Comparative assessment of tongue posture in class II division 1 patients treated with functional appliance and camouflage orthodontic treatment: a retrospective cephalometric study

Background: Class II division 1 malocclusion is frequently associated with mandibular retrognathism, which may compromise tongue posture and airway, increasing the risk of respiratory issues. This study aimed to assess and compare the effects of functional appliance therapy and extraction-based camouflage orthodontic treatment on tongue posture in Class II division 1 patients. Limited literature exists on the impact of anterior retraction on tongue posture in skeletal Class II camouflage cases, warranting further investigation. Methods: A retrospective cephalometric analysis was conducted on two groups: patients treated with functional appliances and those treated with premolar extractions. Pre- and post-treatment lateral cephalograms were analyzed using cephalometric parameters described by Rakosi and Lowe (tg1–tg7, tgH, tgL). Inter- and intra-group comparisons were made using the independent and dependent t-test respectively. Results: Functional therapy showed significant improvement in total tongue length TgL intra and inter-group, suggesting enhanced oral cavity volume and forward tongue positioning. The anterior tongue dimension (Tg1) also showed significant inter-group difference. In contrast, camouflage treatment showed a significant intra-group reduction in TgL, indicating possible tongue space restriction. Other tongue posture parameters showed non-significant trends. Conclusions: Functional appliance therapy benefits tongue posture and airway space, particularly in growing patients, by promoting mandibular and tongue advancement. In contrast, extraction-based camouflage may adversely affect tongue posture, especially in non-growing individuals. These findings emphasize the importance of airway-focused treatment planning and support the use of functional appliances when indicated.