Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review

Introducción y objetivo: La Tracción cervical se ha utilizado durante décadas como tratamiento para la maloclusión de clase II. Aunque los efectos se han informado pre- viamente, son algo contradictorios. El objetivo fué determinar la evidencia científica disponible que respalde los parámetros de us...

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Autores:
Yepes Chamorro, Eliana Carolina
Rueda, Zulma Vanessa
Botero Mariaca, Paola María
Tipo de recurso:
Article of journal
Fecha de publicación:
2019
Institución:
Universidad Cooperativa de Colombia
Repositorio:
Repositorio UCC
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oai:repository.ucc.edu.co:20.500.12494/17370
Acceso en línea:
http://dx.doi.org/10.21615/ cesodon.32.2.2
https://hdl.handle.net/20.500.12494/17370
Palabra clave:
Tracción extraoral cervical
Maloclusión clase II
Tratamiento Temprano
TG 2019 EOF
Cervica Extraoral Traction
Class II malocclusion
Early treatment
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openAccess
License
Atribución – No comercial – Sin Derivar
id COOPER2_1926c84ad764909813e84bca3ab5bb44
oai_identifier_str oai:repository.ucc.edu.co:20.500.12494/17370
network_acronym_str COOPER2
network_name_str Repositorio UCC
repository_id_str
dc.title.spa.fl_str_mv Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
title Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
spellingShingle Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
Tracción extraoral cervical
Maloclusión clase II
Tratamiento Temprano
TG 2019 EOF
Cervica Extraoral Traction
Class II malocclusion
Early treatment
title_short Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
title_full Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
title_fullStr Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
title_full_unstemmed Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
title_sort Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review
dc.creator.fl_str_mv Yepes Chamorro, Eliana Carolina
Rueda, Zulma Vanessa
Botero Mariaca, Paola María
dc.contributor.author.none.fl_str_mv Yepes Chamorro, Eliana Carolina
Rueda, Zulma Vanessa
Botero Mariaca, Paola María
dc.subject.spa.fl_str_mv Tracción extraoral cervical
Maloclusión clase II
Tratamiento Temprano
topic Tracción extraoral cervical
Maloclusión clase II
Tratamiento Temprano
TG 2019 EOF
Cervica Extraoral Traction
Class II malocclusion
Early treatment
dc.subject.classification.spa.fl_str_mv TG 2019 EOF
dc.subject.other.spa.fl_str_mv Cervica Extraoral Traction
Class II malocclusion
Early treatment
description Introducción y objetivo: La Tracción cervical se ha utilizado durante décadas como tratamiento para la maloclusión de clase II. Aunque los efectos se han informado pre- viamente, son algo contradictorios. El objetivo fué determinar la evidencia científica disponible que respalde los parámetros de uso clínico para la terapia con tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Materia- les y métodos: Se realizó una búsqueda sistemática utilizando las bases de datos Medline, Google Scholar, Cochrane y Lilacs. La búsqueda incluyó artículos en inglés, español, portugués y alemán utilizando términos MeSH previamente seleccionados y términos de texto libre. La búsqueda incluyó artículos relacionados con el tratamiento de tracción extraoral cervical, revisiones sistemáticas, metanálisis, ensayos clínicos y estudios de cohortes, casos y controles y estudios transversales. La calidad meto- dológica se evaluó utilizando varias escalas según el tipo de estudio. Resultados: La búsqueda generó 334 artículos, 259 fueron eliminados porque eran duplicados y 34 fueron eliminados porque no cumplían con los criterios de inclusión. Se evaluaron 41 artículos en texto completo, se excluyeron 21 porque no cumplían con los criterios de inclusión, dejando un total de 20 artículos. Conclusiones: Los artículos ofrecieron re- comendaciones variadas, pero claras. De acuerdo con la literatura y el juicio clínico, se recomienda el momento del tratamiento durante el período de crecimiento puberal. La fuerza más eficiente es de 450 a 500 g por lado durante 12 a 14 horas por día. Se debe usar un arco externo largo doblado 15 grados hacia arriba en pacientes con patrones normales e hipodivergentes. El control del crecimiento maxilar depende de la edad, la fuerza, la duración del tratamiento, etc. Se pueden esperar cambios en la sobrecarga debido a cambios en la inclinación dental, el crecimiento o el uso de aparatos adicio- nales. Se puede lograr una distalización molar promedio de 1 m
publishDate 2019
dc.date.issued.none.fl_str_mv 2019-07-25
dc.date.accessioned.none.fl_str_mv 2020-04-01T13:59:04Z
dc.date.available.none.fl_str_mv 2020-04-01T13:59:04Z
2024-07-27
dc.type.none.fl_str_mv Artículo
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dc.identifier.issn.spa.fl_str_mv 2215-9185
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dc.identifier.bibliographicCitation.spa.fl_str_mv Yepes, E., Rueda, Z.V., Botero-Mariaca, P. (2019) Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review. Rev. CES Odont 2019; 32(2): 17-38. Recuperado de: http://revistas.ces.edu.co/index.php/odontologia/article/view/5347
identifier_str_mv 2215-9185
Yepes, E., Rueda, Z.V., Botero-Mariaca, P. (2019) Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review. Rev. CES Odont 2019; 32(2): 17-38. Recuperado de: http://revistas.ces.edu.co/index.php/odontologia/article/view/5347
url http://dx.doi.org/10.21615/ cesodon.32.2.2
https://hdl.handle.net/20.500.12494/17370
dc.relation.isversionof.spa.fl_str_mv http://revistas.ces.edu.co/index.php/odontologia/article/view/5347
dc.relation.ispartofjournal.spa.fl_str_mv Revista CES Odontología
dc.relation.references.spa.fl_str_mv 1. Melsen B, Enemark H. Effect of cervical anchorage studied by the implant me- thod. Rep Congr Eur Orthod Soc. 1969;435–447.
2. Wieslander L. The effect of force on craniofacial development. Am J Orthod. 1974 May;65(5):531–538.
3. Baumrind S, Molthen R, West EE, Miller DM. Mandibular plane changes during maxillary retraction. Am J Orthod. 1978;74(1):32–40.
4. Melsen B. Effects of cervical anchorage during and after treatment: an implant study. Am J Orthod. 197873(5):526–540.
5. Tulloch JF, Proffit WR, Phillips C. Influences on the outcome of early treatment for Class II malocclusion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997111(5):533–542.
6. Tulloch JF, Phillips C, Proffit WR. Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):62–72, quiz 73–74.
7. Kirjavainen M, Kirjavainen T, Hurmerinta K, Haavikko K. Orthopedic cervical headgear with an expanded inner bow in class II correction. Angle Orthod. 2000;70(4):317–325.
8. Henriques FP, Janson G, Henriques JFC, Pupulim DC. Effects of cervical headgear appliance: a systematic review. Dent Press J Orthod. 2015;
9. Pirttiniemi P, Kantomaa T, Mäntysaari R, Pykäläinen A, Krusinskiene V, Laitala T, et al. The effects of early headgear treatment on dental arches and craniofacial mor- phology: an 8 year report of a randomized study. Eur J Ortho
10. Papageorgiou SN, Kutschera E, Memmert S, Gölz L, Jäger A, Bourauel C, et al. Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis. Eur J Orthod. 2017;39(2):176–187.
11. Baumrind S, Korn EL, Isaacson RJ, West EE, Molthen R. Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction. Am J Orthod. 1983;84(5):384–398.
12. Hubbard GW, Nanda RS, Currier GF. A cephalometric evaluation of nonextrac- tion cervical headgear treatment in Class II malocclusions. Angle Orthod. 1994;64(5):359–37
13. Keeling SD, Wheeler TT, King GJ, Garvan CW, Cohen DA, Cabassa S, et al. Antero- posterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):40–50.
14. Ulger G, Arun T, Sayinsu K, Isik F. The role of cervical headgear and lower utility arch in the control of the vertical dimension. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2006;130(4):492–501.
15. Higgins J, Green S. .Manual Cochrane de revisiones sistemáticas de intervenciones. versión 5.1.0. Oxford; 2011.
16. JadadAR,MooreRA,CarrollD,JenkinsonC,ReynoldsDJ,GavaghanDJ,etal.Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.
17. Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS ONE. 2007;2(12):e1350.
18. Berra S, Elorza-Ricart JM, Estrada M-D, Sánchez E. [A tool (corrected) for the critical appraisal of epidemiological cross-sectional studies]. Gac Sanit SESPAS. 2008 ;22(5):492–497.
19. Alió-Sanz J, Iglesias-Conde C, Lorenzo-Pernía J, Iglesias-Linares A, Mendo- za-Mendoza A, Solano-Reina E. Effects on the maxilla and cranial base caused by cervical headgear: a longitudinal study. Med Oral Patol Oral Cirugía Bucal. 2012;17(5):e845–851.
20. Bondemark L, Karlsson I. Extraoral vs intraoral appliance for distal move- ment of maxillary first molars: a randomized controlled trial. Angle Orthod. 2005;75(5):699–706.
21. Godt A, Kalwitzki M, Göz G. Retrospective analysis of casts to assess cervical headgear treatment in the presence of vertical growth pattern. J Orofac Orthop Fortschritte Kieferorthopädie OrganOfficial J Dtsch Ges Für Kieferorthopädie. 2005;66(3):230–240.
22. Godt A, Kalwitzki M, Göz G. Effects of cervical headgear on overbite against the background of existing growth patterns. A retrospective analysis of study casts. Angle Orthod. 2007;77(1):42–46.
23. Godt A, Berneburg M, Kalwitzki M, Göz G. Cephalometric analysis of molar and an- terior tooth movement during cervical headgear treatment in relation to growth patterns. J Orofac Orthop Fortschritte Kieferorthopädie OrganOfficial J Dtsch Ges Für Kieferorthopädie. 2008;69(3):189–200.
24. Kirjavainen M, Kirjavainen T, Haavikko K. Changes in dental arch dimensions by use of an orthopedic cervical headgear in Class II correction. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997;111(1):59–66.
25. Kirjavainen M, Kirjavainen T. Maxillary expansion in Class II correction with or- thopedic cervical headgear. A posteroanterior cephalometric study. Angle Orthod. 2003;73(3):281–285.
26. Kirjavainen M, Hurmerinta K, Kirjavainen T. Facial profile changes in early Class II correction with cervical headgear. Angle Orthod. 2007;77(6
27. Kopecky GR, Fishman LS. Timing of cervical headgear treatment based on skeletal maturation. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1993;104(2):162–169.
28. Lima Filho RMA, Lima AL, de Oliveira Ruellas AC. Mandibular changes in skeletal class II patients treated with Kloehn cervical headgear. Am J Orthod Dentofac Or- thop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2003;124(1):83–90.
29. Lima Filho RMA, Lima AL, de Oliveira Ruellas AC. Longitudinal study of antero- posterior and vertical maxillary changes in skeletal class II patients treated with Kloehn cervical headgear. Angle Orthod. 2003;73(2):187–193.
30. Lione R, Franchi L, Laganà G, Cozza P. Effects of cervical headgear and pendulum appliance on vertical dimension in growing subjects: a retrospective controlled clinical trial. Eur J Orthod. 2015;37(3):338–344.
31. Mäntysaari R, Kantomaa T, Pirttiniemi P, Pykäläinen A. The effects of early headgear treatment on dental arches and craniofacial morphology: a report of a 2 year randomized study. Eur J Orthod. 2004;26(1):59–64.
32. Melsen B, Dalstra M. Distal molar movement with Kloehn headgear: is it stable? Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2003;123(4):374–378.
33. Varlik SK, Iscan HN. The effects of cervical headgear with an expanded inner bow in the permanent dentition. Eur J Orthod. 2008;30(4):425–4
34. Kloehn SJ. Evaluation Of Cervical Anchorage Force In Treatment. Angle Orthod. 1961;31(2):91–104.
35. King EW. Cervical Anchorage in Class II, Division I Treatment, A Cephalometric Appraisal. Angle Orthod. 1957;27(2):98–104.
36. Tulloch JF, Phillips C, Koch G, Proffit WR. The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Or- thod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997;111(4):391–400.
37. Hunter CJ. The correlation of facial growth with body height and skeletal matu- ration at adolescence. Angle Orthod. 1966;36(1):44–54.
38. Yepes E, Quintero P, Rueda ZV, Pedroza A. Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion. Eur J Orthod. 2014;36(5):586–594.
39. Cook AH, Sellke TA, BeGole EA. Control of the vertical dimension in Class II co- rrection using a cervical headgear and lower utility arch in growing patients. Part I. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1994;106(4):376–388.
40. Brown P. A cephalometric evaluation of high-pull molar headgear and face-bow neck strap therapy. Am J Orthod. 1978;74(6):621–632.
41. Boecler PR, Riolo ML, Keeling SD, TenHave TR. Skeletal changes associated with extraoral appliance therapy: an evaluation of 200 consecutively treated cases. Angle Orthod. 1989;59(4):263–270.
42. Boatwright P. Single arch treatment with the Kloehn headgear: A cephalometric evaluation. [unpublished Master’s Thesis]. Department of Orthodontics, St. Louis University;; 1968.
43. CangialosiTJ,MeistrellME,LeungMA,KoJY.Acephalometricappraisalofedgewise Class II nonextraction treatment with extraoral force. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1988;93(4):315–324.
44. Ghafari J, Shofer FS, Jacobsson-Hunt U, Markowitz DL, Laster LL. Headgear ver- sus function regulator in the early treatment of Class II, division 1 malocclusion: a randomized clinical trial. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):51–61.
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spelling Yepes Chamorro, Eliana Carolina Rueda, Zulma VanessaBotero Mariaca, Paola María 32 (2)2020-04-01T13:59:04Z2024-07-272020-04-01T13:59:04Z2019-07-252215-9185http://dx.doi.org/10.21615/ cesodon.32.2.2https://hdl.handle.net/20.500.12494/17370Yepes, E., Rueda, Z.V., Botero-Mariaca, P. (2019) Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review. Rev. CES Odont 2019; 32(2): 17-38. Recuperado de: http://revistas.ces.edu.co/index.php/odontologia/article/view/5347Introducción y objetivo: La Tracción cervical se ha utilizado durante décadas como tratamiento para la maloclusión de clase II. Aunque los efectos se han informado pre- viamente, son algo contradictorios. El objetivo fué determinar la evidencia científica disponible que respalde los parámetros de uso clínico para la terapia con tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Materia- les y métodos: Se realizó una búsqueda sistemática utilizando las bases de datos Medline, Google Scholar, Cochrane y Lilacs. La búsqueda incluyó artículos en inglés, español, portugués y alemán utilizando términos MeSH previamente seleccionados y términos de texto libre. La búsqueda incluyó artículos relacionados con el tratamiento de tracción extraoral cervical, revisiones sistemáticas, metanálisis, ensayos clínicos y estudios de cohortes, casos y controles y estudios transversales. La calidad meto- dológica se evaluó utilizando varias escalas según el tipo de estudio. Resultados: La búsqueda generó 334 artículos, 259 fueron eliminados porque eran duplicados y 34 fueron eliminados porque no cumplían con los criterios de inclusión. Se evaluaron 41 artículos en texto completo, se excluyeron 21 porque no cumplían con los criterios de inclusión, dejando un total de 20 artículos. Conclusiones: Los artículos ofrecieron re- comendaciones variadas, pero claras. De acuerdo con la literatura y el juicio clínico, se recomienda el momento del tratamiento durante el período de crecimiento puberal. La fuerza más eficiente es de 450 a 500 g por lado durante 12 a 14 horas por día. Se debe usar un arco externo largo doblado 15 grados hacia arriba en pacientes con patrones normales e hipodivergentes. El control del crecimiento maxilar depende de la edad, la fuerza, la duración del tratamiento, etc. Se pueden esperar cambios en la sobrecarga debido a cambios en la inclinación dental, el crecimiento o el uso de aparatos adicio- nales. Se puede lograr una distalización molar promedio de 1 mIntroduction and objective: Cervical headgear has been used for decades as a treatment of class II malocclusion. Although the effects have been reported previously they are somewhat contradictory. The objective was to determine the available scientific evidence that supports the parameters of clinical use for therapy with cervical extraoral traction in early treatment for class II malocclusion. Materials and methods: A systematic search was conducted using Medline, Google Scholar, Cochrane, and Lilacs data- bases. The search involved articles in English, Spanish, Portuguese, and German using previously selected MeSH terms and free-text terms. The search included articles dealing with cervical extraoral traction treatment, systematic reviews, meta-analysis, clinical trials, and cohort, case-control, and cross-sectional studies. Methodological quality was evaluated using various scales according to the type of study. Results: The search generated 334 articles, 259 were eliminated because they were duplicates, and 34 were eliminated because they did not meet the inclusion criteria. 41 ar- ticles were evaluated in full text, 21 were excluded because they did not meet the inclusion criteria, leaving a total of 20 articles. Conclusions: The articles offered varied, yet clear, recommendations. According to the litera- ture and clinical judgment, treatment timing is recommended during the pubertal growth spurt. The most efficient force is 450 to 500g per side for 12 to 14 hours per day. A long outer bow bent 15o degrees upward should be used in patients with normal and hypodivergent patterns. Maxillary growth control depends on age, force, treatment duration, etc. Changes in overjet can be expected due to changes in dental inclination, growth, or the use of additional appliances; an average molar distalization of 1 mm to 2 mm can be achieved.GIOMeliana.yepes@campusucc.edu.cozulma.ruedav@campusucc.edu.copaola.botero@ucc.edu.co17 - 38Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Especialización en Endodoncia, Medellín y EnvigadoEspecialización en OrtodonciaMedellínhttp://revistas.ces.edu.co/index.php/odontologia/article/view/5347Revista CES Odontología1. Melsen B, Enemark H. Effect of cervical anchorage studied by the implant me- thod. Rep Congr Eur Orthod Soc. 1969;435–447.2. Wieslander L. The effect of force on craniofacial development. Am J Orthod. 1974 May;65(5):531–538.3. Baumrind S, Molthen R, West EE, Miller DM. Mandibular plane changes during maxillary retraction. Am J Orthod. 1978;74(1):32–40.4. Melsen B. Effects of cervical anchorage during and after treatment: an implant study. Am J Orthod. 197873(5):526–540.5. Tulloch JF, Proffit WR, Phillips C. Influences on the outcome of early treatment for Class II malocclusion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997111(5):533–542.6. Tulloch JF, Phillips C, Proffit WR. Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):62–72, quiz 73–74.7. Kirjavainen M, Kirjavainen T, Hurmerinta K, Haavikko K. Orthopedic cervical headgear with an expanded inner bow in class II correction. Angle Orthod. 2000;70(4):317–325.8. Henriques FP, Janson G, Henriques JFC, Pupulim DC. Effects of cervical headgear appliance: a systematic review. Dent Press J Orthod. 2015;9. Pirttiniemi P, Kantomaa T, Mäntysaari R, Pykäläinen A, Krusinskiene V, Laitala T, et al. The effects of early headgear treatment on dental arches and craniofacial mor- phology: an 8 year report of a randomized study. Eur J Ortho10. Papageorgiou SN, Kutschera E, Memmert S, Gölz L, Jäger A, Bourauel C, et al. Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis. Eur J Orthod. 2017;39(2):176–187.11. Baumrind S, Korn EL, Isaacson RJ, West EE, Molthen R. Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction. Am J Orthod. 1983;84(5):384–398.12. Hubbard GW, Nanda RS, Currier GF. A cephalometric evaluation of nonextrac- tion cervical headgear treatment in Class II malocclusions. Angle Orthod. 1994;64(5):359–3713. Keeling SD, Wheeler TT, King GJ, Garvan CW, Cohen DA, Cabassa S, et al. Antero- posterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):40–50.14. Ulger G, Arun T, Sayinsu K, Isik F. The role of cervical headgear and lower utility arch in the control of the vertical dimension. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2006;130(4):492–501.15. Higgins J, Green S. .Manual Cochrane de revisiones sistemáticas de intervenciones. versión 5.1.0. Oxford; 2011.16. JadadAR,MooreRA,CarrollD,JenkinsonC,ReynoldsDJ,GavaghanDJ,etal.Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.17. Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS ONE. 2007;2(12):e1350.18. Berra S, Elorza-Ricart JM, Estrada M-D, Sánchez E. [A tool (corrected) for the critical appraisal of epidemiological cross-sectional studies]. Gac Sanit SESPAS. 2008 ;22(5):492–497.19. 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Yepes E, Quintero P, Rueda ZV, Pedroza A. Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion. Eur J Orthod. 2014;36(5):586–594.39. Cook AH, Sellke TA, BeGole EA. Control of the vertical dimension in Class II co- rrection using a cervical headgear and lower utility arch in growing patients. Part I. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1994;106(4):376–388.40. Brown P. A cephalometric evaluation of high-pull molar headgear and face-bow neck strap therapy. Am J Orthod. 1978;74(6):621–632.41. Boecler PR, Riolo ML, Keeling SD, TenHave TR. Skeletal changes associated with extraoral appliance therapy: an evaluation of 200 consecutively treated cases. Angle Orthod. 1989;59(4):263–270.42. Boatwright P. Single arch treatment with the Kloehn headgear: A cephalometric evaluation. [unpublished Master’s Thesis]. Department of Orthodontics, St. Louis University;; 1968.43. CangialosiTJ,MeistrellME,LeungMA,KoJY.Acephalometricappraisalofedgewise Class II nonextraction treatment with extraoral force. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1988;93(4):315–324.44. Ghafari J, Shofer FS, Jacobsson-Hunt U, Markowitz DL, Laster LL. Headgear ver- sus function regulator in the early treatment of Class II, division 1 malocclusion: a randomized clinical trial. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):51–61.Tracción extraoral cervicalMaloclusión clase IITratamiento TempranoTG 2019 EOFCervica Extraoral TractionClass II malocclusionEarly treatmentCervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. 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