Camouflage might not mean compromise.

After reading this issue of the Journal, you might find that planning treatment for an adult patient with a skeletal Class II malocclusion is a little easier. In fact, I think you’ll agree with me after you read just 1 article, “Long-term follow-up of Class II adults treated with orthodontic camouflage: A comparison with orthognathic surgery outcomes,” by Mihalik, Proffit, and Phillips. There are really only 2 options for correcting a skeletal Class II relationship in an adult: camouflage orthodontic treatment, based on retraction of the protruding maxillary incisors without changing the underlying skeletal problem, or orthognathic surgery to reposition the mandible or the maxilla. According to Mihalik et al, mandibular deficiency is the problem in about two thirds of the surgical patients; one third require maxillary surgery, either alone (15%) or combined with mandibular surgery (20%). Having described these 2 dramatically different treatment options, wouldn’t it be interesting to compare long-term treatment outcomes? This group of North Carolina researchers essentially did just that by (1) comparing long-term skeletal and soft tissue changes in the 2 groups of patients, (2) evaluating long-term changes in occlusal relationships after orthodontic camouflage treatment and comparing these with the stability observed in the surgery patients, and (3) evaluating patient satisfaction after camouflage treatment. “But how will new data make it any easier to determine the final plan of treatment?” you might be wondering. The answer is in the detailed findings of this study. Despite differences in overall severity before treatment, jaw relationships and dental occlusion were similar at the end of treatment, with both treatment modalities meeting their original objectives. Cephalometrically, the camouflage patients were quite stable in the long term, with only 10% showing an increase in overbite. Although over half of the camouflage patients had a long-term increase in incisor irregularity over time, so did 50% of the surgery patients. Regarding evaluation of the patients’ perceptions of treatment outcomes, the results are even more interesting. Those in the camouflage group were very satisfied with their treatment overall, and they had fewer functional and temporomandibular joint problems than did the patients in the surgical group. Kiyak et al reported similar findings in the 1980s, noting that even though Class II camouflage patients were aware of differences in chin projection, the great majority were pleased with the outcome of treatment. Mihalik goes on to state, “From our perspective, these data show that properly selected patients for orthodontic camouflage treatment are as likely or more likely to be satisfied with the outcome of treatment as those who have surgery. Proper selection of patients, of course, is neither simple nor easy.” In today’s world, as the cost of surgery goes up and more insurance companies decline to pay for even the most severe cases, it is good news to hear that camouflage treatment might be a successful alternative to surgery. There might not be a need to call it “compromised” treatment if the stability is comparable to that of surgery and if the patients’ perceptions of outcomes are also highly positive. Effective communication is still a challenge in managing adult Class II treatment. This is when the use of computer imaging can help the patient to visualize and compare the expected changes as they are discussed. I hope you will spend some time reading this article. If you do, I think your practice will benefit from the results almost immediately. Am J Orthod Dentofacial Orthop 2003;123:241 Copyright © 2003 by the American Association of Orthodontists. 0889-5406/2003/$30.00 0 doi:10.1067/mod.2003.112