ABSTRACT 

Class II malocclusion, characterized by a distal relationship of the mandibular dental arch relative to the maxillary arch, is among the most common malocclusions encountered in orthodontic practice, and its management spans the entire range of orthodontic and orthognathic therapy. The appropriate treatment approach depends on the patient’s growth status, the severity and skeletal versus dentoalveolar nature of the discrepancy, and the presence of vertical or transverse complicating factors. In growing patients, growth modification with removable or fixed functional appliances, alone or combined with headgear, aims to harness the pubertal growth spurt to correct the underlying skeletal discrepancy; randomized clinical trials indicate that, although early treatment produces short-term skeletal and psychosocial benefits, it does not reduce the need for, or shorten, a subsequent phase of comprehensive treatment. A 2026 systematic review comparing seven functional appliance types found the Twin Block to be the most efficient removable design and the Forsus device the most efficient fixed design. Clear aligner-based mandibular advancement has also emerged as an esthetic alternative for both growing and adult patients. In adolescents and adults with mild-to-moderate discrepancies, camouflage strategies-Class II intermaxillary elastics, extraction-based space closure, and temporary anchorage device (TAD)-supported maxillary molar distalization-achieve occlusal correction primarily through dentoalveolar compensation. When the skeletal discrepancy is severe and growth is complete, combined orthodontic-surgical treatment is required; a 2026 systematic review of 65 studies (6,482 patients) found that orthognathic surgery achieves a mean ANB improvement of 5.4° for Class II corrections, with skeletal stability maintained in 87.3% of patients at one year and patient satisfaction of 87.6%. This review synthesizes classic and current evidence to provide an updated framework for Class II treatment selection across the growing and nongrowing patient.

KEYWORDS

Class II malocclusion; functional appliances; growth modification; Class II elastics; clear aligners; temporary anchorage devices; orthognathic surgery; review

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Cite this article

Sağır, E. (2026). Treatment Modalities for Class II Malocclusion: A Comprehensive Review of Growth Modification, Camouflage, and Orthognathic Surgical Approaches. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(9), 881-888. https://doi.org/10.58806/ijhmr.2026.v5i9n03