Orthodontic treatment for deep bite and retroclined upper front teeth in children

University Dental School and Hospital, Oral Health and Development, Wilton, Cork, Ireland.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; DOI: 10.1002/14651858.CD005972.pub2
Source: PubMed


Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth.
To establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. The handsearching of the main international orthodontic journals was updated to April 2006. There were no restrictions with regard to publication status or language of publication. International researchers, likely to be involved in Class II division 2 clinical trials, were contacted to identify any unpublished or ongoing trials.
Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.
Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.
No RCTs or CCTs were identified that assessed the treatment of Class II division 2 malocclusion in children.
It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

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Article: Orthodontic treatment for deep bite and retroclined upper front teeth in children

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    • "Additionally, it is unclear whether pretreatment severity, extractions of premolars, or differing methods of retention are related to long-term stability of deep-bite correction. Some systematic reviews have investigated intrusion of incisors [4] or treatment for Class II, Division 2 malocclusion [5], however, we are unaware of any systematic review that addresses long-term stability of deep-bite treatment. The purpose of this systematic review was to investigate stability of orthodontically corrected deep-bite malocclusions. "
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    The Journal of clinical pediatric dentistry 02/2008; 32(4):325-9. DOI:10.17796/jcpd.32.4.8833x52755364hx4 · 0.35 Impact Factor
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    ABSTRACT: The Cochrane Collaboration is an international scientific not-for-profit organization the purpose of which is to produce and distribute systematic reviews of randomized clinical trials. The aim of this paper is to list the different existing Cochrane systematic reviews in the field of dentofacial orthopedics (DFO) and to analyse their main features. The choice of Cochrane systematic reviews based on dentofacial orthopedics was made from the exhaustive list published by the Cochrane Oral Health Group. A total of 12 systematic Cochrane reviews related to dentofacial orthopedics were listed. All concluded on the need to conduct randomized clinical trials using more appropriate methodologies and comprising larger samples. None of these systematic reviews offered clear proof supporting any one form of treatment or treatment modality. Despite the lack of relevant conclusions in the still meagre number of Cochrane systematic reviews related to DFO, it is essential for orthodontists to regularly consult the reviews in the framework of their daily evidence-based orthodontic practice. This is true too for orthodontic researchers as clinical DFO research needs to be extended with the setting up of methodologically unquestionable randomized clinical trials. However, there exist alternatives to randomized clinical trials offering a lower level of proof but which are better suited to the field of dentofacial orthopedics.
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