Treatment and stability of Class II Division 2 malocclusion in children and adolescents: A systematic review

Introduction: Our objectives were to evaluate the evidence with regard to the effectiveness and stability of orthodontic treatment interventions for Class II Division 2 malocclusion in children and adolescents. This is a systematic review conducted according to the PRISMA statement. Methods: The Cochrane Oral Health Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched to November 2011. Relevant conference abstracts were also screened. No language restrictions were applied. Inclusion criteria were clinical studies with at least 20 subjects with Class II Division 2 malocclusion in which comparisons were made with an untreated Class II Division 2 malocclusion group, another treated Class II Division 2 malocclusion group, or neither. For included studies ranked best on the hierarchy of evidence, assessments of methodologic quality and risk of bias were undertaken. Abstracts and, when appropriate, full articles were examined independently by 2 investigators. Disagreements were resolved through discussion. Treatment changes and stability with or without retainers were measured with the following: skeletal, soft tissue, dental, and occlusal changes; gingival health; temporomandibular joint status and related muscular activity; and quality of life. Results: Of the 322 studies identified in the search, 20 met the final inclusion criteria. All had a high risk of bias. Conclusions: Highly biased evidence exists with regard to management and stability of Class II Division 2 malocclusion. Guidelines are proposed based on current evidence.