Attitudes and compliance of pre-adolescent children during early treatment of Class II malocclusion

A comparison of children's experiences with fixed and removable functional appliances: A qualitative study

INTRODUCTION

The objective of this study was to compare children's experiences and perceptions of treatment with Hanks-Herbst (HH) and modified Twin-block (MTB) functional appliances.

METHODS

A pragmatic nested qualitative study was undertaken in a single hospital setting. Participants from a randomized controlled trial (International Standard Randomised Controlled Trial Number 11717011) wearing HH and/or MTB appliances were interviewed using a topic guide in a one-to-one, semistructured format. Interviews were recorded and transcribed verbatim for framework methodology analysis until data saturation was reached.

RESULTS

Eighteen participants (HH, 7: MTB, 4; switched group, 7) were interviewed. Thirteen codes were constructed and grouped into 3 themes: (1) functional impairment and symptoms, (2) psychosocial factors and impacts, and (3) feedback on appliances and patient care. Both appliances had a negative impact on quality of life, with disruption to children's daily routines and psychological well-being. Speaking was more problematic for MTB participants, whereas HH participants encountered mastication and breakage issues. HH was preferred by most participants, as its nonremovable feature meant less managing and self-discipline was required. MTB was considered a suitable option for children with good self-discipline and who preferred a versatile lifestyle. Feedback included wishes for the availability of multiple appliance options and a degree of autonomy in decision-making processes.

CONCLUSIONS

HH and MTB can negatively affect children's quality of life. Participants preferred HH over MTB because of its nonremovable feature, and children requested to be empowered during decision-making processes.

Update on the pediatric adverse vocal behavior voice disorders: a clinical practice review

The main causes of voice disorders in children with adverse vocal behavior include benign lesions of the vocal folds caused by voice abuse or misuses, such as vocal fold nodules, vocal fold polyps, and laryngitis. Long-term voice disorders can affect the physical and mental health of children. Reviewing the literature of the last two decades on "Vocal Fold Nodules," "Vocal Fold Polyp," "Voice disorder," "Voice Abuse," "Voice Misuse," "Pediatrics," and "Children" with the appropriate Boolean operators.  Conclusion: A total of 315 results were returned on an initial PubMed search. All articles from 2000 to 2022 written in English or Chinese were screened. Duplicate articles, those relating to adults only or concerned with the malignant lesion of the vocal cord, were excluded, resulting in 196 articles of interest. Relevant references and books have also been consulted, and we provide a review of the pathogenesis, diagnosis, and treatment of these maladaptive vocal behavioral voice disorders. What is Known: • Hoarseness is the most common voice symptom in children, and there are various causes of hoarseness in children. However, there is a lack of reviews on voice disorders caused by adverse vocal habits in children. • Voice training is a conservative treatment method for children with voice disorders , and it is important to clarify the factors that influence the effectiveness of voice training for children. What is New: • This review of the personality and family characteristics of children with adverse vocal behavioural voice disorders provides a valuable guide to the clinical planning of subsequent treatment. • This article discusses and summarises some of the factors that may influence the effectiveness of voice training in children and collates some of the scales and questionnaires currently used in children that are important in predicting the effectiveness of voice training.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial

INTRODUCTION

This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children.

METHODS

Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T₁), at the end of RPE (T₂), and 1 month after the appliance removal (T₃). Generalized mixed models were used for data analysis (α = 0.05).

RESULTS

Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T₁ and T₂, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T₁ 95% confidence interval [CI], 1.08-1.26; T₂ 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T₃ are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T₃ 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T₃ (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T₁ and T₂.

CONCLUSIONS

Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.

Perception of pain in Class II malocclusion children treated with cervical headgear: a randomized controlled trial

OBJECTIVES

The aims of this study were: 1. to evaluate the experience of pain perceived by children during separator placement and headgear wear; 2. to find possible associations between the perceived intensity of pain and the levels of Substance P (SP) and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) during these procedures; 3. to identify other factors, such as previous pain experience, which could be associated to the patients' perceived discomfort or pain during treatment.

TRIAL DESIGN

Nine-month parallel-group randomized controlled trial.

METHODS

Forty Class II malocclusion children (8-12 years) were included, half of which received a cervical headgear while the other half did not receive any treatment during the study period. Baseline pain data were recorded including previous experience to general and dental pain, Corah's Dental Anxiety Scale, and baseline pain using a visual analogue scale (VAS). Elastic separators were placed in children for 1 week, followed by molar band and cervical headgear placement. Children were seen at various time points throughout the 9-month period where at each appointment, a VAS assessment of pain as well as GCF sampling was carried out to quantify the levels of SP and IL-1β. Multiple regression analysis was performed to ascertain the influence of factors including sex, age, time, headgear wear, and baseline pain data on pain severity.

RESULTS

Pain severity and SP and IL-1β levels in the GCF follow a similar pattern, with peaks being observed 1 day after orthodontic elastic separator placement. Pain was more severe after the placement of orthodontic separators than following cervical headgear wear. With regard to pain predictors, pain is more severe in older children, those with a worse previous general pain experience, and those with higher levels of IL-1β, particularly after elastic separator placement.

CONCLUSIONS

Orthodontic pain and discomfort following orthodontic separator placement and cervical headgear wear depends on factors including age, previous pain experience, and the level of IL-1β in the GCF.

The impact of general self-efficacy and the severity of malocclusion on acceptance of removable orthodontic appliances in 10- to 12-year-old patients

Background

The patients’ acceptance of a treatment plan and their subsequent cooperation play a crucial role in achieving the best results in orthodontic treatments. Evidences show some personality traits such as general self-efficacy (GSE) and some dental traits such as severity of malocclusion are correlated with motivation of orthodontic treatment. These factors may predict the patients’ compliance and acceptance in using removable orthodontic appliances. This cross sectional study was conducted to assess the correlation of GSE and the severity of malocclusion with patients’ acceptance in using removable orthodontic appliances.

Methods

This study recruited 50 patients aged 10–12 years who required removable orthodontic appliances. The severity of malocclusion was determined using the index of orthodontic treatment need (IOTN) before the onset of treatment and GSE of participants were assessed using GSE scale self-report. The acceptance questionnaire was proposed to the patients on first (T1), third (T2), and sixth (T3) month after the delivery of the appliance.

Results

The GSE score had a statistically significant correlation with the total score of the acceptance questionnaire, subscale score of satisfaction with the appliance during eating and oral hygiene practice, duration of usage of the appliance, and interest in using it (P < 0.05). The IOTN had no significant correlation with the acceptance questionnaire.

Conclusions

Our findings substantiate the role of the GSES, concurrently declining the role of the IOTN in prediction of 10–12-year-old children’s acceptance and cooperation in treatment of malocclusion with removable appliances.

[Discontinuation of Orthodontic Treatment: what are the early predictive factors?]

INTRODUCTION

Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment.

MATERIALS AND METHODS

We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance.

RESULTS

In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance.

CONCLUSION

Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

BACKGROUND

Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence.

OBJECTIVES

To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.

DATA COLLECTION AND ANALYSIS

Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies.

MAIN RESULTS

We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).

AUTHORS' CONCLUSIONS

Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

Patients' and Parents' Perception of Functional Appliances: A Survey Study

OBJECTIVE

To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders.

METHODS

Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.

RESULTS

Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other.

CONCLUSION

Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.

Discomfort, expectations, and experiences during treatment of large overjet with Andresen Activator or Prefabricated Functional Appliance: a questionnaire survey

BACKGROUND

The purpose of this study was to investigate the amount of functional and social discomfort experienced after 1 and 6 months of appliance wear, comparing a slightly modified Andresen Activator (AA) and a Prefabricated Functional Appliance (PFA).

METHODS

Ninety-seven patients randomly selected by lottery in an AA (40 subjects), and a PFA (57 subjects) group, with an Angle Class II, Division 1 malocclusion, were eligible for the study. One month and 6 months after start of treatment, a questionnaire, addressing discomfort, perception of treatment need and outcome, was used.

RESULTS

The response rate was 69% after 1 month, and 45% after 6 months. The most common discomfort reported was the 'appliance falling out during sleep' followed by 'difficulties in remembering it'. The only difference was for pain, which was experienced more extensively in the AA group after 1 month of treatment. The dentist appeared to have the greatest impact on the decision to initiate treatment. Teasing, because of appearance, occurred in 13% of the cases.

CONCLUSIONS

No difference could be seen between groups for the experience of functional or social discomfort after 6 months of appliance use. Adequate time should be allowed for clarifying treatment difficulties, using treatment need as motivation.

PRACTICAL IMPLICATIONS

The PFA eliminates the need for taking impressions. Furthermore, it can be economically advantageous to both patients and clinicians.

The impact of orthodontic treatment on the quality of life a systematic review

Background

Although a great number of specific quality of life measures have been developed to analyze the impact of wearing fixed appliances, there is still a paucity of systematic appraisal of the consequences of orthodontics on quality of life. To assess the current evidence of the relationship between orthodontic treatment and quality of life.

Methods

Four electronic databases were searched for articles concerning the impact of orthodontic treatment on quality of life published between January 1960 and December 2013. Electronic searches were supplemented by manual searches and reference linkages. Eligible literature was reviewed and assessed by methodologic quality as well as by analytic results.

Results

From 204 reviewed articles, 11 met the inclusion criteria and used standardized health related quality of life and orthodontic assessment measures. The majority of studies (7/11) were conducted among child/adolescent populations. Eight of the papers were categorized as level 1 or 2 evidence based on the criteria of the Oxford Centre for Evidence-Based Medicine. An observed association between quality of life and orthodontic treatment was generally detected irrespective of how they were assessed. However, the strength of the association could be described as modest at best. Key findings and future research considerations are described in the review.

Conclusions

Findings of this review suggest that there is an association (albeit modest) between orthodontic treatment and quality of life. There is a need for further studies of their relationship, particularly studies that employ standardized assessment methods so that outcomes are uniform and thus amenable to meta-analysis.

Acceptance of orthodontic miniscrews as temporary anchorage devices

OBJECTIVE

To study the patient's acceptance, expectation, and experience of pain with orthodontic temporary miniscrews.

METHODS

Questionnaires were distributed to 165 potential temporary orthodontic miniscrew recipients or their parents. Using the numeric rating scale, patients who received miniscrews as part of their orthodontic treatment were also asked to rate the pain or discomfort experience after miniscrew placement.

RESULTS

A total of 165 subjects completed the first set of questions. There was a significant relationship between level of education and prior knowledge about orthodontic miniscrews (P=0.029). Even though only 12.7% had heard about miniscrews, 82.4% agreed to have miniscrews placed to facilitate orthodontic tooth movement. Eighty-three subjects who needed miniscrews as part of their orthodontic treatment completed two more sets of questions after 6 and 24 hours of miniscrew insertion. After 6 hours of miniscrew insertion, there was a significant difference in pain perception between men (mean =2.6±2.2) and women (mean =2.1±1.5; P=0.03). After 24 hours, there was no difference between men (0.2±0.4) and women (0.2±0.5; P>0.05). Postplacement, 32.5% did not require any pain medication, while 59.1% required a single dose and only 8.4% required two doses. A total of 76 patients (91.6%) said that they would recommend this procedure.

CONCLUSION

Patients do accept miniscrew as a treatment option in orthodontics. Postoperative pain is significantly low. The acceptance of miniscrews was not related to patient's previous knowledge of the device, and patients preferred miniscrews to extractions.

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children

BACKGROUND

Prominent upper front teeth are a common problem affecting about a quarter of 12-year old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. These teeth are more likely to be injured and their appearance can cause significant distress.If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence.

OBJECTIVES

To assess the effects of orthodontic treatment for prominent upper front teeth when this treatment is initiated when the child is seven to 11 years old compared to when they are in early adolescence, or when treatment uses different types of orthodontic braces.

SEARCH METHODS

We searched the following databases: Cochrane Oral Health Group's Trials Register (to 17 April 2013), CENTRAL (The Cochrane Library 2013, Issue 3), MEDLINE (OVID) (1946 to 17 April 2013) and EMBASE (OVID) (1980 to 17 April 2013). There were no restrictions regarding language or publication date.

SELECTION CRITERIA

Randomised controlled trials of children and/or adolescents (age < 16 years) on early treatment (either one or two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces compared with late treatment with any type of orthodontic braces or head-braces; or, on any type of orthodontic braces or head-braces compared with no treatment or another type of orthodontic brace or appliance (with treatment starting in children of similar ages in both groups) to correct prominent upper front teeth.

DATA COLLECTION AND ANALYSIS

Review authors screened the search results, extracted data and assessed risk of bias independently, used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, mean differences (MDs) and 95% CIs for continuous outcomes and a fixed-effect model for meta-analyses as there were fewer than four studies.

MAIN RESULTS

We included 17 studies based on data from 721 participants.Three trials (n = 343) compared early (two-phase) treatment (7-11 years of age) with a functional appliance, with adolescent (one-phase) treatment. Statistically significant differences in overjet, ANB and PAR scores were found in favour of functional appliance when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18) (low quality evidence), final ANB (MD -0.02, 95% CI -0.47 to 0.43, P = 0.92), PAR score (MD 0.62, 95% CI -0.66 to 1.91, P = 0.34) or self concept score (MD 0.83, CI -2.31 to 3.97, P = 0.60). However, two-phase treatment with functional appliance showed a statistically significant reduction in the incidence of incisal trauma (OR 0.59, 95% CI 0.35 to 0.99, P = 0.04) (moderate quality evidence). The incidence of incisal trauma was clinically significant with 29% (54/185) of patients reporting new trauma incidence in the adolescent (one-phase) treatment group compared to only 20% (34/172) of patients receiving early (two-phase) treatment.Two trials (n = 285), compared early (two-phase) treatment using headgear, with adolescent (one-phase) treatment. Statistically significant differences in overjet and ANB were found in favour of headgear when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.22, 95% CI -0.56 to 0.12, P = 0.20) (low quality evidence), final ANB (MD -0.27, 95% CI -0.80 to 0.26, P = 0.32) or PAR score (MD -1.55, 95% CI -3.70 to 0.60, P = 0.16). The incidence of incisal trauma was, however, statistically significantly reduced in the two-phase treatment group (OR 0.47, 95% CI 0.27 to 0.83, P = 0.009) (low quality evidence). The adolescent treatment group showed twice the incidence of incisal trauma (47/120) compared to the young children group (27/117).Two trials (n = 282) compared different types of appliances (headgear and functional appliance) for early (two-phase) treatment. At the end of the first phase of treatment statistically significant differences, in favour of functional appliances, were shown with respect to final overjet only. At the end of phase two, there was no evidence of a difference between appliances with regard to overjet (MD -0.21, 95% CI -0.57 to 0.15, P = 0.26), final ANB (MD -0.17, 95% CI -0.67 to 0.34, P= 0.52), PAR score (MD -0.81, 95% CI -2.21 to 0.58, P = 0.25) or the incidence of incisal trauma (OR 0.79, 95% CI 0.43 to 1.44, P = 0.44).Late orthodontic treatment for adolescents with functional appliances showed a statistically significant reduction in overjet of -5.22 mm (95% CI -6.51 to -3.93, P < 0.00001) and ANB of -2.37° (95% CI -3.01 to -1.74, P < 0.00001) when compared to no treatment (very low quality evidence).There was no evidence of a difference in overjet when Twin Block was compared to other appliances (MD 0.01, 95% CI -0.45 to 0.48, P = 0.95). However, a statistically significant reduction in ANB (-0.63°, 95% CI -1.17 to -0.08, P = 0.02) was shown in favour of Twin Block. There was no evidence of a difference in any reported outcome when Twin Block was compared with modifications of Twin Block.There was insufficient evidence to determine the effects of Activator, FORSUS FRD EZ appliances, R-appliance or AIBP.

AUTHORS' CONCLUSIONS

The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective in reducing the incidence of incisal trauma than providing one course of orthodontic treatment when the child is in early adolescence. There appears to be no other advantages for providing treatment early when compared to treatment in adolescence.

[Is retention justified after interceptive treatment of Class II malocclusion?]

Indication of intermediate retention after early treatment of class II malocclusion has not been yet assessed by comparative studies. Therefore, it is up to the practitioner to analyse the need for retention in the time period between the two phases. Does wearing a retainer indeed decrease the chance of relapse between phase one and phase two? We performed a retrospective comparative study consisting of 90 subjects in mixed dentition with class II molar relationships with an increased overjet (> or = 5 mm) treated in the J.-J. Aknin office with DAC appliance. The sample was divided into two groups: 31 patients wearing retention represented by a removable Hawley plate and 59 children in supervision without retention. Three lateral head-films were made at the beginning and the end of early treatment and before the resumption of the second phase treatment. Studied cephalometrics parameters were assessed according to superimposing Pancherz's analysis. A statistical analysis was performed. Results showed a significantly lower relapse of incisor's protrusion in the group wearing an upper retainer. Results' interpretation was in accordance with the assessment of confusion's factors and selection's criteria. Besides, this study was carried out in intention-to-treat and retention's effectiveness in proportion with patient's compliance. Nevertheless, the study was performed in real conditions. In conclusion, and without randomised trial, results show that retention seems to decrease maxillary incisor movements. It is therefore justified in cases presenting with important class II especially with procumbent incisors.

Orthodontic treatment for prominent upper front teeth in children

BACKGROUND

Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. When treatment is provided during adolescence the orthodontist may provide treatment with various orthodontic braces, but there is currently little evidence of the relative effectiveness of the different braces that can be used.

OBJECTIVES

To assess the effectiveness of orthodontic treatment for prominent upper front teeth, when this treatment is provided when the child is 7 to 9 years old or when they are in early adolescence or with different dental braces or both.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. The handsearching of the key international orthodontic journals was updated to December 2006. There were no restrictions in respect to language or status of publication. Date of most recent searches: February 2007.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design - randomised and controlled clinical trials; participants - children or adolescents (age < 16 years) or both receiving orthodontic treatment to correct prominent upper front teeth; interventions - active: any orthodontic brace or head-brace, control: no or delayed treatment or another active intervention; primary outcomes - prominence of the upper front teeth, relationship between upper and lower jaws; secondary outcomes: self esteem, any injury to the upper front teeth, jaw joint problems, patient satisfaction, number of attendances required to complete treatment.

DATA COLLECTION AND ANALYSIS

Information regarding methods, participants, interventions, outcome measures and results were extracted independently and in duplicate by two review authors. The Cochrane Oral Health Group's statistical guidelines were followed and mean differences were calculated using random-effects models. Potential sources of heterogeneity were examined.

MAIN RESULTS

The search strategy identified 185 titles and abstracts. From this we obtained 105 full reports for the review. Eight trials, based on data from 592 patients who presented with Class II Division 1 malocclusion, were included in the review.Early treatment comparisons: Three trials, involving 432 participants, compared early treatment with a functional appliance with no treatment. There was a significant difference in final overjet of the treatment group compared with the control group of -4.04 mm (95% CI -7.47 to -0.6, chi squared 117.02, 2 df, P < 0.00001, I(2) = 98.3%). There was a significant difference in ANB (-1.35 mm; 95% CI -2.57 to -0.14, chi squared 9.17, 2 df, P = 0.01, I(2) = 78.2%) and change in ANB (-0.55; 95% CI -0.92 to -0.18, chi squared 5.71, 1 df, P = 0.06, I(2) = 65.0%) between the treatment and control groups. The comparison of the effect of treatment with headgear versus untreated control revealed that there was a small but significant effect of headgear treatment on overjet of -1.07 (95% CI -1.63 to -0.51, chi squared 0.05, 1 df, P = 0.82, I(2) = 0%). Similarly, headgear resulted in a significant reduction in final ANB of -0.72 (95% CI -1.18 to -0.27, chi squared 0.34, 1 df, P = 0.56, I(2) = 0%). No significant differences, with respect to final overjet, ANB, or ANB change, were found between the effects of early treatment with headgear and the functional appliances. Adolescent treatment (Phase II): At the end of all treatment we found that there were no significant differences in overjet, final ANB or PAR score between the children who had a course of early treatment, with headgear or a functional appliance, and those who had not received early treatment. Similarly, there were no significant differences in overjet, final ANB or PAR score between children who had received a course of early treatment with headgear or a functional appliance. One trial found a significant reduction in overjet (-5.22 mm; 95% CI -6.51 to -3.93) and ANB (-2.27 degrees; 95% CI -3.22 to -1.31, chi squared 1.9, 1 df, P = 0.17, I(2) = 47.3%) for adolescents receiving one-phase treatment with a functional appliance versus an untreated control.A statistically significant reduction of ANB (-0.68 degrees; 95% CI -1.32 to -0.04, chi squared 0.56, 1 df, P = 0.46, I(2) = 0%) with the Twin Block appliance when compared to other functional appliances. However, there was no significant effect of the type of appliance on the final overjet.

AUTHORS' CONCLUSIONS

The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence.