Comparison Between 2 Protocols for the Treatment of Class II Division 2 Malocclusion

Study Overview
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Brief Summary
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The aim of this prospective study was to compare between two different treatment modalities of class II division 2; to start treatment in upper arch first until adequate overjet is obtained or to start in the lower arch first with removable anterior bite plane in upper arch.

Detailed Description
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Fifty four subjects with class II division 2 participated in this study. The subjects were randomly divided into two groups; Group one (28 patients): orthodontic treatment with upper arch bond up first and lower arch was bonded when 4 mm overjet was reached. The treatment continued until 0.019 x 0.025  stainless steel wires were reached in both arches. Group 2 (26 patients): orthodontic treatment with lower arch bond up first with removable anterior bite plane in upper arch. When 0.019 x 0.025 stainless steel wire was reached, the upper arch was bonded. The treatment continued until 0.019 x 0.025 stainless steel wires were reached. Three cephalograms were taken for each patient in both groups; pretreatment (T0) , after bonding the other arch (T1) and at the end of leveling and alignment in both arches (T2). Cephalometric measurements and superimpositions were made. Skeletal and dentoalveolar treatment changes were compared within and between the 2 groups.

Official Title
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A Prospective Randomized Clinical Trial to Compare Between Two Leveling and Alignment Protocols for the Treatment of Class II Division 2 Malocclusion

Conditions
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Class II Div 2 Incisal Relationship

Intervention / Treatment
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* Device: Fixed appliance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 17 years and ≤ 26 years Class II division 2 malocclusion. Overjet (OJ) < 4 mm. Overbite (OB) covering more than half of the lower incisor height. Mild to moderate crowding with tooth contact displacement no more than 2 mm. Good oral hygiene and healthy periodontium. Exclusion Criteria:- Systemic health problems and medications were taken. History of previous orthodontic treatment.

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized clinical trial


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Upper Arch Treatment First<br>Intervention : using fixed orthodontic pre-adjusted edgewise appliance in the upper and lower arches. starting treatment in the upper arch The upper ach was bonded for 28 patients and teeth alignment was started using round 0.014NiTi arch wire. The 0.014NiTi arch wire was placed into the slots of the brackets and tied with elastomers by figure of 8. Orthodontic treatment was continued in the upper arch with arch wire sequence of 0.014NiTi, 0.018NiTi, 0.016X0.022NiTi, 0.019X0.025NiTi, and 0.019X0.025stainless steel arch wires. The patients were followed up on a monthly basis until sufficient proclination of the upper incisors achieved to establish an overjet of at least 4 mm. After reaching the full working arch wire in lower arch (0.019 X 0.025stainless steel wire), lateral cephalogram and study models were taken. | Device: Fixed appliance<br> <br> |
| Experimental: Lower Arch Treatment First<br>Intervention : using fixed orthodontic pre-adjusted edgewise appliance in the lower arch and anterior bite plate in the upper arch. The lower arch was bonded after taking the pretreatment records. At the same appointment an anterior bite plate in the upper arch was delivered to prevent shearing off the mandibular incisor brackets and help in correction of anterior deep bite .After lower arch alignment and leveling in the same arch wire sequence as the other group and 0.019 X 0.025stainless steel arch wire was reached, the anterior bite plate was removed and the upper arch was bonded. The same arch wire sequence was used in the upper arch as was used in the lower arch. When the full working arch wire (0.019 X 0.025stainless steel arch wire) was reached in the upper arch, study models and lateral cephalogram were taken. | Device: Fixed appliance<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper and lower incisors proclination | Cephalometric analysis. Treatment changes in the values for upper and lower incisors in degrees, Upper incisor /Maxillary plane in degrees and lower incisors/Mandibular plane in degrees. | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of treatment | Measurements of time of treatment in months | 2 years | 
| Pain perception | Using visual analogue scale. From 0 where is no pain to 10 with severe pain | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Class II division 2, Alignment, Leveling