Abstract

Innovative Strategies in Early Treatment: Lights and Shadows

by Conigliaro Andrea

Class II malocclusion is one of the most frequently observed conditions in childhood and presents clinicians with the choice between early interceptive treatment and a two-stage approach, traditionally performed with functional and fixed appliances. In recent years, the introduction and growing evolution of clear aligners have expanded therapeutic options even for patients with mixed dentition, offering new perspectives in terms of clinical efficacy, comfort, and compliance. The aim of this paper is to critically analyze the role of clear aligners in the early treatment of Class II malocclusions, evaluating the decision-making criteria that guide the choice between one- or two-stage treatment. The main clinical indications will be discussed based on skeletal age, growth pattern, severity of the sagittal discrepancy, and patient cooperation, as well as the biomechanical and biological limitations of this approach. Through the presentation of clinical protocols and representative cases, the sagittal, vertical, and transverse control mechanisms achievable with early-stage aligners will be illustrated, with particular attention to the use of planned mandibular advancements, treatment timing, and management of the maintenance phase or any second corrective phase. The analysis suggests that, in selected patients, early treatment of Class II patients with clear aligners may represent a valid and predictable alternative to traditional methods, provided it is supported by a correct diagnosis, structured protocols, and rigorous case selection.