In the course of a clinical and radiological follow-up study of 55 patients with class II malocclusions, who had been treated with functional appliances, the dental and skeletal changes were critically studies and statistically analyzed in relation to long term aesthetic, dental, and skeletal changes. Differences between class II, division 1 cases and class II, division 2 cases were also compared. The study revealed that at the end of the treatment period 80% of the functionally treated patients displayed much better nose to upper lip relations than at treatment begin. Aesthetically the best treatment results were in the class II, first group patients with an average 4.2 degree reduction of the soft tissue H-angle in the course of functional therapy. It was shown that both dental and skeletal changes were responsible fo the in most cases good treatment results, whereas the changes in patients in the two subgroups with class II malocclusions showed significant differentiations. This paper describes these changes in detail. Viewed in its entirety this study clearly supports the efficacy of functional therapy in adolescents. In relation to long-term stability the results of functional balanced occlusion and the stability of the maxillo-mandibular relationship should be especially emphasized, whereas the therapeutically induced protrusion of the mandibular incisors and their relapse should be critically viewed.

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The amount of overbite reduction and the stability of the results three to 14.5 years post-retention were analysed in a follow-up study of 60 patients who had been treated with functional appliances. To establish therapeutic and posttherapeutic changes in dento-facial relationships, plaster casts and lateral cephalograms were evaluated at the beginning, at the end of treatment and at the follow-up examination. Posttherapeutic deepening of the overbite (> 0.8 mm) was found in 54.2% of the cases, while overbite reduction remained stable in 39%. A number of skeletal and dental factors were found to be involved in overbite reduction and posttreatment deepening. In this connection, changes in the ML-NSL angle, the ML-NL angle and the gonion angle were found to be just as important as the therapeutic and posttherapeutic changes in anterior and posterior facial height and changes in the skeletal pattern. It is emphasized that strict application of retention is of the greatest importance to minimize vertical relapse.