Cephalometric and dental analysis of Class II, Division 2 reveals various subtypes of the malocclusion and the primacy of dentoalveolar components

Class II, Division 2 malocclusion defies the original definition by Angle, both as phenotype and in etiology. Many subtypes have been described, including “Class I, Division 2,” mostly on the basis of occlusion and cephalometric measurements. In this article, we explore a stratification of four cephalometric patterns of Class II, Division 2, based on the inclination of maxillary incisors and vertical divergence. While strong genetic components have been recognized, the influence of environmental factors is emphasized through a hypothesis to be tested. Elements of this theory include the seemingly self-restrictive dentoalveolar complex through underoccluded posterior teeth and supraerupted anterior teeth, along with the development of the mandible in a mesial direction relative to this complex. The dominance of the vertical dimension is highlighted in this context. The results suggest that treatment stability may be related to the malocclusion type, thus the importance of personalizing treatment. The issue of timing treatment becomes paramount, but research has lagged behind; potentially, because of the morphological differentiations.