Evaluation of an Elastodontic Bioactivator Versus High-Pull Headgear for the Treatment of Skeletal Class II Hyperdivergent Pediatric Patients: A Retrospective Study

<b>Background/Objectives</b>: This retrospective study evaluated and compared the cephalometric effects of an elastodontic bioactivator and conventional high-pull headgear in growing patients with hyperdivergent Class II malocclusion. <b>Methods</b>: Patients aged 7-11 years were divided into two groups according to the appliance used for the orthodontic treatment performed: elastodontic device (ED) and high-pull headgear (HPHD). Cephalometric measurements were recorded at baseline (T0) and after 18 months of treatment (T1). The data were subjected to statistical analysis, descriptive statistics were calculated, and an ANOVA test and post hoc Tukey test were performed (repeated measures correction was applied for intragroup comparisons). Linear regressions were conducted. Significance was predetermined as <i>p</i> < 0.05 for all the tests performed. <b>Results</b>: 40 patients were included, 20 belonging to the ED group and 20 to the HPHD group. Both groups showed a significant increase in SNB (<i>p</i> < 0.05), suggesting favorable mandibular positional changes. SNA and ANB did not show significant intra- or intergroup variations (<i>p</i> > 0.05). Regarding vertical skeletal parameters, no significant intra- or intergroup changes were observed at T0 and T1, indicating that both devices preserved vertical stability without worsening the hyperdivergent pattern. Dentoalveolar and soft-tissue effects were limited. <b>Conclusions</b>: Both ED and HPHD are effective in managing hyperdivergent Class II growing patients. The two appliances provide comparable improvements in mandibular positioning. Both devices seem to preserve vertical skeletal dimensions, avoiding further mandibular clockwise rotation. Both appliances are associated with minimal undesirable effects on the soft tissues.