Early orthodontic treatment: what are the imperatives?

Prevalence of Malocclusion and Orthodontic Treatment Need in 9- to 12-Year-Old Schoolchildren in Ulaanbaatar, Mongolia

Background The prevalence of malocclusion in Mongolia is increasing every year. Estimating the need for orthodontic treatment in the population is crucial for planning orthodontic care services and monitoring oral health programs. Therefore, the present study aimed to assess the need for orthodontic treatment among schoolchildren in Ulaanbaatar, Mongolia, using the Index of Orthodontic Treatment Need (IOTN). Methods A total of 656 schoolchildren aged 9-12 years were enrolled from 8 schools located in urban and suburban areas of 6 districts of Ulaanbaatar city. All the children were assessed according to the two components of the IOTN, the Dental Health Component (DHC) and the aesthetic component (AC). Statistical analyses were carried out using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States). Results The prevalence of malocclusion was 561 (84.5%), consisting of 452 (68%) Angle Class I, 178 (26.8%) Angle Class II, and 34 (5.2%) Angle Class III malocclusion. For the DHC, the moderate need for treatment was 194 (29.3%) and the definite need was 53 (8.1%). For the AC, the moderate need was 148 (22.3%) and the definite need was 45 (6.9%). The association between the DHC and the AC was found to be statistically significant (p<0.001). The most common malocclusions were an increased overjet (maxillary protrusion), a contact point displacement (crowding), and an increased overbite (deep bite). The AC, Angle's molar relationship, an increased overjet, a contact point displacement, and an increased overbite were factors associated with the need for orthodontic treatment. Conclusion Approximately one-third of schoolchildren in Ulaanbaatar, Mongolia, require orthodontic treatment. This finding helps dental practitioners to better understand oral health problems, leading to an improvement in the overall quality of life of children.

The association between dental and dentoalveolar arch forms of children with normal occlusion and malocclusion: a cross-sectional study

BACKGROUND

Symmetrical and coordinated dental and alveolar arches are crucial for achieving proper occlusion. This study aimed to explore the association between dental and dentoalveolar arch forms in children with both normal occlusion and malocclusion.

METHODS

209 normal occlusion subjects (5-13 years, mean 8.48 years) and 199 malocclusion subjects (5-12 years, mean 8.19 years) were included. The dentoalveolar arch form was characterized by the smoothest projected curve representing the layered contour of the buccal alveolar bone, referred to as the LiLo curve. Subsequently, a polynomial function was utilized to assess dental and dentoalveolar arch forms. To facilitate separate analyses of shape (depth/width ratio) and size (depth and width), the widths of dental and dentoalveolar arch forms were normalized. The normalized dental and dentoalveolar arch forms (shapes) were further classified into 6 groups, termed dental/dentoalveolar arch clusters, using the k-means algorithm.

RESULTS

The association between dental and dentoalveolar arch clusters was found to be one-to-many rather than one-to-one. The mismatch between dental and dentoalveolar arch forms is common in malocclusion, affecting 11.4% of the maxilla and 9.2% of the mandible, respectively.

CONCLUSIONS

There are large individual variations in the association between dental and dentoalveolar arch forms. Early orthodontic treatment may play an active role in coordinating the relationship between the dental and dentoalveolar arch forms.

Assessment of Dental Crowding Occurring in Mixed Dentition in Maxillary and Mandibular Arches Based on Tooth Size-Arch Length Relationships and Certain Cephalometric Parameters

Aim

The aim of the study is to find indicators of crowding in primary and mixed dentition that may lead to occurrence of dental crowding in future dentition using dental measurements.

Materials and methods

A sample of 300 children was selected and divided into two groups based on their age primary dentition and mixed dentition. Dental arch impressions were made and casts were poured. The study was then divided into two phases for assessment of degree of crowding by Little's irregularity index (LII) and by measurement of tooth size-arch length discrepancies. Appropriate statistical analysis was used to assess the correlation of measurements in crowded and noncrowded groups.

Results

It was found that Little's index is less dependable as an indicator of anterior crowding. In the primary dentition, there is significant difference in inter-canine width between lower noncrowded and crowded dentition. In the mixed dentition, there is significant difference in Intermolar width between upper noncrowded and crowded dentition and in sum of incisors between noncrowded and crowded dentition in both the arches.

Conclusion

Little's index is not a reliable indicator of crowding in both primary and mixed dentition. Inter-canine width of lower arch can be considered as an indicator of crowding in primary dentition. The intermolar width of upper arch, sum of incisors in upper and lower arch and the intercanine width of upper and lower arch can be considered indicators of crowding in the mixed dentition.

How to cite this article

Kandakkeel FN, Nagar P, Saseendran A, et al. Assessment of Dental Crowding occurring in Mixed Dentition in Maxillary and Mandibular Arches based on Tooth Size-Arch Length Relationships and Certain Cephalometric Parameters. Int J Clin Pediatr Dent 2023;16(2):357-362.

Knowledge and Perception of Orthodontic Treatment among General and Non-Orthodontic Dental Specialists: A Comparative Study

The objective of this study is to discover any possible association of gender or practitioner classification with orthodontic knowledge and attitudes towards orthodontic treatment. Descriptive cross-sectional research was conducted on two groups of dentists in the Ha'il region of Saudi Arabia. Group I included general practitioners, while Group II had non-orthodontic specialists. The findings suggest a statistically significant (p < 0.05) difference between the knowledge and attitudes of general practitioners and non-orthodontic specialists. Independent two tailed t-scores for difference in Knowledge (t-score = 3.19919, p = 0.003) and Attitude (t-score = 2.16314, p = 0.048319), highlight significant disparities in the knowledge and attitudes of general practitioners and non-orthodontic specialists. However, no statistically significant difference was observed in terms of knowledge and attitudes based on gender differences. This study captures and highlights subtle information that is very significant in dealing with critically important orthodontics issues. The study suggests that it is possible that a non-orthodontic specialist may suggest an altogether different line of treatment with different consequences when compared to a general practitioner and vice versa. This may result in unwanted, permanent orthodontic effects, highlighting the significance of the early stage of orthodontic treatment awareness. This research reveals disparities between the perceptions of general practitioners and non-orthodontic specialists about the stage and relevance of orthodontic treatment. It is strongly advised to see an orthodontic expert rather than a general practitioner or non-orthodontic specialist for orthodontic issues.

Should we recommend early overjet reduction to prevent dental trauma?

There is an association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. It would therefore seem sensible to recommend overjet reduction as early as possible to help reduce this risk. However, orthodontic outcomes are essentially the same whether you start treatment in the early or late mixed dentition, while early treatment carries a heavier burden on compliance - taking longer and involving more appointments. This article explores the complex association between early overjet reduction and dental trauma in the context of current best evidence. Careful case selection is advised when justifying early intervention for increased overjet based on reducing trauma risk.

Elastodontic Therapy of Hyperdivergent Class II Patients Using AMCOP® Devices: A Retrospective Study

Background: The management of a hyperdivergent growth pattern is one of the most challenging in orthodontics and different treatments are advocated. The present study analyses the effectiveness of elastodontic therapy with AMCOP® devices in treating children with hyperdivergent class II malocclusion and the effect on the upper airway patency. Methods: The study group included 21 patients (10 males and 11 females, mean age 8.22 ± 1.17 years) with a hyperdivergent growth and a class II malocclusion treated with AMCOP® devices. Cephalometric analysis was performed before treatment (T0) and after treatment (T1). Results: After treatment, the cephalometric analysis revealed a correction of the class II malocclusion and a modification of the growth pattern with a divergence reduction. The improvement of the upper airway space was also observed. Conclusion: The elastodontic therapy effectively corrected hyperdivergent class II malocclusion in growing patients over a short period.

The Efficacy of a New AMCOP® Elastodontic Protocol for Orthodontic Interceptive Treatment: A Case Series and Literature Overview

BACKGROUND

Elastodontics is a specific interceptive orthodontic treatment that uses removable elastomeric appliances. They are functional appliances that produce neuromuscular, orthopedic and dental effects. Thus, these devices are useful in the developmental age, when skeletal structures are characterized by important plasticity and adaptation capacity, allowing to remove factors responsible for malocclusions. Elastomeric devices are generally well tolerated by patients requiring simple collaboration and management. This work can be useful to update all orthodontists already adopting these appliances or for those who want to approach them for the first time. This study aimed to describe four cases treated with new elastomeric devices called AMCOP Bio-Activators and to provide an overview of elastodontics, its evolution, indications and limits.

METHODS

A total of four clinical cases were presented after a treatment period of 16-20 months to evaluate the clinical and radiological effects of the elastodontic therapy.

RESULTS

The effectiveness of Bio-Activators on clinical cases was evidenced with a significant improvement in skeletal and dentoalveolar relationship, and malocclusion correction in a limited treatment period (16-20 months).

CONCLUSIONS

The Bio-Activators showed clinical effectiveness to achieve therapeutic targets according to a low impact on the patient's compliance.

Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs

Aim and objective

To find the prevalence of malocclusion and orthodontic treatment need in children of East Lucknow city.

Materials and methods

The present study was conducted in the Department of Pedodontic and Preventive Dentistry, Babu Banarasi Das College of Dental Sciences, Lucknow. The nursery and primary schools of East Lucknow were included in the study. Baby-ROMA Index and Index of Orthodontic Treatment Needs (IOTN) were tested on 400 children, which were divided into two groups of 200 in each group, referred from the Out Patient Department and school camps. A single operator who was trained and calibrated for the use of indices evaluated children.

Results

Intra-reliability test showed higher reproducibility of the index. It is shown that around 70% of the patient presented malocclusion from both indices.

Conclusion

Baby-ROMA Index and IOTN were helpful to assess the severity of malocclusion and the timing for orthodontic malocclusion in young patients (primary and mixed dentition).

How to cite this article

Singh A, Rathore M, Govil S, et al. Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs. Int J Clin Pediatr Dent 2021;14(S-1):S22–S28.

Early timely orthodontic treatment: Treatment of unerupted maxillary laterals

There is no universal agreement as to which type of orthodontic or orthopedic treatment deserves early intervention. In addition, there is a need for more information as to which treatments are the most effective and less costly if they are initiated timely in the mixed dentition. Early timely treatment may benefit young patients with a maxillary transverse deficiency with or without a posterior crossbite that requires maxillary expansion. It may also be indicated in children with anteroposterior jaw discrepancy that requires chin cup or maxillary protraction. In this paper, the authors will focus on early maxillary expansion to facilitate the eruption of maxillary laterals. In specific, the authors will present a contemporary protocol using a bonded maxillary expander as anchorage for treatment of unerupted maxillary laterals. The use of this protocol was illustrated with two case reports to enable clinicians to routinely achieve a beautiful smile on a young patient by timely alignment of the maxillary incisors.

Perspectives of Indonesian Orthodontists on the Ideal Orthodontic Treatment Time

OBJECTIVE

The aim of this study was to explore the types of orthodontic treatment provided by Indonesian orthodontists and to analyse their perspectives on the ideal time to initiate orthodontic treatment.

MATERIALS AND METHODS

A cross‑sectional survey was conducted using the Google Drive questionnaire template. This electronic questionnaire was sent to a sample of orthodontists across different regions of Indonesia. The participants were asked to report the stage at which they would start orthodontic treatment, as well as answer questions about occlusal abnormalities and functional problems. Descriptive statistics for all variables were determined, including both practice characteristics and orthodontic treatment timing.

RESULTS

A total of 152 orthodontists agreed to participate in the study, of which 64.5% were female and 35.5% were male. Indonesian orthodontists prefer two-phase orthodontic treatment. Sucking habits and open bite were found to be the most frequent indications for treatment in the primary dentition. Anterior crossbite was found to be the most frequent indication for treatment during the early mixed dentition stage. Severe Class II was found to be the most frequent indication for treatment during the late mixed dentition stage. Indonesian orthodontists are more concerned about impacted canines and midline diastema than other occlusal deviations in the permanent dentition.

CONCLUSION

Based on the results of this study, we can conclude that Indonesian orthodontists favor two-phase orthodontic treatment. They also prefer to treat sucking habits and open bite in the primary dentition, anterior crossbite in the early mixed dentition, and severe Class II during the late mixed dentition stage.

Assessment of orthodontic treatment need among tribal children of Indore division, Central India

Introduction

India is home to many tribes which have an interesting and varied history of origins, customs and social practices. Oral health care in tribal areas is limited due to shortage of dental manpower, financial constraints and the lack of perceived need for dental care among tribal masses.

Objective

To assess orthodontic treatment need among tribal children of Indore division, Central India.

Methods

A cross-sectional house to house survey was carried out among 800 tribal children aged 5 to 15 years old in two major tribal districts of Indore division. Permissions and consent were obtained from local administrative authorities, ethical committee and parents respectively. A structured proforma was used to record demographic data. Examination for dentofacial anomalies was conducted according to WHO 1997 survey methods. Descriptive tables and analytical tests like ANOVA, post-hoc and chi-square test were employed.

Results

The mean age was 9.75(±2.43) years. The mean DAI score among 12 to 15 years old children was 23.19±5.22. Female exhibited higher (24.51±5.34) mean DAI score compared to males (22.12±4.87) (p<0.05). The Patelia tribes (24.38±5.13) reported higher mean DAI score than Bhilala (23.02±5.69) and Bhil tribe (22.73±4.79) (p<0.005).

Conclusion

The tribal children had minor malocclusion with no or slight treatment need. Categorization of orthodontic treatment need according to malocclusion severity is particularly important for the planning of corresponding public policies. The isolation of the villages, lack of transportation options imposes limitations on the availability of health professionals to provide dental services.

Prediction of agenesis of the mandibular second premolar using the developmental stages of the mandibular canine, first premolar, and second molar

OBJECTIVE

The aim in this study was to suggest a standard for early diagnosis of agenesis of the mandibular second premolars (L5) by estimating the developmental stages of the mandibular canines (L3), first premolars (L4), and second molars (L7).

DESIGN

Among all 5136 pediatric patients aged 5-11 years who received panoramic radiographs between June 2008 and December 2009 at Seoul National University Dental Hospital, 215 control patients and 74 agenesis patients who met inclusion criteria were analyzed. The developmental stages of all L3, L4, L5, and L7 of control and agenesis patients were estimated using the method proposed by Demirjian. To identify the tooth (L3, L4, L7) with the developmental pattern most similar to that of L5, Kendall rank correlation coefficients and Bootstrap method were used. To verify that patients with agenesis of L5 show delayed development, Wilcoxon rank sum test was used. To identify the stages in which to diagnose agenesis of L5, we performed survival analysis.

RESULTS

There was a significant correlation between the developmental stages of L3, L4, L7 and L5. The developmental stages of those three teeth in the agenesis group were delayed compared with those in the control group at certain ages. If the developmental stages of at least two of those three teeth reach Demirjian stage D without the calcification of L5, agenesis of L5 can be confirmed.

CONCLUSIONS

Agenesis of L5 can be confirmed when two of the three teeth (L3, L4, L7) reach Demirjian stage D.

Association between oral habits, mouth breathing and malocclusion

The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.

Malocclusion and early orthodontic treatment requirements in the mixed dentitions of a population of Nigerian children

INTRODUCTION

The aims of this study were to establish the prevalence of dental features that indicate a need for early intervention and to ascertain the prevalence of different methods of early treatment among a population of Nigerian children in mixed dentition.

METHODS

Occlusal relationships were evaluated in 101 children in mixed dentition between the ages of 6 and 12 years who presented at the Orthodontic Unit, Department of Child Dental Health, Lagos University Teaching Hospital over a 2 years period. The need for different modes of early orthodontic treatment was also recorded.

RESULTS

Anterior tooth rotations (61.4%) and increased overjet (44.6%) were the most prevalent occlusal anomalies. Others included deep bite (31.7%), reverse overjet (13.9%), and anterior open bite (14.8%). Severe maxillary spacing and crowding were exhibited in 12.0% and 5.0%, respectively. About a third (35.7%) of the subjects presented with crossbite while lip incompetence was observed in 43.6% of the subjects. About 44% of the subjects also presented with various oral habits with digit (15.8%) and lip sucking (9.9%) being the most prevalent. Subjects were recommended for treatment with 2 by 4 fixed orthodontic appliances (22.3%), habit breakers (20.7%), removable orthodontic appliances (16.5%), and extractions (15.7%).

CONCLUSIONS

Increased overjet and anterior tooth rotation were the majority of occlusal anomalies seen, which are not only esthetically displeasing but may also cause an increased susceptibility to trauma to these teeth. Treatment options varied from extractions only to the use of appliance therapy.

Early vs late orthodontic treatment of tooth crowding by first premolar extraction: A systematic review

OBJECTIVE

To investigate the body of evidence in the literature about the most favorable time for initiating orthodontic treatment in patients with severe crowding caused by tooth size arch length deficiency (TSALD).

MATERIALS AND METHODS

Electronic databases (PubMed, Ovid Medline, Scopus, Virtual Health Library, and The Cochrane Library) were searched for articles published between 1900 and April 2014. Studies were included that evaluated treatment of patients with severe crowding caused TSALD, who were treated with first premolar extraction. The association between the stage of development of occlusion at which treatment was started, and the primary and/or secondary outcomes of early and late treatment were investigated.

RESULTS

After application of the eligibility criteria and reading of the full texts, six articles were included in the final review. Of these six articles, all of which were retrospective, four showed that the primary outcome (correction of severe crowding) of the early and late groups was improved, but without statistically significant differences after treatment. Therefore, the findings of secondary outcomes in the literature (postretention crowding relapse, duration of total and active treatment [treatment with appliances], external apical root resorption, and soft tissue profile) were the target of this study. These studies presented low or moderate methodological quality and control of bias.

CONCLUSIONS

Both early and late extraction had a similar effect on correction of crowding. Early treatment had two favorable secondary outcomes (less relapse and reduced active treatment time) vs late treatment. However, the levels of evidence were not sufficient to assert which protocol was superior.

Εvaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children

AIM

To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment.

METHODS

Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded.

RESULTS

Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545).

CONCLUSIONS

The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

Two-phase treatment of skeletal class II malocclusion with the combination of the twin-block appliance and high-pull headgear

The patient was a boy with a Class II skeletal and dental relationship, a large overjet, an impinging overbite, and a steep mandibular plane angle. Treatment started with the Twin-block appliance combined with high-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior and vertical planes, and improve his profile. This was followed by extraction of the maxillary second premolars and the mandibular first premolars. Then fixed appliances were used to align and level the dentition. Pretreatment and posttreatment records are shown, and the treatment results are stable 2 years after debonding.

The nance lingual arch: an auxiliary device in solving lower anterior crowding

After exfoliation of the primary incisors and eruption of the permanent incisors, the dentist has the opportunity of observing closely the beginning of occlusal changes. In several cases, alterations, such as lower anterior crowding, can be prevented and treated with proper follow-up. In the mixed dentition, one of the mechanisms for maintaining space and favoring dental alignment is to preserve leeway space before permanent second molar irruption. Among the devices with this function, the Nance lingual arch helps maintaining the position of the permanent mandibular molars and incisors after a premature loss of the primary canines. This paper describes the applicability of Nance lingual arch for preserving leeway space, thus contributing for correction of lower anterior crowding.

Mandibular open-close motion in children with anterior crossbite occlusion

Anterior crossbite (ACB) malocclusions are frequent; however, its characteristic functional features have not been fully described. The purpose of this study was to determine the characteristics of habitual mandibular open-close motion in children with ACB of their primary dentition. Two groups of children were selected for study; 17 with ACB (eight boys and nine girls; four years one month to seven years one month) and 19 with normal occlusion (eight boys and 11 girls; four years six months to six years seven months). The motion was recorded using an optoelectronic analysis system with six degrees-of-freedom. Mandibular incisor and condylar motion were analyzed by measuring their three-dimensional ranges and trajectories. Also estimated incisor and condylar pathways of the two groups were compared. Patients with ACB opened wider with more anterior-posterior condylar translation and more mandibular rotation. Although between-subject (inter-individual) variance of all variables in children with ACB was larger, they had less within-subject variance at the condyles. These results indicate that open-close mandibular motion in children with ACB is completely different from that of children with normal occlusion. The different motions might be related to morphological differences between the two groups.

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.

Appropriateness of orthodontic referrals: self-perceived and normative treatment needs of patients referred for orthodontic consultation

OBJECTIVES

The aims of this prospective study were to evaluate the self-perceived and normative orthodontic treatment needs of children referred for orthodontic consultation and to determine the proportion of children who were inappropriately referred.

METHODS

The sample consisted of 257 children with a mean age of 12.0 years (SD = 2.4). An orthodontist assessed the children's normative treatment need using the dental health component (DHC) of the index of orthodontic treatment need (IOTN), and for patients in the mixed dentition the need for interceptive treatment was assessed. Questionnaires were answered by both the child and the parent to assess satisfaction with dental appearance and desire for treatment.

RESULTS

The distribution of the IOTN grades showed that 73% of the children had definite need while 27% had borderline/no need for orthodontic treatment. Twenty-six per cent of children and 17% of parents did not express orthodontic concern, even though more than half of these children were in definite need of treatment as assessed by IOTN. The children's orthodontic concern was significantly related to the DHC scores. Out of the 103 children who were in the mixed dentition, only about 16% required interceptive treatment.

CONCLUSIONS

The results indicated that a significant number of children were inappropriately referred for orthodontic treatment. Referring dentists need to assess the normative treatment needs of the children as well as the children's and parents' commitment and desire for orthodontic treatment before deciding on the need for referral.