Is treatment of class II malocclusion with class II elastics effective?

iStock_000002551343XSmall colourful braces on teeth

The class II malocclusion is a common problem that people attend for orthodontic treatment. The main aim of this review was to assess whether Class II elastics are effective in correcting Class II malocclusions

PubMed, Scopus, Web of Science, Embase, Medline, and Cochrane databases, were searched. This was complemented by a hand search, with no date limitation. Retrospective or prospective studies reporting the treatment of Class II malocclusions using class II elastics that reported dental or skeletal outcomes of treatment were included. Only English language studies were included.

  • Eleven studies were included. Four studied the isolated effects of Class II elastics, and 7 were comparisons between a single use of elastics and another method for Class II malocclusion correction.
  • The authors considered that majority of the included provided inadequate information regarding the elastic usage, only one being considered adequate.

The authors concluded

  • Class II elastics are effective in correcting Class II malocclusions, and their effects are mainly dentoalveolar, including lingual tipping, retrusion, and extrusion of the maxillary incisors; labial tipping and intrusion of the mandibular incisors; and mesialization and extrusion of the mandibular molars. Little attention has been given to the soft-tissue effects of this treatment modality.


While there is a wide ranging search for multiple databases or information to address the key question of this review. There is no formal assessment of study quality and the fact that all except one of the included studies failed to provide adequate information regarding the elastic usage causes concern regarding the overall conclusions of this review.  Also  the author have included both prospective and retrospective studies and it is not clear which of the included studies are prospective.   Furthermore a 2012 Cochrane review by Millett et al which we highlighted previously (Dental Elf 27th Jan 2012) did not find any randomised controlled or controlled clinical trials that addresses orthodontic treatment for children with a Class II division 2 malocclusion.


Janson G, Sathler R, Fernandes TM, Branco NC, de Freitas MR. Correction of Class II malocclusion with Class II elastics: A systematic review. Am J Orthod Dentofacial Orthop. 2013 Mar;143(3):383-92. doi: 10.1016/j.ajodo.2012.10.015. PubMed PMID: 23452973.

Dental Elf 27th Jan 2012   No evidence to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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