A Modern Rationale for Orthopedics and Orthopedic Retention

Growth modification has been used in orthodontics for many years, however, there has been recent increased debate about the appropriate timing and value of early phase orthopedic treatment in patients with Class II skeletal patterns. While orthopedic appliances have proven their effectiveness in correcting Class II malocclusions, the value of such treatment has recently been challenged by randomized clinical trials (RCTs) that suggest relapse of gains made in the early phase of treatment, minimizing long-term benefits. Although RCTs are a powerful tool for clinicians and researchers, they are not without their limitations and the design of such studies should be carefully considered. Relapse of orthopedic improvement may involve skeletal components, but has been found to be largely dentoalveolar in nature. Despite recent questions of the effectiveness of early treatment, it is generally recognized that the use of growth modification still has a place in modern orthodontic practices. Thus, if early phase treatment is warranted in a growing patient, greater consideration must be given to retention of not only the skeletal change, but maintenance of the dental relationship as well.