Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

Abstract

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.

Sagittal and vertical craniofacial growth and attainment of circumpubertal middle phalanx maturation (MPM) stages: A multiple regression study

“…1 Moreover, the MPM stages 2 and 3 have been associated with the onset and maximum mandibular growth peak, respectively, in most of the subjects. 21 Intersubject variability in the duration of each stage of the different radiographical indicator of skeletal maturity has been reported, 35 including the MPM method.…”

“…1,2 Therefore, the knowledge of whether attainment of a specific maturation phase is associated to the different sagittal and vertical craniofacial growth pattern becomes of relevance in dentofacial orthopedics and orthodontics. For instance, deficiency 3 and increased 4 mandibular length in skeletal Class II and Class III subjects, respectively, was suggested to be in part a consequence of the different durations of the pubertal growth spurt in these subjects, as compared to that of Class I subjects.…”

“…For instance, deficiency 3 and increased 4 mandibular length in skeletal Class II and Class III subjects, respectively, was suggested to be in part a consequence of the different durations of the pubertal growth spurt in these subjects, as compared to that of Class I subjects. [5][6][7][8] However, in spite of the wide indications for orthopedic treatments in case of skeletal malocclusion, only a few studies investigated on possible correlation between craniofacial growth pattern and attainment/duration of the different skeletal maturation phases [5][6][7]9,10 (according to which timing of intervention is based 1,2 ). These studies also reported contrasting evidence with clinically relevant [5][6][7][8][9] or not relevant 10 correlations.…”

Management of Amelogenesis Imperfecta in Adolescent Patients: Clinical Report

“…The pubertal growth spurt begins between the age of 10 to 12 in girls and 15 to 16 in boys; however, age ranges cannot be used as the sole indicator for initiation of definitive dental treatment, because the rate of growth during puberty varies widely. If implant therapy is selected, the stabilization of the growth spurt should be verified with hand and wrist radiographic analyses for the fusion of the epiphysis and metaphysis and the third distal phalanx, as there are large differences in the pubertal growth spurt with ages and sexes …”

Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

“…1 These indicators are based on the attainment of discrete stages according to pre-established morphological maturational features. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth.…”