Controversies in the Timing of Orthodontic Treatment

The approaches to the skeletal component of malocclusion and the timing of treatment are reviewed based on changing concepts in craniofacial growth and evidence-based results from clinical trials and meta-analysis. Timing of treatment has traditionally been considered “early” versus “late mixed” or “preadolescent dentition.” The rationales are based on modification of growth during the greatest somatic and facial growth period or the option of camouflage and orthognathic surgery depending on the severity of the malocclusion. To illustrate controversies in the timing of treatment a retrospective study is reported with data from three approaches: (1) growth modification, (2) camouflage, and (3) orthognathic surgery in Class II skeletal correction. Inclusion criteria for all 3 groups included overjet of 6 mm or greater and Class II molar relationships. Results demonstrated positive skeletal changes for the growth modification group and orthognathic surgery group. Upper incisor retraction was common in all treatment groups, but compensation in the camouflage group resulted in the upper incisors being in a significantly retrusive position. Growth modification treatment resulted in lower incisor compensation. In the orthognathic surgery group, upper incisor retraction occurred pre and post surgery and lower incisor decompensation occurred post surgery. For all treatments incisor axial inclination changes and bodily movement played an important part in treatment outcome. The timing of treatment interventions was influenced by the severity of the malocclusion and the age and maturation of the patient at the time the patient presented for treatment.