ORIGINAL ARTICLE

Overjet reduction and molar correction in fixed appliance

treatment of Class II, Division 1, malocclusions: Sagittal and
vertical components

Birgitta Nelson, DDS,a Ken Hansen, DDS, OdontDr,b and Urban Hägg, DDS, OdontDrc
Malmö, Sweden, and Hong Kong

The purpose of this study was to quantitatively evaluate skeletal and dental changes contributing to Class II
correction in patients treated with the Begg technique. The sample consisted of 18 male subjects with Class
II, division 1, malocclusions treated with fixed appliances (Begg technique, nonextraction) for an average
period of 1.3 years (standard deviation, 0.24 years). Lateral radiographs in habitual occlusion taken at 6
months before the start of treatment, at the start of treatment, and 6, 12, and 18 months after the start of
treatment were analyzed. During the control period, normal sagittal and vertical growth changes occurred. In
the initial treatment period (0 to 6 months), the overjet reduction (6.6 mm; P < .001) and the molar
correction (2.2 mm; P < .001) were obtained mainly by dental movements. The overbite was reduced by 4.1
mm (P < .001). The NSL/ML and NL/ML angles increased by 1.5° (P < .05) and 1.4° (P < .01), respectively,
and the anterior lower facial height increased by 3.1 mm (P < .001). During the second period of treatment
(6 to 12 months), the molar correction continued to improve, and the anterior lower facial height continued
to increase. During the third period (12 to 18 months), a small relapse in overjet and overbite was noted, but
the anterior lower facial height continued to increase. During the total treatment period (0 to 18 months), the
overjet reduction and molar correction were 5.8 mm (P < .001) and 3.0 mm (P < .001), respectively.
Mandibular growth exceeded maxillary growth by 1.1 mm (P < .01). The overbite correction and the increase
in anterior lower facial height were 3.0 mm (P < .001) and 5.0 mm (P < .001), respectively. The NSL/ML
angle increased 1.0° (P < .05). The conclusions were that the changes contributing to the Class II correction
were mostly dental. Vertically, the net effects of treatment were an increase in the mandibular plane angle
and in lower anterior facial height. (Am J Orthod Dentofacial Orthop 1999;115:13-23)

Several articles in the orthodontic literature
have addressed treatment of Class II malocclusions
with fixed orthodontic appliances.1-8 However, these
investigations were retrospective, and the treatment
times and the follow-up periods varied.
The purpose of this prospective study was to quan-
titatively evaluate the skeletal and dental changes con-
tributing to Class II corrections in subjects treated
nonextraction with the Begg technique.9
SUBJECTS
The total sample consisted of 20 male patients with
Class II, Division 1, malocclusions consecutively treat-
Study supported by the Swedish Dental Society.
aOrthodontic clinic, Public Dental Health Service, Malmö, Sweden.
bDepartment of Orthodontics, Faculty of Odontology, Lund University, Malmö,
Sweden.
cDepartment of Orthodontics, Faculty of Odontology, The
University of Hong Kong.
Reprint requests to: Dr. Birgitta Nelson, Specialistkliniken för ortodonti, Claes-
gatan 12, S-214 26 Malmö, Sweden.
Copyright © 1999 by the American Association of Orthodontists.
0889-5406/99/$8.00 + 0 8/1/89372
ed nonextraction with fixed appliances and Class II
elastics (Begg technique9). Two subjects were exclud-
ed from the study because treatment was discontinued
before the treatment goal was accomplished. The aver-
age treatment period was 1.3 years (standard deviation
[SD], 0.24 years), and all patients were in the late
mixed dentition at the start of treatment. An outline of
the patient details is given in Table I.
METHODS
Initially, the first molars were banded and the
canines and incisors were bonded only. The dental
arches were leveled and aligned with plain arches, Aus-
tralian 016 (TP special plus), combined with coaxial
auxiliaries. Anchor bends were placed anterior to the
molar tubes. A piece of plastic tube was inserted
between the molars and canines to maintain premolar
space and to protect the cheeks from irritation. Class II
elastic traction in the range of 1 to 2 ounces on each
side was used day and night. When a Class I molar and
canine relationship was achieved, the premolars were
bonded and engaged onto the arch wire (prestage III).
13
14 Nelson, Hansen, and Hägg American Journal of Orthodontics and Dentofacial Orthopedics
January 1999

Table I. Distribution of 18 male Class II, Division 1, patients treated with fixed appliances without extraction
Age at Age at Age at
start of start of end of Control Treatment Treatment Treatment Total
control treatment observation period 1 2 3 treatment
(years) (years) (years) (years) (years) (years) (years) (years)

Mean 12.9 13.5 15.0 0.6 0.5 0.5 0.5 1.5

SD 1.1 1.1 1.1 0.3 0.0 0.0 0.1 0.1
Maximum 14.5 15.1 17.0 1.5* 0.6 0.6 0.9 1.9
Minimum 10.7 11.2 12.7 0.5 0.5 0.5 0.4 1.5

*The control period for subject 6 was 1.5 years. The changes for all variables during the control period were reduced by two thirds for this indi-
vidual.

Stage III mechanics9 were used when needed. All
patients were treated by one of the authors (B.N., Figs
1 and 2).
Records of height were obtained from the patients’
school clinics and from the Department of Orthodon-
tics Public Dental Health Service in Malmö. The
somatic maturation was assessed by analyzing the dis-
tance curve of standing height.10
Lateral skull radiographs in habitual occlusion were
analyzed at 5 stages: 6 months before the start of treat-
ment, at the start of treatment, and 6, 12, and 18 months
after start of treatment. The cephalometric changes
occurring during the four observation periods were
analyzed:
Control period. Changes during the period from 6
months before treatment to the start of treatment. In
one subject (no. 6), the control period lasted 18 months.
The changes for this individual were reduced by two
thirds for all variables during the control period.
Treatment period 1. Changes during the period
from start of treatment to 6 months after the start of
treatment (0 to 6 months).
Treatment period 2. Changes during the period
from 6 months after the start of treatment to 12 months
after the start of treatment (6 to 12 months).
Treatment period 3. Changes during the period
from 12 months after the start of treatment to 18
months after the start of treatment (12 to 18 months).
Total treatment period. Changes during the period
from start of treatment to 18 months after start of treat-
ment (0 to 18 months).
The anatomic landmarks were marked directly on
the radiographs with an All-stabilo pencil (Schwan-
Stabilo, Germany). The radiographs were digitized
with a Scriptel RDT digitizer (Scriptel Corporation,
Columbus, Ohio), and the measurements and calcula-
tions were performed by a computer. No corrections
were made for linear radiographic enlargement
(approximately 7% in the medial-plane).
The analysis of sagittal, skeletal, and dental
changes was performed according to the method of
Pancherz11 (Fig 3). The treatment radiographs were
superimposed on the radiograph from 6 months before
treatment; the nasion sella line (NSL) with sella (s) was
used as a registration point. The vertical changes were
analyzed by the angles and distances given below. The
measuring points and reference lines used (Fig 3) are
those defined by Björk,12 Jacobson,13 and Pancherz.11
1. Sagittal relations:
• A-Olp position of the maxillary jaw base
• Pg-Olp position of the mandibular jaw base
• A-Pg to Olp jaw base relationship: position of the
maxilla in relation to the mandible (A-Olp minus Pg-
Olp)
• is-A position of the central maxillary incisor in rela-
tion to the maxillary base (is-Olp minus A-Olp)
• ii-Pg position of the central mandibular incisor in
relation to the mandibular base (ii-Olp minus Pg-
Olp)
• ms-A position of the first maxillary molar in relation
to the maxillary base (A-Olp minus ms-Olp)
• ms-Pg position of the first mandibular molar in rela-
tion to the mandibular base (Pg-Olp minus mi-Olp)
• Overjet: is-Olp minus ii-Olp
• Molar relationship: ms-Olp minus mi-Olp
2. Vertical relations:
• NSL/NL inclination of the maxilla in relation to the
cranial base
• NSL/ML inclination of the mandible in relation to the
cranial base (mandibular plane angle)
• NL/ML inclination of the maxilla in relation to the
mandible
• Sp´-gn lower anterior facial height
• Overbite: is-NSL minus ii-NSL
Statistical Methods
The arithmetic mean (mean) and SD for each vari-
able was calculated. To assess the statistical signifi-
cance of the changes occurring during the different
observation periods, t tests for paired samples were
performed. To assess the significance of the changes
during the treatment periods t tests for paired samples
were performed between the treatment changes and the
changes occurring during the control period. The asso-
American Journal of Orthodontics and Dentofacial Orthopedics Nelson, Hansen, and Hägg 15
Volume 115, Number 1

Fig 1. Case 1. Photographs of dental casts from start of treatment (A) and from 18 months
after start of treatment (B).

ciations between variables were evaluated with the The size of the combined method error (ME) in
Pearson’s correlation coefficient (r). The levels of sig- locating the landmarks, superimposition of the radio-
nificance used were P < .001 (***), P < .01 (**), and P graphs, and the measuring procedure was calculated by
< .05 (*). P > .05 was considered not significant (NS). the formula
16 Nelson, Hansen, and Hägg American Journal of Orthodontics and Dentofacial Orthopedics
January 1999

Fig 2. Case 2. Photographs of dental casts from start of treatment (A) and from 18 months
after start of treatment (B).

ME = ± √ Σ d2/2n calculation of the ME, the analysis was repeated on 10

randomly selected radiographs at an interval of 2
where d is the difference between two registrations of a months. The combined method error did not exceed 0.8
pair and n is the number of double registrations. In the mm for any of the variables investigated.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 1
RESULTS
Standard cephalometric measurements and the vari-
ables investigated at the five stages of examination are
shown in Table II.
Sagittal Changes (Table III, Figs 4 and 5)
Control period. The control period was character-
ized by sagittal growth changes. The maxillary and the
mandibular jaw bases moved anteriorly an average of
1.2 mm (P < .001) and 1.4 mm (P < .001), respective-
ly. The changes in overjet and molar relationship were
small and insignificant (Fig 4 and Table III).
The significance of the dental and skeletal changes
occurring during the different treatment periods as
compared with the changes during the control period
are shown in Table IV.
Treatment period 1 (0 to 6 months). During the ini-
tial treatment phase, the sagittal maxillary and
mandibular growth decreased as compared with the
control period (Fig 4, Table III). The maxilla moved, on
average, 0.4 mm (NS) anteriorly and the mandible 0.1
mm (NS) posteriorly. Overjet was reduced by 6.6 mm
(P < .001) as a result of dental changes. The maxillary
incisors moved 5.7 mm (P < .001) posteriorly and the
lower incisors 1.5 mm (P < .05) anteriorly. The molar
correction during the first treatment period was 2.2 mm
(P < .001) because the maxillary molars moved 0.6 mm
(NS) posteriorly and the lower molars moved 2.1 mm
(P < .001) anteriorly.
Treatment period 2 (6 to 12 months). The sagittal
jaw growth increased, and the maxilla and the
mandible moved anteriorly an average of 0.9 mm (P <
.05) and 1.8 mm (P < .05), respectively (Table III). The
overjet remained almost unchanged (Fig 4) as the max-
illary incisors moved 0.6 mm (NS) anteriorly and the
lower incisors 0.2 mm (NS) posteriorly. The molar
relationship continued to improve (Fig 5) by an average
of 1.0 mm (P < .05), mainly as a result of the improve-
ment in the jaw base relationship. However, the sagittal
changes during this period did not differ statistically
from the changes occurring during the control period
(Table IV).
Treatment period 3 (12 to 18 months). During the
last treatment period, sagittal jaw growth decreased but
the jaw base relationship improved by 0.8 mm (P < .05,
Table III). Overjet relapsed (Fig 4) an average of 0.9
mm (P < .05) as the maxillary incisors moved anterior-
ly (1.3 mm, P < .05) and the mandibular incisors
moved posteriorly (0.4 mm, NS). A small and insignif-
icant relapse was also noted in the molar relationship
(Fig 5). The reduction of the maxillary growth, the
anterior movement of the maxillary incisors and the
relapse in overjet were statistically significantly differ-
Nelson, Hansen, and Hägg 17
Fig 3. Measuring points and reference lines used in the
cephalometric analysis. The reference grid (Ol and Olp)
was used to measure the sagittal changes during the
different observation periods.11
ent from the changes found during the control period
(Table IV).
Total treatment period (0 to 18 months). During the
total treatment period, the jaw base relationship
improved an average of 1.1 mm (P > .01, Table III).
The overjet was reduced by 5.8 mm (P > .001) as a
result of an improvement in jaw base relationship and
the favorable dental movements. The maxillary
incisors moved 3.7 mm (P < .001) posteriorly and the
mandibular incisors 1.0 mm (P < .05, Fig 4) anteriorly.
The molar relationship improved on average by 3.0
mm (P < .001) as a result of skeletal and dental
changes. The maxillary molars remained almost in
their original position and the mandibular molars were
moved anteriorly by 2.0 mm (P < .001, Fig 5).
Vertical Changes (Tables III and V, Fig 6)
Control period. During the control period, with
normal growth changes, the anterior lower facial height
increased an average of 1.0 mm (P < .05) and the
NL/ML angle decreased by 0.7° (P < .05). Overbite,
the NSL/NL, and the NSL/ML angles remained on
average unchanged.
Treatment period 1 (0 to 6 months). In the initial
treatment phase, the overbite was reduced by an aver-
age of 4.1 mm (P < .001). The NSL/ML and the
NL/ML angles increased 1.5° (P < .05) and 1.4° (P <
.01), respectively, and the anterior lower facial height
increased by an average of 3.1 mm (P < .001). The
NSL/NL angle on the other hand remained unchanged.
The vertical changes were all significantly different
18 Nelson, Hansen, and Hägg American Journal of Orthodontics and Dentofacial Orthopedics
January 1999

Table II. Cephalometric records describing dentofacial morphology in 18 Class II, Division 1, cases treated with fixed appliances, without
extraction
Six months before Six months after Twelve months after Eighteen months after
start Start start start start

Variables Mean SD Mean SD Mean SD Mean SD Mean SD

SNA 81.0 4.5 81.3 4.7 81.0 4.4 81.0 4.2 80.3 4.6
SNB 75.5 3.6 76.0 3.7 75.4 3.5 75.6 3.7 75.6 3.9
ANB 5.4 1.6 5.3 1.8 5.7 1.4 5.3 1.6 4.7 1.5
NSL/NL 7.1 2.4 7.4 2.6 7.4 2.9 8.2 3.3 7.6 3.3
NSL/ML 32.9 5.1 32.5 5.8 34.0 5.8 33.9 5.9 33.5 6.0
NL/ML 25.8 4.8 25.1 5.2 26.5 5.3 25.6 6.2 25.9 5.7
Overjet 8.9 1.5 8.8 1.3 2.2 1.2 2.1 0.6 3.0 1.2
Overbite 6.2 2.0 5.9 2.3 1.8 1.4 1.8 1.0 3.0 1.4
ILs/NL 114.5 5.9 116.2 5.8 98.8 5.7 104.4 5.9 107.0 4.2
ILi/ML 98.1 5.9 98.5 6.4 103.2 6.3 104.2 6.0 103.8 8.0
Sp´-gn 61.7 5.1 62.7 5.2 65.9 5.5 66.9 5.6 67.6 5.3
N-gn 113.3 6.3 115.2 7.2 119.3 8.0 121.1 7.5 122.2 7.1
N-Sp´ 51.6 3.0 52.5 3.6 53.5 4.0 54.2 3.2 54.6 3.0

Table III. Sagittal and vertical changes during the four observation periods in 18 Class II, Division 1, cases treated with fixed appliances, with-
out extraction
Control Treatment 1 Treatment 2 Treatment 3 Total treatment

mm or degrees Mean SD Mean SD Mean SD Mean SD Mean SD

Sagittal changes
A-OLP 1.2*** 1.1 0.4 1.3 0.9* 1.7 –0.3 1.6 1.0* 1.9
is-A 0.1 1.1 –5.7*** 1.9 0.6 1.5 1.3* 1.7 –3.7*** 2.0
A-ms –0.1 1.2 0.6 1.8 –0.1 1.5 –0.6 1.4 –0.1 1.9
Pg-OLP 1.4*** 1.3 –0.1 2.3 1.8* –2.8 0.5 2.0 2.1* 2.8
ii-Pg 0.0 0.8 1.5* 2.3 –0.2 1.5 –0.4 1.5 1.0* 1.8
Pg-mi –0.1 1.0 –2.1 1.9 –0.2 1.4 0.4 1.4 –2.0*** 1.9
A-Pg –0.2 1.3 0.5 1.6 –0.9 2.0 –0.8* 1.5 –1.1** 1.7
Overjet –0.1 0.6 –6.6*** 1.3 –0.1 1.2 0.9* 1.5 –5.8*** 1.4
ms-mi –0.3 0.6 –2.2*** 1.1 –1.0* 1.6 0.1 1.3 –3.0*** 0.8
Vertical changes
NSL/NL (degrees) 0.3 1.0 0.0 1.6 0.7 1.6 –0.5 1.6 0.2 1.5
NSL/ML (degrees) –0.4 1.2 1.5* 1.7 –0.2 1.8 –0.4 0.8 1.0*
NL/ML (degrees) –0.7* 1.2 1.4** 1.4 –0.9 1.9 0.2 1.3 0.8 1.6
Anterior lower = 1.0** 1.4 3.1*** 1.5 1.1** 1.3 0.7* 1.2 5.0*** 1.4
facial height
Overbite –0.3 1.0 –4.1*** 2.3 –0.0 1.4 1.1** 1.4 –3.0*** 2.0

*Significant changes at P < .05 level.

**Significant changes at P < .01 level.
***Significant changes at P < .001 level.

from the changes occurring during the control period,
except for the angle NSL/NL (Table IV).
Treatment periods 2 (6 to 12 months) and 3 (12 to
18 months). During the second and third treatment peri-
ods, the anterior lower facial height continued to
increase an average of 1.1 mm (P < .01) and 0.7 mm (P
< .01), respectively. The NSL/NL angle increased dur-
ing the second treatment period but decreased during
the third treatment period (Fig 6). The anterior rotation
of the maxilla during the third treatment period was
significantly different from the posterior rotation
occurring during the control period (Table IV, Fig 6).
During the third period, a small relapse (1.1 mm, P <
.01) was noted in overbite that differed from the small
improvement that occurred during the control period
(P < .001, Table IV).
Total treatment period (0 to 18 months). During the
total treatment period, the overbite was reduced by an
average of 3.0 mm (P < .001) and the anterior lower
facial height increased by 5.0 mm (P < .001). The
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 1
Fig 4. Overjet reduction (mm) in 18 male Class II, Division 1 patients treated with fixed
appliances, without extraction.
NSL/ML angle increased 1.0° (P < .05). There were no
statistically significant changes noted in the NSL/NL
and NL/ML angles (Table III).
DISCUSSION
The patients in this investigation were followed for
a control period of 6 months before treatment was
started. Growth changes during this pretreatment peri-
od were used to compare those occurring during the
different treatment periods.
In seven of the subjects (Fig 7), the treatment start-
ed before the maximum of pubertal growth (prepeak),
in five subjects at the pubertal maximum (peak), and in
six subjects after the pubertal maximum (postpeak).
Control Period
The sagittal and vertical changes that occurred dur-
ing this period could be considered as normal growth
changes in a sample of subjects with Class II, Division
1, malocclusions. The period was characterized by for-
ward sagittal growth of both the maxilla and the
mandible, and the dental movements were small (Figs
4 and 5). The NL/ML angle decreased 0.7° (P < .05) on
average. In 12 cases (67%), there was a reduction of the
NL/ML angle, and in 6 cases (33%), it increased. The
changes in the NL/ML angle (Fig 6) were associated
Nelson, Hansen, and Hägg 19
with mandibular rotation (r = 0.68, P < .01; Table V).
The anterior lower facial height increased, and as there
was a positive association with the changes in the
NSL/ML angle (r = 0.47, P < .05), the lower facial
height seemed to increase more in individuals with
posterior rotation of the mandible than those with more
anteriorly directed rotation.
Treatment Period 1 (0 to 6 months)
The overjet reduction and the improvement in the
molar relationship that occurred during the initial treat-
ment period were mainly dental effects (Figs 4 and 5,
Table III) caused by the fixed appliance and the Class
II elastics.9 The forces of the Class II elastics, howev-
er, did not improve the sagittal jaw base relationship
although the anterior maxillary growth was restrained.
Sagittal mandibular growth was, on the contrary,
reversed due to an auto-rotation of the mandible in a
posterior direction which resulted in a posterior move-
ment of point Pg (Fig 4) and an opening of the
NSL/ML and NL/ML angles (Fig 6, Table III). An
exception was seen in two subjects in whom the
NSL/ML angle decreased. The anterior lower facial
height increased significantly more during this period
than during the control period (Table IV), but the asso-
ciation between the mandibular rotation and the
20 Nelson, Hansen, and Hägg
Fig 5. Correction in molar relationship (mm) in 18 male Class II, Division 1 patients treat-
ed with fixed appliances, without extraction.
increase in lower facial height was low (r = 0.44; NS;
Table V). Thus, it seems that the increase in lower
facial height was not only due to a rotational effect of
the mandible but possibly to a bodily vertical move-
ment of the mandible. However, this bodily movement
could not be confirmed in this investigation.
The association between the reduction of overbite
and the mandibular rotation was low and insignificant
(NSL/ML – Overbite r = –0.25, NS; Table V), indicat-
ing that the overbite correction was only to a minor
extent caused by the posterior rotation of the mandible.
Treatment Period 2 (6 to 12 months)
The growth pattern seemed to be normalized during
the second treatment period and it may initiate a catch- up
of the sagittal mandibular growth when compared with
the control period (Table III, Fig 4). The mandibular
growth was, however, not significantly different between
these two periods (Table IV). The proclination of the
maxillary incisors (Table III, Fig 4) was due to the
torquing auxiliaries and reduced use of the Class II elas-
tics (elastics were only used to balance the overjet and to
avoid anterior crossbite9). The reduced use of the Class II
elastics might also explain the rebound of the mandibular
incisors in a posterior direction (Table III, Fig 4) and in
the unchanged position of the maxillary and mandibular
molars and inter-molar relationship (Fig 5).
American Journal of Orthodontics and Dentofacial Orthopedics
January 1999
The vertical growth pattern also seemed to return to
“normal.” The mandible on average rotated anteriorly,
but a posterior rotation was found in seven subjects
(39%). The association between the reduction of the
NSL/ML and the NL/ML angles was comparable to the
pretreatment value (r = 0.64, P > .01; Table V).
Treatment Period 3 (12 to 18 months)
In the last observation period, 12 of the 18 patients
(67%) were in the retention phase. The significant
relapse, as compared with the control period, in the
overjet and molar relationship was probably a result of
the settling of dental movements. However, the reduced
amount of sagittal maxillary and mandibular growth as
compared with the control period (P < .01; Table III, Fig
4) is difficult to explain. The maxillary effect might be
influenced by those patients who still wore the torquing
auxiliaries but the mandibular effect is puzzling.
The increase in the NL/ML angle and the signifi-
cant decrease (as compared with the control period) in
the NSL/NL angle (P < .05; Table IV, Fig 6) implies,
however, that the maxillary plane tilts in superior-ante-
rior direction, and this might have some effect on the
positioning of the mandible. The changes in the
NL/ML angle were strongly associated with the rota-
tion of the nasal plane (NL/ML - NSL/NL; r = 0.84, P
< .001; Table V).
American Journal of Orthodontics and Dentofacial Orthopedics Nelson, Hansen, and Hägg 21
Volume 115, Number 1

Table IV. Significant sagittal and vertical treatment Table V. Associations between vertical changes during
changes when compared with changes occurring dur- the four observation periods in 18 Class II, Division 1,
ing the control period. Control period versus treatment cases treated with fixed appliances without extraction
periods 1 to 3 NSL/ML NL/ML Sp´-gn Overbite
Control- Control- Control–
mm or degrees treatment 1 treatment 2 treatment 3 NSL/NL
Control period 0.46 –0.34 –0.16 0.02
Sagittal changes Treatment 1 0.60** –0.37 0.01 –0.24
A-Olp P < .01 Treatment 2 0.42 –0.41 –0.02 –0.21
Pg-Olp P < .05 Treatment 3 0.42 –0.84*** –0.11 0.19
A-Pg Total treatment 0.34 –0.72*** 0.21 –0.01
is-A P < .001 P < .05 NSL/ML
ii-Pg P < .05 Control period 0.68** 0.47* 0.41
A-ms Treatment 1 0.51* 0.44 –0.24
Pg-mi P < .01 Treatment 2 0.64** 0.05 –0.17
Overjet P < .001 P < .05 Treatment 3 0.11 0.11 –0.13
ms-mi P < .001 Total treatment 0.41 –0.05 –0.04
Vertical changes NL/ML
NSL/ML (degrees) P < .05 Control period 0.63** 0.42
NSL/ML (degrees) P < .01 Treatment 1 0.50* –0.05
NL/ML (degrees) P < .001 P < .01 Treatment 2 0.06 0.07
Anterior lower facial P < .001 Treatment 3 0.20 –0.27
height Total treatment –0.24 –0.03
Overbite P < .001 P < .001 Sp´-gn
Control period 0.39
Treatment 1 –0.35
Treatment 2 –0.29
During the first three observation periods, an ante- Treatment 3 –0.03
Total treatment 0.03
rior maxillary rotation was found in 7 subjects (39%),
but during treatment period 3 (12 to 18 months), an *Significant changes at P < .05 level.
anterior rotation was found in 13 subjects (71%). This **Significant changes at P < .01 level.
***Significant changes at P < .001 level.
finding is difficult to explain especially because 11 of
the 13 subjects were in the retention phase.

Total Treatment Period (0 to 18 months)
The overjet reduction during the total treatment
period was 5.8 mm (P < .001). The skeletal part of the
reduction was 18.9% and the dental changes were
71.1%. Weichbrodt7 found a similar reduction (6.6
mm) of overjet in 25 cases (15 boys and 10 girls) treat-
ed without extraction with the Begg technique. Howev-
er, the dental and skeletal components of the treatment
changes in that investigation differed from the present
study. The observation period in that study was 30
months and also includes a retention period after treat-
ment, with a normal growth pattern contributing to the
treatment changes. The overbite reduction in the total
treatment period was 3.0 mm and can be compared
with the study by Bishara et al8 who reported an over-
bite reduction of 2.3 mm. However, the observation
period (5 years) also included a long follow-up period
with no treatment. The overjet and overbite correction
during the total treatment period are also in agreement
with a study6 of 20 patients (8 males and 12 females)
treated without extraction with Edgewise therapy.
The molar correction in the total treatment period
was 3.0 mm (P < .001) of which the dental changes
were 1.9 mm (63%) and the skeletal 1.1 mm (37%).
The dental changes were mainly due to the lower
molars being moved 2.0 mm mesially. Similar changes
have been reported in an investigation5 of 42 Class II
patients (a mixture of Class II, Division 1 and Division
2, patients) treated with Begg technique.
Gianelly4 reported on 16 patients (boys and girls)
treated with Begg technique for 23 months and
observed an anterior movement of Pg of 1.6 mm,
which is in general agreement with the findings in the
present study.
During the total treatment period the NSL/ML
angle increased by an average of 1.0° (P < .05), which
is in general agreement with results from other stud-
ies.2,4,5 However, a decrease of 0.5° and 1.6° have been
reported,7,8 but the observation periods in these studies
also involved a retention phase during which the
NSL/ML angle is likely to remain unchanged or
decrease.14 The anterior lower facial height increased
an average of 5.0 mm (P < .001) during the total treat-
ment period, which is in general agreement with previ-
ous studies.1,3,8 From the age of 11 years to 16 years,
the annual increase of the anterior lower facial height
22 Nelson, Hansen, and Hägg American Journal of Orthodontics and Dentofacial Orthopedics
January 1999

Fig 6. Rotational changes of the NSL/NL and NSL/ML angles in 18 male Class II, Division
1 patients treated with fixed appliances without extraction.

Fig 7. Distribution of 18 male Class II, Division 1 patients treated with fixed appliances,
without extraction in relation to the peak height velocity at start of treatment.

in untreated males with normal occlusion varies
between 0.8 to 2.8 mm.14 Subsequently, it seems that
the Begg treatment may to some extent affect the ante-
rior lower facial height.
In summary, the improvement of the occlusion as
a result of treatment is mainly the result of dental
changes, and skeletal growth seems to be little
affected.
CONCLUSIONS
The changes contributing to Class II correction in
this investigation are mostly dental. Vertically, the net
effects of treatment are an increase in both the mandibu-
lar plane angle and the lower anterior facial height.
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