Camouflage IN

Orthodontics
DR. SHREYA
Postgraduate student
 Introduction
 Camouflage treatment is the displacement of teeth relative to
their supporting bone to compensate for an underlying jaw
discrepancy.
 It implies that growth modification to overcome the basic
problem is not feasible. The technique to camouflage a skeletal
malocclusion was developed as an extraction treatment and
introduced into orthodontics in the 1930s and 1940s.
 During that era, extraction to camouflage a skeletal malocclusion
became popular because growth modification had been largely
rejected as ineffective, and surgical correction had barely begun
to develop

INDICATIONS
 1. Too old for successful growth modification
Patient s not willing for surgery
 2. Mild to moderate skeletal class II or mild skeletal class III
  3. Reasonably good alignment of teeth (so that the
extraction spaces would be available for controlled
anteroposterior displacement and not used to relieve
crowding.
 4. Good vertical facial proportions, neither extreme short
face nor long face.

CONTRAINDICATIONS
 1.Severe class II, moderate or severe class III and vertical
skeletal discrepancies
 2. Patients with severe crowding or protrusion of incisors, in
whom space created by extractions will be required to achieve
proper alignment of the incisors
 3. Adolescents with good growth potential nongrowing adults
with more than mild discrepancies.
 4. Medically compromised patients
 5. Periodontaly compromised patients
 6. Need for immediate results (patient going abroad,
marriage etc.)

What are dental

compensations?
 As deviations from harmonious skeletal base relations
occur, teeth may undergo alteration in their normal axial
inclinations and vertical position.
 The alterations are due to the influence of the lips, cheeks
& tongue and they may overcome skeletal base
disproportions and maintain a functional occlusion.
Alterations of axial inclination and vertical position in
response to disharmonious skeletal growth are termed
“dental compensations”.
Dental compensation

Occur in 3 planes of space:

1) Anteroposterior plane:
Mandibular prognathism: lower incisors retroclined
and upper incisors proclined. In Class III
maloocclusions, the amount of anterior dental crossbite,
therefore, is almost always less than the skeletal
imbalance suggests.
 Class II: maxillary incisors may be retroclined
and mand. incisors proclined .
2) Vertical plane: When the maxilla and mandible
have divergent growth patterns, an open bite may
result. However , if the incisors continue to erupt
more than the standard norm, satisfactory
occlusion and function may be maintained.
3) Lateral plane: eg: in Class III malocclusions,
maxillary arch is often constricted and mandible is
wider than maxilla. Consequently, mandibular
buccal teeth tilt lingualy and maxillary buccal
teeth may tilt buccally to meet each other.
Camouflage versus surgery

 The goal of treatment in an orthodontic camouflage or

masking procedure is to maximize dental compensations
without compromising the esthetic result. If the patient
 chooses not to move the skeletal components
responsible for the discrepancy, then the only
other option for improving the occlusion is to move the teeth
(except in children with remaining growth potential , where
growth modification would be a preferred approach ).
 In many cases, forces exerted on teeth from surrounding soft
tissues, have contributed to their axial inclinations, which
reduce the severity of the occlusal discrepancy. In such cases,
the orthodontic treatment plan may be to continue or
exaggerate the dental compensation to minimize or eliminate
the dental discrepancy.
 In some patients such as some class II div 1 malocclusions,
few natural dental compensations have occurred and the
orthodontic goal is to initiate the process.

Envelope of discrepancy
Proffit & Ackerman
  It shows the amount of change in all 3 planes of
space that could be produced by
1)Orthodontic tooth movement alone
2)Orthodontic tooth movement combined with growth
modification in a growing child 3)
Orthognathic surgery.
Envelope of discrepancy
Key features:

 The possibilities for each type of treatment are not symmetric

with regard to the planes of space.
 More potential to retract than procline teeth.
 More potential for extrusion than intrusion.
 More tooth movement is possible anteroposteriorly than
vertically.
 Growth modification is more effective in mandibular
deficiency than in mandibular excess.
 Surgery to move the lower jaw back has more potential than
surgery to advance it.
 Envelope of discrepancy history
The 3 Dimensions: Consideration of
pitfalls & advantages of camouflage

Patient Motivation/
expectations cooperation
Chief complaint
Cost

Factors influencing treatment

plan

Etiologic factors

Growth potential/ Medical Dental histor

orthodontics

I) Anteroposterior Dimension: Camouflage is more likely

to be successful in anteroposterior than in other
dimensions.
Class II malocclusions: camouflage would be more
successful in patients with maxillary protrusion, than in
patients with mandibular deficiency.
Prominent Upper Jaw
& Lower Jaw Deficiency
 Camouflage options for skeletal Class
II:

44 extraction
44
4 4 extraction

4 4
extraction
5 5

Class II elastics/ non-extraction

 Factors to consider:
 Effect on facial esthetics
nasolabial angle, mentolabial
sulcus Lower incisor
inclination.
 Degree of crowding.
 Non-extraction is favourable in
patients with increased overjet &
spacing in upper arch and normal/
retroclined lower incisors.
Special Considerations in
Adolescents
 The recommendation of this study was that in Class II
adolescents who are beyond the growth spurt, surgery is most
likely to be needed for successful correction of the
malocclusion if the overjet is
 greater than 10 mm
 if the distance from pogonion to nasion perpendicular is 18
mm or more
 if mandibular body length is less than 70 mm if facial
height is greater than 125 mm.
Proffit WR, Phillips C, Tulloch JFC, et al: Surgical versus orthodontic
correction of skeletal Class II malocclusion in adoles- cents: Affects and
indications. Int J Adult Orthod Orthognath Surg 7:209, 1992

NON EXTRACTION TREATMENT

CLASS II ELASTICS

•Modest retraction of the upper arch, major forward

displacement of the lower arch(prominent lower lip)

•Elongate maxillary incisors(gummy smile) and mandibular

molars(Tipping down of occlusal plane)
•If molars extrude more than ramus growth mandible will rotate
downwards(hence contraindicated in non growing patients)

Janson G, Sathler R, Fernandes TM;Correction of Class II malocclusion

with Class II elastics: a systematic review. Am J Orthod Dentofacial Orthop.
2013 Mar;143(3):383-92 19

Class II malocclusion can be corrected23 with the use of

intermaxillary elastics by means of forward movement of
the mandibular teeth relative to the mandible and retraction
of the upper teeth.
24
•Result is likely to be neither stable nor esthetically
acceptable
25
•After treatment lip pressure tends to move the lower incisors
lingually leading to crowding
,return of overjet and overbite

CLASS II ELASTICS MAY PRODUCE OCCLUSAL

RELATIONSHIPS THAT LOOK GOOD ON DENTAL
CASTS BUT ARE LESS SATISFACTORY WHEN
SKELETAL RELATIONSHIPS AND FACIAL
AESTHETICS ARE CONSIDERED
PREMOLAR EXTRACTION
UNIARCH EXTRACTION 26
✓Retracting the upper incisors into the extraction
space

✓Anchorage reinforced-HG ,TPA ,Nance palatal

button ,
Skeletal anchorage devices

✓Class II elastics are contraindicated

✓Maintaining the class II molar relationship

✓UPPER 4 LOWER 5

retracted

✓Ending in a class I molar relationship

✓Extraction protocol of choice

✓Lower molars moved forward and upper incisors

ASYMMETRIC EXTRACTION

✓✓cases2823Class II subdivision
subjects(3subjects(4Extractionlower first pre on the class II
sidepremolar) premolar)both the upper first premolars and

There is a tendency for a slightly better treatment success rate

✓when Class II subdivision patients are treated with asymmetric
Ending in a class II subdivision with class I canine

extraction of 3 premolars,relation bil coincident midlines

 ✓compared with extraction of 4 premolarsCheney and Wertz
suggested extracting
the second premolar Class II side(greater elastic
Fink and Smith-Treatment time is increased by 0.9 months for use
and difficult midline control)
each extracted premolar

Janson G, Dainesi EA, Henriques JF, de Freitas MR, de Lima KJ. Class II
subdivision treatment success rate with symmetric and asymmetric extraction
protocols. Am J Orthod Dentofacial Orthop. 2003 Sep;124(3):257-64
2
4
•Group 1- 49 patients with 2 premolar extractions(14.35yrs)

•Group 2 -48 patients with 4 premolar extractions(13.03yrs)

 •Treatment time will be shorter and the occlusal results more
predictable with a 2-premolar-extraction protocol
compared with 4 premolar extractions
Janson G, Busato MC, Henriques JF, de Freitas MR, de Freitas LM.
Alignment stability in Class II malocclusion treated with 2- and 4-premolar
extraction protocols. Am J Orthod Dentofacial Orthop. 2006
Aug;130(2):189-95

Treatment of complete Class II malocclusions with 2 maxillary

premolar extractions or 4 premolar extractions had similar
longterm post treatment stability
Janson G, Leon-Salazar V, Leon-Salazar R, Janson M, de Freitas MR.
Long- term stability of Class II malocclusion treated with 2- and
4premolar extraction protocols. Am J Orthod Dentofacial Orthop. 2009
Aug;136(2):154.e1-10 25

Retraction of the upper incisors into a premolar extraction

space:
A straight forward way to correct
overjet is to retract the protruding incisors into
 the extraction space created by the
Extraction of maxillary 1st premolars.
29

Without extractions on the lower

patient would still have a Class excessive
relationship but normal canine
relationship the end of the treatment.
Class II correction: Extraction
or nonextraction? arch, the
James L. Vaden; II molar
AJODO 2018 at

• The patient with a Class II

malocclusion, proclination, or moderate crowding of the

 mandibular anterior teeth, and a moderate-tolow
mandibular plane angle is a treatmentplanning challenge.
• The clinician must weigh the pros and cons of each approach
and decide which approach will give the patient the best
long-term benefit.

Drawbacks of Class II camouflage

 Dishing in of profile
 Class II cases often have a typical dorsal hump of the nose;
this nasal prominence can be exaggerated when extraction
for camouflage is carried out and the teeth are retracted.
 patients with lack of upper lip support, an obtuse
nasolabial angle, a large nose, and a long lower face height,
all of these may become more apparent as a result of
orthodontic camouflage treatment. ( Tucker, JOMS 1995)
 Adverse effect on TMJs: individual case reports and
viewpoint articles have reported increased prevalence
 of joint signs/ symptoms and posterior displacement
of the condyles in patients treated with 4 premolar
extractions. However, various long-term studies (
Janson & Hasund, EJO 1981;
Sadowsky AJO 1991; Paquette, Beattie and Johnston
AJO 1992)
 Excessive proclining of lower incisors with class II
elastics can cause labial gingival recession.
 Increased chance of root resorption: A major risk factor
for severe resorption of maxillary incisor roots during
ortho treatment, is contact of the roots with the lingual
cortical plate
 Risk of resorption increases 20 fold, when lingual plate
contact occurs.
 Two circumstances can cause the roots to contact the
lingual cortical plate: torquing the upper incisors back
 Soft tissue limitations in Orthodontics:
Treatment planning guidelines
Ackermann and Profitt

during class II camouflage, and tipping them facially in

class III camouflage
 • Soft tissue and stability
• Dental expansion and periodontium
• Neuromuscular influences on
condylar
position
• Lip support, tooth position and
facial esthetics

• Esthetic guidelines:
➢ size of nose
➢ Position of upper lip
➢ High smile line
➢ Everted lower lip
 ➢ Concave profile with thinning of lips
➢ Lack of well defined mentolabial
sulcus
➢ Bilabial protrusion
➢ Soft tissue surgical procedures
• Lack of space for eruption of premolars
due to 37 mesial migration of
permanent first molars
• End on molar relationship with mild to
moderate space requirement

rd • Cases with less than a full cusp class

missing 3
II molar relationship
• Good soft tissue profile
• Borderline cases
• Mild to moderate space discrepancy
with
molars or 2nd molars not yet erupted
MOLAR DISTALISATION
INDICATIONS
 Profile :
Straight profile
 Functional
Normal, healthy
temperomandibular joint
Correct mandible to maxillary
relationship
 Skeletal
Class I skeletal
Normal, short lower face height
 Maxilla, normal transverse width
Brachycephalic growth pattern
Skeletal closed bite
 Dental
Class II molar relationship
Deep overbite
Permanent dentition
Maxillary first molar mesially inclined.
Preferably prior to eruption of
second molar.
Loss of arch length due to premature
loss of second deciduous molar.

CONTRAINDICATIONS
 Profile :
Retrognathic profile Functional :
 Numerous signs and symptoms of
temperomandibular joint.
Posteriorly and superiorly displaced
condyles.
 Skeletal :
Class II skeletal
Skeletal open
Excess lower face height
Constricted maxillary arch
Dolicocephalic growth pattern
Dental :
Class I or III molar relation.
Dental open bite
Maxillary first molar distally inclined.
42
 43
A limiting factor in orthodontic class II
treatment is the extent to which the lower teeth
can be moved forward relative to the mandible.
Moving the lower incisors forward more than 2
mm is highly unstable unless they were severely
tipped lingually, but this is likely to occur during
camouflage treatment when class II elastics are
used unless lower premolars were extracted
The advent of TADs or skeletal anchorage devices has led
many orthodontists to get good results without
44 surgery
There are four main areas of their use
•Positioning individual teeth when no other satisfactory
anchorage is available

•Retraction of severely proclined incisors

•Distal or mesial movement of the molars

•Intrusion of posterior teeth to close an anterior open bite or of

anterior teeth to open a deep bite
 6
6

Class III
skeletal
discrepancy
Lower Jaw
Prominence
 Skeletal Pseudo class III
Maxilla retrusion More Less when compared with
skeletal
Mandibular Increased SNB Less
prognathism
Incisor interference -ve +Ve
Compensatory Proclined maxillary
mechanism incisors and
retroclined
mandibular
incisors

Retroclined maxillary
incisors and/or
proclined mandibular
incisors
 Facial profile The soft tissues Pseudo-class III profile
tend to appears normal in centric
relation and slightly
camouflage the
concave in centric
underlying
occlusion.
discrepancy, and
the patient often
displays a concave
facial profile
Gonial angle Obtuse Same as class I
Cephalometric characteristics of Pseudo-class III and skeletal class III
patients GU YAN et al[jco2000]
 74
• The goals of camouflage, are to obtain satisfactory
dental and facial esthetics, along with acceptable
dental occlusion and function .
• The problem is that most Class III patients already
have some dental compensation that developed
during growth .
• Typically, the upper incisors are at least somewhat
proclined and protrusive relative to the maxilla,
whereas the lower incisors are upright and
retrusive relative to the chin.
 75
• Extraction of two lower first premolars,
corrects the malocclusion, but it almost always produces an
esthetically undesirable result.

• Extraction of mandibular second premolars is a way to

reduce the amount of lower incisor retraction that would
occur.
76
Mandibular incisor extraction

The incisor extraction decision is supported by a

large inter canine width, relatively minor crowding,
some mandibular anterior tooth size excess, and
normal rather than triangular incisor shape
 UPPER INCISOR MOVEMENT IN CLASS III TREATMENT

If a Class III case 81

requires mesial
in two
movement of upper incisors, it can be achieved
ways: and mesial
1. By proclination incisors withinmovementthe
ofbone;
upper
available

When incisors are proclined forwards, each 2.5°

proclination creates approximately 1mm of space per
side, or 2mm in total.
 2.By mesial movement of the maxillary bone as a result of
normal growth or orthodontic procedures
Limits to mesial movement of upper incisors

82
1. Excessive proclination.. As a proclination of general
the the rule,
upper incisors beyond 120 ° to
maxillary plane should be there is individual
avoided, although
variation .

2. Failure to fully achieve a positive overjet. This can

be due to the forward position of the lower
the resulting bite
incisors, or other reasons, and can be
difficult to manage
• Distal movement of the lower incisors can be
achieved by distal movement of the teeth within
the mandibular bone, or by distal movement of
the mandible itself, when there is a displacement.

• Unfavorable mesial movement of the lower incisors can

 occur because of mandibular growth

84
In most non-surgical Class III treatments, it is helpful to
retract and retrocline the lower incisors

• Retraction and retroclination beyond a figure of

approximately 80° to the mandibular plane undesirable,is
because of the risk of dehiscence and lack of bone support
Drawbacks of Class IIIcamouflage:
 Class III malocclusions that present with compensations in the
form of retroclined mandibular anteriors, typically display
exaggerated root prominence that gives a characteristic
“washboard” appearance. In patients with mandibular
prognathisn, the chin prominence may be increased as the
lower teeth are retracted.

 Single lower incisor extraction can cause collapse of the

intercanine dimension and unesthetic gingival contour.
Limitations in Orthopedic and Camouflage Treatment
for Class III Malocclusion
 Hyoung Seon Baik ;SEMINARS IN ORTHODONTICS 2007

Treatment of skeletal class III

malocclusions: Orthognathic surgery or
orthodontic camouflage? How to decide
International Orthodontics 2011

• The aim of the study was to uncover a guide model

enabling the practitioner to distinguish between skeletal
Class III cases which can be suitably treated with
orthodontics and those requiring orthognathic surgery.

• The H angle was singled out by discriminant analysis as

being the decisive parameter. The threshold or borderline
value was 7.2
USE OF SKELETAL
ANCHORAGE
 Evolution of Class III treatment iN orthodontics;AJODO
2015 ;Peter Ngan

• Improving Anchorage for Camouflage Class III Treatment:

• Camouflaging became more predictable with microimplants;
consequently, more severe Class III problems can be treated.
• Sakthi et al82 reported creating a regional acceleratory
phenomenon during the en-masse distalization, and it increased
the speed of tooth movements.
• Extraction of the mandibular third molars immediately before
distalization can create a regional acceleratory phenomenon
and assist in speedy tooth movements. Puncturing cortical bone
in localized areas during microimplant-assisted retraction can
potentially create a regional acceleratory phenomenon.

II) Vertical dimension

Least amenable to orthodontic camouflage.
 1) Vertical maxillary excess (VME) : presents with increased
lower anterior facial height and gummy smile.
 Camouflage options: depend on the clinical crown height. If it is
larger than the normal range, and if some amount of deep bite
is present, then incisor intrusion may be carried out. However
this approach is not suitable if a concurrent open bite is present.
 If the clinical crown height is below the normal range, gingival
recontouring can be done to reduce the excessive gingival
display, and camouflage the
VME.
2)Skeletal Deep bite: Usually seen in hypodivergent facial
patterns , with reduced lower anterior facial height.
 Camouflage options:
Extrusion of premolars and molars: Long-term stability is
questionable in adults.

 The major disadvantages of correcting deep overbite by

extrusion are an excessive incisor display, an increase in
the interlabial gap, and worsening of a gingival smile.
 Incisor intrusion:When a patients incisor display at rest
measures 3-4 mm, with a deep overbite, the treatment of
choice may be lower incisor intrusion.
 In adult patients, intrusion of the upper incisors should be
planned only if their display at rest is more than 3 mm.
 Drawbacks:
Risk of root resorption.
At least 2 mm of incisor display at rest should be seen, else
the effect may appear like premature ageing.
3) Skeletal Open bite: Vast majority presents with vertical
maxillary excess. Another option is molar intrusion.
Rationale: mandibular autorotation, as the molars
intrude, resulting in anterior open bite closure. For every
millimeter of molar intrusion, approx. 3 mm of open bite
reduction is seen anteriorly.
( Kuhn, Angle 1968). Methods: Bite plates, High pull
headgear, Active vertical corrector, Implants.
Drawback: difficult to achieve absolute intrusion without
use of implants.
III) Transverse dimension:
If the transverse discrepancy is less than 4
mm, the clinician may elect to camouflage it by
tipping the teeth
If the discrepancy is greater than 4 mm, then
attempts to camouflage it by only moving the
teeth, may cause periodontal problems, mainly
buccal gingival recession, and instability of the
occlusal scheme.
So in such situations, orthopedic expansion in
preadolescents, and Surgically- assisted Rapid
Maxillary Expansion in adults are the preferred
approaches.
Skeletal and dentoalveolar changes in the transverse
dimension using microimplant -assisted rapid palatal
expansion (MARPE) appliances;Seminars
inortho;2019
 Camouflage versus surgery:
Comparison of outcomes
 Proffit, Phillips & Douvartidis ( AJO 1992)
 Both orthodontic treatment and surgical-orthodontic treatment
improved the malocclusion as judged from dental casts.
 Surgery resulted in greater reduction of overjet and greater
improvement in most cephalometric skeletal, dental, and soft
tissue criteria.
 Before treatment, the surgical patients had lower esthetic ratings
than the orthodontics-only patients.
 After treatment, the esthetic ratings for the orthodontic patients
were unchanged. The surgical patients had improved but not to
the pretreatment level of the orthodontics patients.
Camouflage versus surgery: Comparison of
outcomes
Mihalik , Proffit , Phillips (AJO 2003)
 In the camouflage patients, small mean changes in skeletal
landmark positions occurred in the long term, but the changes
were generally much smaller than in the surgery patients.
 The patients' perceptions of outcomes were highly positive in
both the orthodontic and the surgical groups.
 The orthodontics-only patients reported fewer
functional or temporomandibular joint problems than
did the surgery patients.
 similar satisfaction with treatment, but patients who had their
mandibles advanced were more positive about their dentofacial
images.
Camouflage versus surgery: Comparison of
outcomes; Phillips, Trentini & Douvartzidis ( JOMS 1992)

 The orthodontic camouflage group was rated as significantly

more attractive than the orthognathic surgery patients before
treatment.
 There was no significant change in the facial attractiveness mean
score for the orthodontic group, whereas the orthognathic
surgery group was rated as showing a significant improvement.
 However, the orthognathic surgery group was still rated as being
significantly less attractive after treatment than the
orthodontics-only group.
Growth modification versus orthognathic
surgery: comparison of outcomes
 Shell & Woods ( Angle O 2003)
 It was found that neither the average pre- and
posttreatment esthetic scores nor the change in
esthetic score with treatment was significantly different for
the two groups.
 the findings of this study suggest that the perceived esthetic
outcome in many Class II division 1 patients may be as
favorable, regardless of whether they are managed early
during the growth phase or later, at the completion of
growth by orthognathic surgery.
Growth modification versus camouflage:
comparison of outcomes

 Battagel ( EJO 1989) She reported that in the

camouflage group, despite good positioning of the
lower incisor with respect to A-Po, both lips finished
well behind the esthetic plane, and the resulting
profile was undesirably retrusive, while the Frankel
appliance produced a more pleasing, well balanced
 profile with a more ideal position of the lips
to the esthetic plane.
SURGICAL CAMOUFLAGE
 Surgical camouflage Surgical camouflage has the same goal as
orthodontic camouflage to remove the appearance of jaw
deformity without correcting the underlying problem.
 This type of treatment includes chin surgery, nasal surgery
and other facial soft tissue procedures, including onlay grafts
to improve soft tissue contours.

Surgical masking procedures:

( Van Sickels, Atlas of oral and maxillofacial
clinics of North America 2001)
 Ideal cases are patients with mild to moderate discrepancy.
 Dentally, they would have been treated to an overjet of 2 to 5
mm.
 Skeletally, their discrepancy can be masked or minimized by
moving their chin. Patients with large discrepancies may not do
as well with these masking procedures.
 Options:
✓ Genial advancement in skeletal Class II patients
✓ Submental liposuction in combination, to define the
angles of the mandible and enhance the chin-throat angle.
✓ Reduction Rhinoplasty in skeletal Class II ( Makes chin appear
more prominent).

Summary &

Conclusion

Reasonably good results

Camouflage orthodontics
Suitable in mild to moderate cases

economical
 Less morbidity
May facilitate Advantages adjunctive
procedures like genioplasty, to reduce
extent of surgery.
Can be attempted
Prior to growth
completion: early
psychological benefit
Esthetic
improvement limited
by
Extent of skeletal discrepancy
Limited scope in
Pitfalls vertical malocclusions
Risk of
Root resorption
Limited scope in
Class III and in Class II with
Signoficant mand deficiency/
Overjet >10mm
ACCEPTABLE RESULTS LIKELY

Average or short facial pattern

Mild anteroposterior jaw discrepancy
Crowding< 4-6mm
Normal soft tissue features(nose, lips,
chin)
No transverse skeletal problem

Orthodontic Camouflage
Of skeletal malocclusion

POOR RESULTS LIKELY

Long vertical facial pattern
Moderate or severe anteroposterior discrepanc
Crowding > 4-6 mm.
Exaggerated features
Transverse skeletal component of problem
THANK YOU!
 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.
 When alternative treatment approaches are possible, the
ratio of benefit to risk must be considered for each
procedure.
 For orthodontic camouflage versus surgery, the
important decision is whether the greater improvement in
dentofacial image that is possible with surgery would be
worth the increased cost and risk.


REFERENCES
 Camouflage might not mean compromise ;David L.
Turpin, DDS, AJODO 2003
 Correction of Class II malocclusion with Class II elastics: A
systematic review ;Guilherme Janson ;ajodo2013
 Janson G, Busato MC, Henriques JF, de Freitas MR,
de Freitas LM. Alignment stability in Class II
malocclusion treated with 2- and 4-premolar
extraction protocols. Am J Orthod Dentofacial Orthop. 2006
Aug;130(2):189-95
 Janson G, Leon-Salazar V, Leon-Salazar R, Janson M, de
Freitas MR. Long- term stability of Class II malocclusion
treated with 2- and 4-premolar extraction protocols. Am J
Orthod Dentofacial Orthop.
2009 Aug;136(2):154.e1-10
 Class II correction: Extraction or nonextraction? James L.
Vaden; AJODO 2018
 Orthognathic Surgery Versus Orthodontic
Camouflage in the Treatment of Mandibular
Deficiency ;MYRON R. TUCKER;JOMS1995
 Proffit WR, Phillips C, Tulloch JFC, et al: Surgical versus
orthodontic correction of skeletal Class II malocclusion in
adolescents:
Affects and indications. Int J Adult Orthod
Orthognath Surg 7:209, 1992
 Proffit WR, Phillips C, Douvartzidis N: A comparison of
out- comes of orthodontic and surgical-orthodontic
 treatment of Class II malocclusions in adults. Am
J Adult Orthod
Dentofac Orthop 101:556, 1992
 Soft tissue limitations in Orthodontics: Treatment planning
guidelines;Ackermann and Profitt;Angle Orthodontist 1992
 Total distalization of the maxillary arch in a patient with skeletal Class
II malocclusion ;Yoon Jeong Choi, Jong-Suk Lee ;AJODO 2011
 Textbook of Orthodontics.Samir E. Bishara;355-361
 Orthodontics-Principles and practice;Phulari
 Contemporary orthodontics;William R. Proffitt
 Skeletal and dentoalveolar changes in the transverse dimension using
microimplant-assisted rapid palatal expansion (MARPE)
appliances;Seminars inortho;2019
 Efficiency of Class II subdivision malocclusion treatment with 3 and 4
premolar extractions ;Guilherme
Janson;AJODO 2016
 Long-term follow-up of Class II adults treated with orthodontic
camouflage: A comparison with
orthognathic surgery outcomes ; Mihalik, Proffit, and Phillips
;AJODO 2003
 Treatment of skeletal class III malocclusions:
 Orthognathic surgery or orthodontic camouflage? How to
decide; Hicham BENYAHIA,Mohamed Faouzi
AZAROUAL International Orthodontics 2011
 Limitations in Orthopedic and Camouflage Treatment for
Class III Malocclusion ;Hyoung Seon Baik ; Seminars in Orthodontics,
Vol 13, No 3 (September), 2007
 Class III camouflage treatment: What are the limits?
Nikia R. Burns,a David R. Musich;;, American Journal of
Orthodontics and Dentofacial Orthopedics January 2010
 Class II correction: Extraction or nonextraction? James L. Vaden,a
Richard A. Williams, ;AJODO 2018