{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:20:53Z","timestamp":1789842053986,"version":"4.0.1"},"reference-count":40,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare efficacy and treatment duration of early versus late Class II elastics in patients with Class II malocclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Forty patients were randomized into two groups based on the timing of elastics use: early and late. In the early group, light short elastics were used from the day of placement of fixed preadjusted edgewise appliances. In the late group, elastics were inserted once 0.016 \u00d7 0.022-inch stainless steel archwires were in place. Lateral cephalograms and standardized smile photographs were taken before treatment and after achieving a Class I buccal segment relationship. Treatment duration, dental, skeletal, and soft tissue measurements were then compared between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Maxillary central incisors were retroclined relative to the SN plane (95% confidence interval (CI): 3.75\u00b0\u201311.99\u00b0 and 3.96\u00b0\u20139.18\u00b0 in the early and late groups, respectively) with clockwise rotation of the occlusal plane (95% CI: 3.75\u00b0\u201311.99\u00b0 and 3.96\u00b0\u20139.18\u00b0 in the early and late groups, respectively). Treatment duration to level and align and reach Class I buccal occlusion was significantly less in the early group (95% CI: 4.74\u201310.8 months). Comparison between groups revealed no significant differences for all measurements except MP\/SN and PP\/SN angles (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Class II elastics were equally effective and more efficient in the early group with significantly less time needed to level and align and reach Class I buccal occlusion compared to the late group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/113024-985.1","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T20:32:37Z","timestamp":1751488357000},"page":"587-594","source":"Crossref","is-referenced-by-count":3,"title":["Early versus late intermaxillary elastics in patients with Class II malocclusion: a randomized clinical trial"],"prefix":"10.2319","volume":"95","author":[{"given":"Maha Sabry","family":"Sayed","sequence":"first","affiliation":[{"name":"Lecturer of Orthodontics, Faculty of Dentistry, Ain Shams University, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mais Medhat","family":"Sadek","sequence":"additional","affiliation":[{"name":"Assistant Professor and MDS Orthodontics Program Director, College of Dental Medicine, University of Sharjah, United Arab Emirates; and Associate Professor of Orthodontics, Faculty of Dentistry, Ain Shams University, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha Hussein","family":"Abbas","sequence":"additional","affiliation":[{"name":"Professor of Orthodontics, Faculty of Dentistry, Ain Shams University, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"issue":"5","key":"i1945-7103-95-6-587-b01","series-title":"Eur J Orthod","first-page":"532","article-title":"Can the use of skeletal anchors in conjunction with fixed functional appliances promote skeletal changes? A systematic review and meta-analysis","volume":"38","author":"Elkordy","year":"2016","unstructured":"Elkordy SA,\nAboelnaga AA,\nFayed MMS,\nAboulfotouh MH,\nAbouelezz AM. Can the use of skeletal anchors in conjunction with fixed functional appliances promote skeletal changes? A systematic review and meta-analysis. Eur J Orthod. 2016;38(5):532\u2013545."},{"key":"i1945-7103-95-6-587-b02","series-title":"Clin Impr","article-title":"Honing Damon System Mechanics for the ultimate in efficiency and excellence","volume":"16","author":"Kozlowski","year":"2008","unstructured":"Kozlowski J. Honing Damon System Mechanics for the ultimate in efficiency and excellence. Clin Impr. 2008;16."},{"key":"i1945-7103-95-6-587-b03","series-title":"The 20 Principles of the Alexander Discipline","first-page":"163","author":"Alexander","year":"2008","unstructured":"Alexander RGW. The 20 Principles of the Alexander Discipline. Chicago: Quintessence Publishing;2008:163\u2013170."},{"key":"i1945-7103-95-6-587-b04","series-title":"The Protocol","first-page":"8","article-title":"Overcoming challenges in PSL with Active Early","volume":"4","author":"Pitts","year":"2016","unstructured":"Pitts T,\nBraun D. Overcoming challenges in PSL with Active Early. The Protocol. 2016;4:8\u201319."},{"issue":"4","key":"i1945-7103-95-6-587-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"375","article-title":"Efficacy of planned moderate to severe torque changes in maxillary central incisors with the Invisalign appliance: a retrospective investigation","volume":"166","author":"Rajan","year":"2024","unstructured":"Rajan N,\nWeir T,\nMeade MJ. Efficacy of planned moderate to severe torque changes in maxillary central incisors with the Invisalign appliance: a retrospective investigation. Am J Orthod Dentofacial Orthop. 2024;166(4):375\u2013383."},{"issue":"4","key":"i1945-7103-95-6-587-b06","series-title":"Am J Orthod Dentofac Orthop","first-page":"585","article-title":"Root resorption in Class II malocclusion treatment with Class II elastics","volume":"150","author":"Janson","year":"2016","unstructured":"Janson G,\nNiederberger A,\nGarib DG,\nCaldas W. Root resorption in Class II malocclusion treatment with Class II elastics. Am J Orthod Dentofac Orthop. 2016;150(4):585\u2013591."},{"key":"i1945-7103-95-6-587-b07","series-title":"Int J Orthod Implant","first-page":"54","article-title":"Correction of a full cusp Class II malocclusion and palatal impingement with intermaxillary","volume":"38","author":"Tseng","year":"2015","unstructured":"Tseng L,\nChris C,\nEugene R. Correction of a full cusp Class II malocclusion and palatal impingement with intermaxillary. Int J Orthod Implant. 2015;38:54\u201372."},{"issue":"3","key":"i1945-7103-95-6-587-b08","series-title":"Am J Orthod Dentofac Orthop","first-page":"383","article-title":"Correction of Class II malocclusion with Class II elastics: a systematic review","volume":"143","author":"Janson","year":"2013","unstructured":"Janson G,\nSathler R,\nFernandes TMF,\nBranco NCC,\nDe Freitas MR. Correction of Class II malocclusion with Class II elastics: a systematic review. Am J Orthod Dentofac Orthop. 2013;143(3):383\u2013392."},{"issue":"3","key":"i1945-7103-95-6-587-b09","series-title":"Am J Orthod","first-page":"290","article-title":"A scientific assessment of the straight-wire appliance","volume":"73","author":"Dellinger","year":"1978","unstructured":"Dellinger EL. A scientific assessment of the straight-wire appliance. Am J Orthod. 1978;73(3):290\u2013299."},{"issue":"5","key":"i1945-7103-95-6-587-b10","series-title":"Dental Press J Orthod","article-title":"Attractiveness of the facial profile: comparison of Class II patients treated with twin force\u00ae or intermaxillary elastics","volume":"26","author":"Pozza","year":"2021","unstructured":"Pozza OA,\nCan\u00e7ado RH,\nValarelli FP,\nFreitas KMS,\nOliveira RC,\nde Oliveira RCG. Attractiveness of the facial profile: comparison of Class II patients treated with twin force\u00ae or intermaxillary elastics. Dental Press J Orthod. 2021;26(5)."},{"key":"i1945-7103-95-6-587-b11","series-title":"Clinical Guidelines: Orthodontic Retention","author":"Johnston","year":"2013","unstructured":"Johnston C,\nBurden D. Clinical Guidelines: Orthodontic Retention (revised by \nParvizi F,\nMorris D,\nAtack N). London: British Orthodontic Society; 2013."},{"issue":"2","key":"i1945-7103-95-6-587-b12","series-title":"Angle Orthod","first-page":"332","article-title":"Class II non-extraction patients treated with the Forsus Fatigue Resistant Device versus intermaxillary elastics","volume":"78","author":"Jones","year":"2008","unstructured":"Jones G,\nBuschang PH,\nKim KB,\nOliver DR. Class II non-extraction patients treated with the Forsus Fatigue Resistant Device versus intermaxillary elastics. Angle Orthod. 2008;78(2):332\u2013338."},{"issue":"4","key":"i1945-7103-95-6-587-b13","series-title":"Angle Orthod","first-page":"694","article-title":"Two different applications of class II elastics with nonextraction segmental techniques","volume":"77","author":"Uzel","year":"2007","unstructured":"Uzel A,\nUzel I,\nToroglu MS. Two different applications of class II elastics with nonextraction segmental techniques. Angle Orthod. 2007;77(4):694\u2013700."},{"issue":"1","key":"i1945-7103-95-6-587-b14","series-title":"J Oral Dent Res","first-page":"4","article-title":"Ramus Height and its relationship with skeletal and dental measurements","volume":"1","author":"Yassir","year":"2013","unstructured":"Yassir YA. Ramus Height and its relationship with skeletal and dental measurements. J Oral Dent Res. 2013;1(1):4\u20138."},{"issue":"1","key":"i1945-7103-95-6-587-b15","series-title":"Am J Orthod Dentofacial Orthop","first-page":"16","article-title":"Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images","volume":"128","author":"Cevidanes","year":"2005","unstructured":"Cevidanes LH,\nFranco AA,\nGerig G, et al. Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images. Am J Orthod Dentofacial Orthop. 2005;128(1):16\u201326."},{"issue":"1","key":"i1945-7103-95-6-587-b16","series-title":"Prog Orthod","first-page":"41","article-title":"Changes of occlusal plane inclination after orthodontic treatment in different dentoskeletal frames","volume":"15","author":"Li","year":"2014","unstructured":"Li JL,\nKau CH,\nWang M. Changes of occlusal plane inclination after orthodontic treatment in different dentoskeletal frames. Prog Orthod. 2014;15(1):41."},{"issue":"2","key":"i1945-7103-95-6-587-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"142","article-title":"Class II correction in patients treated with Class II elastics and with fixed functional appliances: a comparative study","volume":"118","author":"Nelson","year":"2000","unstructured":"Nelson B,\nHansen K,\nH\u00e4gg U. Class II correction in patients treated with Class II elastics and with fixed functional appliances: a comparative study. Am J Orthod Dentofacial Orthop. 2000;118(2):142\u2013149."},{"issue":"2","key":"i1945-7103-95-6-587-b18","series-title":"Angle Orthod","first-page":"75","article-title":"Vertical growth versus anteroposterior growth as related to function and treatment","volume":"34","author":"Schudy","year":"1964","unstructured":"Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod. 1964;34(2):75\u201393."},{"key":"i1945-7103-95-6-587-b19","series-title":"Am J Orthod Dentofacial Orthop","first-page":"276","article-title":"Long-term stability of Angle Class II Division 1 malocclusion with successful occlusal results at end of active treatment","volume":"107","author":"Fidler","year":"1995","unstructured":"Fidler BC,\nArtun J,\nJoondeph DR,\nLittle RM. Long-term stability of Angle Class II Division 1 malocclusion with successful occlusal results at end of active treatment. Am J Orthod Dentofacial Orthop. 1995;107:276\u2013285."},{"issue":"1","key":"i1945-7103-95-6-587-b20","series-title":"Angle Orthod","first-page":"19","article-title":"Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction","volume":"93","author":"Davidovitch","year":"2023","unstructured":"Davidovitch M,\nKonstantarakis E,\nAthanasios V,\nSella-Tunis T. Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction. Angle Orthod. 2023;93(1):19\u201325."},{"issue":"5","key":"i1945-7103-95-6-587-b01","series-title":"Eur J Orthod","first-page":"532","article-title":"Can the use of skeletal anchors in conjunction with fixed functional appliances promote skeletal changes? A systematic review and meta-analysis","volume":"38","author":"Elkordy","year":"2016","unstructured":"Elkordy SA,\nAboelnaga AA,\nFayed MMS,\nAboulfotouh MH,\nAbouelezz AM. Can the use of skeletal anchors in conjunction with fixed functional appliances promote skeletal changes? A systematic review and meta-analysis. Eur J Orthod. 2016;38(5):532\u2013545."},{"key":"i1945-7103-95-6-587-b02","series-title":"Clin Impr","article-title":"Honing Damon System Mechanics for the ultimate in efficiency and excellence","volume":"16","author":"Kozlowski","year":"2008","unstructured":"Kozlowski J. Honing Damon System Mechanics for the ultimate in efficiency and excellence. Clin Impr. 2008;16."},{"key":"i1945-7103-95-6-587-b03","series-title":"The 20 Principles of the Alexander Discipline","first-page":"163","author":"Alexander","year":"2008","unstructured":"Alexander RGW. The 20 Principles of the Alexander Discipline. Chicago: Quintessence Publishing;2008:163\u2013170."},{"key":"i1945-7103-95-6-587-b04","series-title":"The Protocol","first-page":"8","article-title":"Overcoming challenges in PSL with Active Early","volume":"4","author":"Pitts","year":"2016","unstructured":"Pitts T,\nBraun D. Overcoming challenges in PSL with Active Early. The Protocol. 2016;4:8\u201319."},{"issue":"4","key":"i1945-7103-95-6-587-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"375","article-title":"Efficacy of planned moderate to severe torque changes in maxillary central incisors with the Invisalign appliance: a retrospective investigation","volume":"166","author":"Rajan","year":"2024","unstructured":"Rajan N,\nWeir T,\nMeade MJ. Efficacy of planned moderate to severe torque changes in maxillary central incisors with the Invisalign appliance: a retrospective investigation. Am J Orthod Dentofacial Orthop. 2024;166(4):375\u2013383."},{"issue":"4","key":"i1945-7103-95-6-587-b06","series-title":"Am J Orthod Dentofac Orthop","first-page":"585","article-title":"Root resorption in Class II malocclusion treatment with Class II elastics","volume":"150","author":"Janson","year":"2016","unstructured":"Janson G,\nNiederberger A,\nGarib DG,\nCaldas W. Root resorption in Class II malocclusion treatment with Class II elastics. Am J Orthod Dentofac Orthop. 2016;150(4):585\u2013591."},{"key":"i1945-7103-95-6-587-b07","series-title":"Int J Orthod Implant","first-page":"54","article-title":"Correction of a full cusp Class II malocclusion and palatal impingement with intermaxillary","volume":"38","author":"Tseng","year":"2015","unstructured":"Tseng L,\nChris C,\nEugene R. Correction of a full cusp Class II malocclusion and palatal impingement with intermaxillary. Int J Orthod Implant. 2015;38:54\u201372."},{"issue":"3","key":"i1945-7103-95-6-587-b08","series-title":"Am J Orthod Dentofac Orthop","first-page":"383","article-title":"Correction of Class II malocclusion with Class II elastics: a systematic review","volume":"143","author":"Janson","year":"2013","unstructured":"Janson G,\nSathler R,\nFernandes TMF,\nBranco NCC,\nDe Freitas MR. Correction of Class II malocclusion with Class II elastics: a systematic review. Am J Orthod Dentofac Orthop. 2013;143(3):383\u2013392."},{"issue":"3","key":"i1945-7103-95-6-587-b09","series-title":"Am J Orthod","first-page":"290","article-title":"A scientific assessment of the straight-wire appliance","volume":"73","author":"Dellinger","year":"1978","unstructured":"Dellinger EL. A scientific assessment of the straight-wire appliance. Am J Orthod. 1978;73(3):290\u2013299."},{"issue":"5","key":"i1945-7103-95-6-587-b10","series-title":"Dental Press J Orthod","article-title":"Attractiveness of the facial profile: comparison of Class II patients treated with twin force\u00ae or intermaxillary elastics","volume":"26","author":"Pozza","year":"2021","unstructured":"Pozza OA,\nCan\u00e7ado RH,\nValarelli FP,\nFreitas KMS,\nOliveira RC,\nde Oliveira RCG. Attractiveness of the facial profile: comparison of Class II patients treated with twin force\u00ae or intermaxillary elastics. Dental Press J Orthod. 2021;26(5)."},{"key":"i1945-7103-95-6-587-b11","series-title":"Clinical Guidelines: Orthodontic Retention","author":"Johnston","year":"2013","unstructured":"Johnston C,\nBurden D. Clinical Guidelines: Orthodontic Retention (revised by \nParvizi F,\nMorris D,\nAtack N). London: British Orthodontic Society; 2013."},{"issue":"2","key":"i1945-7103-95-6-587-b12","series-title":"Angle Orthod","first-page":"332","article-title":"Class II non-extraction patients treated with the Forsus Fatigue Resistant Device versus intermaxillary elastics","volume":"78","author":"Jones","year":"2008","unstructured":"Jones G,\nBuschang PH,\nKim KB,\nOliver DR. Class II non-extraction patients treated with the Forsus Fatigue Resistant Device versus intermaxillary elastics. Angle Orthod. 2008;78(2):332\u2013338."},{"issue":"4","key":"i1945-7103-95-6-587-b13","series-title":"Angle Orthod","first-page":"694","article-title":"Two different applications of class II elastics with nonextraction segmental techniques","volume":"77","author":"Uzel","year":"2007","unstructured":"Uzel A,\nUzel I,\nToroglu MS. Two different applications of class II elastics with nonextraction segmental techniques. Angle Orthod. 2007;77(4):694\u2013700."},{"issue":"1","key":"i1945-7103-95-6-587-b14","series-title":"J Oral Dent Res","first-page":"4","article-title":"Ramus Height and its relationship with skeletal and dental measurements","volume":"1","author":"Yassir","year":"2013","unstructured":"Yassir YA. Ramus Height and its relationship with skeletal and dental measurements. J Oral Dent Res. 2013;1(1):4\u20138."},{"issue":"1","key":"i1945-7103-95-6-587-b15","series-title":"Am J Orthod Dentofacial Orthop","first-page":"16","article-title":"Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images","volume":"128","author":"Cevidanes","year":"2005","unstructured":"Cevidanes LH,\nFranco AA,\nGerig G, et al. Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images. Am J Orthod Dentofacial Orthop. 2005;128(1):16\u201326."},{"issue":"1","key":"i1945-7103-95-6-587-b16","series-title":"Prog Orthod","first-page":"41","article-title":"Changes of occlusal plane inclination after orthodontic treatment in different dentoskeletal frames","volume":"15","author":"Li","year":"2014","unstructured":"Li JL,\nKau CH,\nWang M. Changes of occlusal plane inclination after orthodontic treatment in different dentoskeletal frames. Prog Orthod. 2014;15(1):41."},{"issue":"2","key":"i1945-7103-95-6-587-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"142","article-title":"Class II correction in patients treated with Class II elastics and with fixed functional appliances: a comparative study","volume":"118","author":"Nelson","year":"2000","unstructured":"Nelson B,\nHansen K,\nH\u00e4gg U. Class II correction in patients treated with Class II elastics and with fixed functional appliances: a comparative study. Am J Orthod Dentofacial Orthop. 2000;118(2):142\u2013149."},{"issue":"2","key":"i1945-7103-95-6-587-b18","series-title":"Angle Orthod","first-page":"75","article-title":"Vertical growth versus anteroposterior growth as related to function and treatment","volume":"34","author":"Schudy","year":"1964","unstructured":"Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod. 1964;34(2):75\u201393."},{"key":"i1945-7103-95-6-587-b19","series-title":"Am J Orthod Dentofacial Orthop","first-page":"276","article-title":"Long-term stability of Angle Class II Division 1 malocclusion with successful occlusal results at end of active treatment","volume":"107","author":"Fidler","year":"1995","unstructured":"Fidler BC,\nArtun J,\nJoondeph DR,\nLittle RM. Long-term stability of Angle Class II Division 1 malocclusion with successful occlusal results at end of active treatment. Am J Orthod Dentofacial Orthop. 1995;107:276\u2013285."},{"issue":"1","key":"i1945-7103-95-6-587-b20","series-title":"Angle Orthod","first-page":"19","article-title":"Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction","volume":"93","author":"Davidovitch","year":"2023","unstructured":"Davidovitch M,\nKonstantarakis E,\nAthanasios V,\nSella-Tunis T. Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction. Angle Orthod. 2023;93(1):19\u201325."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/95\/6\/article-p587.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/95\/6\/article-p587.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/95\/6\/article-p587.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:41:44Z","timestamp":1780065704000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/95\/6\/article-p587.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":40,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.2319\/113024-985.1","relation":{},"ISSN":["1945-7103","0003-3219"],"issn-type":[{"value":"1945-7103","type":"electronic"},{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}