Let’s dive into one of orthodontics’ eternal debates — how extraction patterns affect relapse in Class II malocclusion cases. Or, as some call it, “Should we yank two teeth, four teeth, or none at all — and will the molars stay where we put them?”

So here’s the punchline first — long-term stability doesn’t seem to care that much about the number of premolars you extract. Shocking, I know. Whether you go with two maxillary premolars or a full four-premolar extraction, the occlusal stability is pretty much the same.

Now, that’s not a green light to start extracting premolars like you’re harvesting crops — but it is a nice reminder that there’s no rigid extraction formula tied to relapse.

Here’s something else to chew on:
There’s no solid evidence that finishing Class II cases with Class I molar relationships gives you better long-term outcomes. Yeah — you heard that right. You’re not legally or biologically bound to force every molar into Class I just to impress your ortho mentors or keep your cephs symmetrical.

In fact, a case-control study showed that treating a Class II case by extracting two maxillary premolars and finishing with a Class II molar relationship was actually more efficient than trying to wrestle the entire molar segment into Class I. So not only is it okay — it might actually save you time and effort.

And later studies backed it up:
Whether you end with Class I molars or Class II molars, the long-term occlusal results are basically the same. That’s right. The molars don’t seem to care as long as the rest of the arch is harmonious, the bite is functional, and the patient stops chewing ice with their canines.

So to sum it all up:
Extraction pattern? Choose based on case needs, not relapse paranoia.
Class I molar finish? Nice, but not mandatory.
Long-term stability? Not dependent on textbook-perfect molar positioning.

Bottom line?
Orthodontics isn’t always about achieving the prettiest occlusal photo — it’s about functional, stable results that stick around longer than your patient’s post-treatment whitening.

You’ve got options, Class II warriors. Choose wisely — but don’t stress if the molars decide to stay Class II. Stability won’t judge you.