Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study

Merve Berika Kadıoğlu; Meyra Durmaz; Meliha Rübendiz

Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study

Abstract

Aims: This study aimed to evaluate the craniofacial effects of non-extraction class II camouflage treatment using maxillary distalization and intermaxillary class II elastics in late adolescent patients. Methods: This retrospective study included 26 patients (20 females, 6 males; mean age: 15.2±1.3 years) with skeletal and dental class II malocclusion. All patients were treated by the same clinician using a standardized non-extraction protocol involving passive self-ligating brackets, maxillary distalization, and intermaxillary class II elastics. Lateral cephalometric radiographs obtained before (T0) and after treatment (T1) were analyzed. Skeletal, dental, and soft tissue changes were evaluated using conventional cephalometric measurements and Pancherz analysis. Statistical comparisons were performed using paired t-tests (p<0.05). Results: No significant changes were observed in skeletal parameters (SNA, SNB, ANB, SN-GoGn) (p>0.05). A significant decrease in Wits appraisal was observed (p=0.009). Mandibular incisors showed significant proclination (L1-NB, p<0.001; IMPA, p=0.001), whereas maxillary incisor position remained stable (p>0.05). Maxillary molars showed significant distalization, whereas mandibular molars demonstrated significant mesial movement (p<0.001). Overjet and overbite decreased significantly (p<0.001). Occlusal plane angle (Occ/SN) increased significantly (p=0.006). Conclusion: Non-extraction class II camouflage treatment resulted primarily in dentoalveolar rather than skeletal changes. Significant mandibular incisor proclination, maxillary molar distalization, and improvements in overjet and overbite were observed, whereas skeletal parameters remained largely unchanged.

Keywords

Ethical Statement

This study was approved by the Ethics Committee of Ankara University Faculty of Dentistry (Approval No: 8/13, Approval Date: 20.05.2024). All procedures were conducted in accordance with the principles of the Declaration of Helsinki.

References

De Ridder L, Aleksieva A, Willems G, Declerck D, Cadenas de Llano-Pérula M. Prevalence of orthodontic malocclusions in healthy children and adolescents: a systematic review. Int J Environ Res Public Health. 2022;19(12):7446. doi:10.3390/ijerph19127446
Buschang PH. The development, phenotypic characteristics, and etiology of class II malocclusion. In: Araújo EA, Buschang PH, eds. Recognizing and correcting developing malocclusions: a problem-oriented approach to orthodontics. Wiley-Blackwell; 2016:90-107. doi:10.1002/9781118925263.ch06a
Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod. 2006;12(1):11-24. doi:10.1053/j.sodo.2005.10.005
Ngan P, Tai SK. Orthopedic treatment of class II malocclusion with mandibular deficiency: a clinical practice review. Front Oral Maxillofac Med. 2024;6:27. doi:10.21037/fomm-22-69
Giuntini V, McNamara JA, Franchi L. Treatment of class II malocclusion in the growing patient: early or late? Semin Orthod. 2023;29(2):183-188. doi:10.1053/j.sodo.2023.04.008
Nerurkar S, Kamble R, Kaiser J, Mathew J. Non-extraction orthodontic treatment protocol of moderate crowding. Cureus. 2023;15(4):e37483. doi:10.7759/cureus.37483
Rongo R, Dianišková S, Spiezia A, Bucci R, Michelotti A, D'Antò V. Class II malocclusion in adult patients: what are the effects of the intermaxillary elastics with clear aligners? A retrospective single center one-group longitudinal study. J Clin Med. 2022;11(24):7333. doi:10.3390/jcm11247333
Janson G, Sathler R, Fernandes TM, Branco NC, Freitas MR. Correction of class II malocclusion with class II elastics: a systematic review. Am J Orthod Dentofacial Orthop. 2013;143(3):383-392. doi:10.1016/j.ajodo.2012.10.015

Alogaibi YA, Al-Fraidi AA, Alhajrasi MK, Alkhathami SS, Hatrom A, Afify AR. Distalization in orthodontics: a review and case series. Case Rep Dent. 2021;2021:8843959. doi:10.1155/2021/8843959
Almurtadha RH, Alhammadi MS, Fayed MMS, Abou-El-Ezz A, Halboub E. Changes in soft tissue profile after orthodontic treatment with and without extraction: a systematic review and meta-analysis. J Evid Based Dent Pract. 2018;18(3):193-202. doi:10.1016/j.jebdp.2017.09.002
Maaz M, Fida M. Dental, skeletal, and soft-tissue changes in adult orthodontic patients treated with premolar extraction and nonextraction: a cross-sectional study. Am J Orthod Dentofacial Orthop. 2022;162(3):360-366. doi:10.1016/j.ajodo.2021.04.026
Elias KG, Sivamurthy G, Bearn DR. Extraction vs nonextraction orthodontic treatment: a systematic review and meta-analysis. Angle Orthod. 2024;94(1):83-106. doi:10.2319/021123-98.1
Pancherz H. A cephalometric analysis of skeletal and dental changes contributing to class II correction in activator treatment. Am J Orthod. 1984;85(2):125-134. doi:10.1016/0002-9416(84)90004-6
Kinzinger G, Frye L, Diedrich P. Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery--a cephalometric study to evaluate various therapeutic effects. J Orofac Orthop. 2009;70(1):63-91. doi:10.1007/s00056-009-0821-2
Davidovitch M, Konstantarakis E, Athanasios V, Sella-Tunis T. Effects of class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction. Angle Orthod. 2023;93(1):19-25. doi:10.2319/051521-381.1
McNamara JA, Franchi L, Aliaga-Del Castillo A, McClatchey LM, Kim-Berman H. Treatment effects of the Carriere® Motion™ class II (CM2) and class III (CM3) appliances. Semin Orthod. 2026;32(3):527-538. doi:10.1053/j.sodo.2025.09.015
Sayed MS, Sadek MM, Abbas NH. Early versus late intermaxillary elastics in patients with class II malocclusion: a randomized clinical trial. Angle Orthod. 2025;95(6):587-594. doi:10.2319/113024-985.1
Nelson B, Hansen K, Hägg U. Overjet reduction and molar correction in fixed appliance treatment of class II, division 1, malocclusions: sagittal and vertical components. Am J Orthod Dentofacial Orthop. 1999;115(1): 13-23. doi:10.1016/s0889-5406(99)70311-2
Farret MM. Orthodontic biomechanics with intermaxillary elastics. Dental Press J Orthod. 2023;28(3):e23spe3. doi:10.1590/2177-6709.28.3.e23spe3
Nelson B, Hansen K, Hägg U. class II correction in patients treated with class II elastics and with fixed functional appliances: a comparative study. Am J Orthod Dentofacial Orthop. 2000;118(2):142-149. doi:10.1067/mod.2000.104489
Chen SS, Greenlee GM, Kim JE, Smith CL, Huang GJ. Systematic review of self-ligating brackets. Am J Orthod Dentofacial Orthop. 2010;137(6): 726.e1-727. doi:10.1016/j.ajodo.2009.11.009
Konstantonis D, Vasileiou D, Papageorgiou SN, Eliades T. Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis. Eur J Oral Sci. 2018;126(3):167-179. doi:10.1111/eos.12409
Jayachandran S, Wiltshire WA, Hayasaki SM, Pinheiro FH. Comparison of AdvanSync and intermaxillary elastics in the correction of class II malocclusions: a retrospective clinical study. Am J Orthod Dentofacial Orthop. 2016;150(6):979-988. doi:10.1016/j.ajodo.2016.05.008
Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics. 6th ed. Mosby; 2018.
Harradine NW. Self-ligating brackets and treatment efficiency. Clin Orthod Res. 2001;4(4):220-227. doi:10.1034/j.1600-0544.2001.40406.x
Damon DH. The Damon low-friction bracket: a biologically compatible straight-wire system. J Clin Orthod. 1998;32(11):670-680.
Lu W, Zhang X, Mei L, et al. Orthodontic incisor retraction caused changes in the soft tissue chin area: a retrospective study. BMC Oral Health. 2020;20(1):108. doi:10.1186/s12903-020-01099-2
Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod. 1967;53(4):262-284. doi:10.1016/0002-9416(67)90022-x
Janson G, Mendes LM, Junqueira CH, Garib DG. Soft-tissue changes in class II malocclusion patients treated with extractions: a systematic review. Eur J Orthod. 2016;38(6):631-637. doi:10.1093/ejo/cjv083

Details

Primary Language

English

Subjects

Orthodontics and Dentofacial Orthopaedics

Journal Section

Research Article

Authors

Merve Berika Kadıoğlu ^*
0000-0002-7005-6179
Türkiye

Meyra Durmaz
0009-0001-8486-875X
Türkiye

Meliha Rübendiz
0000-0001-6069-0101
Türkiye

Publication Date

September 11, 2026

Submission Date

June 11, 2026

Acceptance Date

August 9, 2026

Published in Issue

Year 2026 Volume: 8 Number: 5

IZ

https://izlik.org/JA47NX67JK

Cite

RIS / Bibtex

APA

Kadıoğlu, M. B., Durmaz, M., & Rübendiz, M. (2026). Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study. Anatolian Current Medical Journal, 8(5), 1014-1020. https://izlik.org/JA47NX67JK

AMA

1.Kadıoğlu MB, Durmaz M, Rübendiz M. Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(5):1014-1020. https://izlik.org/JA47NX67JK

Chicago

Kadıoğlu, Merve Berika, Meyra Durmaz, and Meliha Rübendiz. 2026. “Effects of Non-Extraction Class II Treatment With Maxillary Distalization and Intermaxillary Elastics Using Passive Self-Ligating Brackets: A Cephalometric Study”. Anatolian Current Medical Journal 8 (5): 1014-20. https://izlik.org/JA47NX67JK.

EndNote

Kadıoğlu MB, Durmaz M, Rübendiz M (September 1, 2026) Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study. Anatolian Current Medical Journal 8 5 1014–1020.

IEEE

[1]M. B. Kadıoğlu, M. Durmaz, and M. Rübendiz, “Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 5, pp. 1014–1020, Sept. 2026, [Online]. Available: https://izlik.org/JA47NX67JK

ISNAD

Kadıoğlu, Merve Berika - Durmaz, Meyra - Rübendiz, Meliha. “Effects of Non-Extraction Class II Treatment With Maxillary Distalization and Intermaxillary Elastics Using Passive Self-Ligating Brackets: A Cephalometric Study”. Anatolian Current Medical Journal 8/5 (September 1, 2026): 1014-1020. https://izlik.org/JA47NX67JK.

JAMA

1.Kadıoğlu MB, Durmaz M, Rübendiz M. Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:1014–1020.

MLA

Kadıoğlu, Merve Berika, et al. “Effects of Non-Extraction Class II Treatment With Maxillary Distalization and Intermaxillary Elastics Using Passive Self-Ligating Brackets: A Cephalometric Study”. Anatolian Current Medical Journal, vol. 8, no. 5, Sept. 2026, pp. 1014-20, https://izlik.org/JA47NX67JK.

Vancouver

1.Merve Berika Kadıoğlu, Meyra Durmaz, Meliha Rübendiz. Effects of non-extraction class II treatment with maxillary distalization and intermaxillary elastics using passive self-ligating brackets: a cephalometric study. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Sep. 1;8(5):1014-20. Available from: https://izlik.org/JA47NX67JK