## 3 Review
### Class II

Table 3: _Cont._In a 2003 N-RCT, [PERSON] et al. (2022) evaluated long-term (from 1-year up to \(>\)5 years) skeletal and soft tissue changes, occlusal stability, and patient satisfaction with treatment in a sample of 31 adult patients treated with orthodontic camouflage (involving dental extractions) or orthognathic surgery. Data collection included cephalometric variables, dental casts, intraoral and extraoral photographs, self-evaluation forms, and satisfaction questionnaires. Results showed that OVB change was similar between the groups, and it was related to incis over-eruption and post-treatment incisor irregularity. Surgery patients were twice as likely to have a long-term increased OVJ, which was due to dental compensation related to late soft tissue changes and post-surgery skeletal remodeling. In this study, camouflage patients have, in general, less severe problems than those treated surgically, as well as fewer functional and/or temporomandibular joint problems. The greater amount of change produced by surgery contributes to the greater prevalence of long-term changes in surgery patients. The overall satisfaction with treatment was comparable within groups, but patients who underwent mandibular advancement were significantly more positive about their appearance. [PERSON], therefore, suggested that the ideal patient for camouflage should have good initial facial esthetics, with an increased OVJ related to maxillary incisor protrusion rather than skeletal mandibular retrusion. A greater mandibular deficiency and a large OVJ have an increased need for surgery in order to obtain satisfactory clinical correction. In conclusion, the way that patients perceive the severity of their problem is a key in the decision-making process to elect for surgery rather than a camouflage plan or no treatment. In a 2004 N-RCT by [PERSON] et al. (2014) the efficacy of the Herbst appliance (a fixed Class II corrector), used in 23 adult patients with borderline skeletal Class II Division 1, was compared to a similar group of 46 adult patients treated with non-extraction mandibular advancement by means of bilateral sagittal split osteotomy (BSSO). The surgery group showed greater changes in mandibular advancement, with reduction in SNB, SNPg, ANB, and Wits Appraisal; increased anterior facial height, profile convexity reduction, retrusion of upper lip, and Class II molar correction, whereas SNA changes were comparable for both groups. As expected, these changes showed the same direction except for the mandibular plane angle (increased in the surgery group) and the posterior facial height (smaller in the surgery group). The data suggest that, whereas occlusion can be successfully corrected by the means of a Herbst Appliance, chin projection and facial esthetics cannot. If the patient's main goal is to greatly improve facial profile, BSSO or advancement genioplasty only (if the main complaint is chin prominence) are a better option. The absence of a follow-up and over-representation of women in both samples are some important limits of this study. Moreover, it would have been useful to compare these results to those from a third group of patients, treated with an orthodontic camouflage plan involving dental extraction. In a 2009 retrospective cephalometric study, [PERSON] et al. (2017) compared skeletal, dentoalveolar, and soft-tissue profile effects of three different treatment approaches in patients with skeletal Class II Division 1 malocclusion. A group of 20 patients were treated by orthodontic camouflage with upper premolar extractions, 20 with fixed functional  
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multirow{2}{*}{**Article Selected**} & \multirow{2}{*}{ \begin{tabular}{c} **Cephalometric Values (Pre-Treatment Characteristics of** \\ **Subjects—Means**) \\ \end{tabular}  } & \multicolumn{2}{c}{**Value Range**} \\ \hline \hline \multirow{4}{*}{[PERSON] et al., 2015} & \multirow{4}{*}{ \begin{tabular}{c} ANB \\ Wits \\ OVJ \\ U1-SN \\ LT-Md Plane \\ Interincisal \\ \end{tabular}  } & \multirow{4}{*}{\