerated root, and peg-shaped lateral incisors. Am J
J Dent Res 1996;75(Spec iss):696-705. Orthod Dentofacial Orthop 2008;133:762-70).
Extraction treatment by itself does not have a deleterious
effect unless the orthodontist is so biomechanically inept that
A different look at treating a patient he or she cannot move teeth toward the desired and desirable
with Binder syndrome end positions. I admit that it might be more difficult to hold
maxillary central incisors where they are after extracting
I read with great interest and thoroughly enjoyed the compromised lateral incisors; however, just because it might
recent article on Binder syndrome (Kau CH, Hunter LM, be difficult and more taxing to do at the chair does not mean
Hingston EJ. A different look: 3-dimensional facial imag- that the approach is automatically less desirable than some
ing of a child with Binder syndrome. Am J Orthod apparently easier nonextraction approach, supposedly blessed
Dentofacial Orthop 2007;132:704-9). I believe this article with an always more favorable face. Dr Lysle E. Johnston and
is the most comprehensive review of Binder syndrome in others have proven that false.1,2
the orthodontic literature. However, I would like to com- Size and shape of the nose might be relevant but not
ment (not criticize) on the treatment plan mentioned. In a pertinent. We are back to Pinocchio and his nose. Is it wiser