OPTIMIZING ORTHODONTIC TREATMENT PROTOCOLS FOR DISTAL OCCLUSION (ANGLE CLASS II MALOCCLUSION): EVIDENCE SYNTHESIS, DECISION PATHWAYS, AND PROTOCOL OPTIMIZATION ACROSS THE LIFESPAN

Khamidjonova Shakhzoda Bakhrilloevna; Khayitova Raykhona Tolibovna; : Juraev Firdavs Abdurakhmonovich

Authors

Khamidjonova Shakhzoda Bakhrilloevna Samarkand State Medical University
Khayitova Raykhona Tolibovna Samarkand State Medical University
: Juraev Firdavs Abdurakhmonovich Samarkand State Medical University

Keywords:

Class II malocclusion; distal occlusion; functional appliances; cervical headgear; fixed functional appliances; temporary anchorage devices; molar distalization; extraction therapy; orthognathic surgery; retention; stability; evidence synthesis.

Abstract

Distal occlusion (Angle Class II malocclusion) is a highly prevalent sagittal discrepancy that encompasses heterogeneous etiologies and phenotypes, including maxillary protrusion, mandibular retrognathia, dentoalveolar compensation, and functional disturbances. Optimizing treatment therefore requires structured diagnosis and deliberate selection among growth modification, orthodontic camouflage, skeletal anchorage strategies, and orthognathic surgery. This scholarly review synthesizes contemporary primary studies, systematic reviews, and clinical guidance to propose an evidence‑informed framework for optimizing Class II protocols across children, adolescents, and adults.

References

1. Ministry of Health of the Republic of Belarus. (2022). Diagnosis and treatment of patients with distal occlusion (adult and child population): Clinical protocol (Republic of Belarus). (Published in MedElement clinical protocols repository).

2. Cochrane Collaboration. Batista, K. B. S. L., Thiruvenkatachari, B., Harrison, J. E., O’Brien, K. D., & others. (2018). Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents (Cochrane Database systematic review).

3. Henriques, J. F. C., Maltagliati, L. Á., Janson, G., et al. (2015). Effects of cervical headgear appliance: A systematic review. Dental Press Journal of Orthodontics.

4. Rosa, A. J., do Nascimento, R. R., Mucha, J. N., & Vilella, O. V. (2020). Effects of the cervical headgear in growing Angle Class II malocclusion patients: A prospective study. Dental Press Journal of Orthodontics.

5. Xu, F., et al. (2024). Comparison of Twin Block appliance and Herbst appliance in the treatment of Class II malocclusion among children: A meta-analysis. BMC Oral Health.

6. Australian Society of Orthodontists. (2024). Class II correction with functional appliances (professional educational document).

7. British Orthodontic Society. (2026). Functional appliances (patient and clinician information page).

8. Liu, F., Liu, J., Guo, M., Li, Z., Shu, G., & Dai, F. (2024). Miniscrew anchorage versus Class II elastics for maxillary arch distalization using clear aligners. The Angle Orthodontist.

9. Huang, Y. T. L., et al. (2025). Analysis of the efficacy of conventional, skeletal and invisible orthodontic appliance for upper molar distalization in Class II malocclusion patients: A systematic review and meta-analysis. BMC Oral Health.

10. Alhammadi, M. S., et al. (2022). Skeletal and dentoalveolar effects of Class II malocclusion treatment using bi-maxillary skeletal anchorage: A systematic review. BMC Oral Health.

11. Gotti, E., et al. (2024). Mandibular advancement and skeletal anchorage in Class II malocclusion patients: A systematic review with meta-analysis. Bioengineering.

12. del Rosso, C., et al. (2025). Clinical management of orthodontic miniscrew complications: A scoping review. MDPI (open access via PMC).