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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Available from: Kevin D O'Brien, Oct 14, 2015
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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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    ABSTRACT: Deep bite occurs in about 15% to 20% of the US population. Currently, it is unknown which types of correction are most efficient or stable. The purpose of this systematic review was to investigate factors related to stability of deep-bite correction. An electronic search of 4 databases was performed from January 1, 1966 to June 27, 2012. Studies were considered for inclusion if they reported on deep bite samples that underwent orthodontic treatment in the permanent dentition. Records were required at the initial, posttreatment, and 1-year posttreatment times. Hand searching of reference lists of the included studies was performed. Data were abstracted using custom forms, and risk of bias was assessed using a modified Newcastle-Ottawa Scale. Twenty-six studies met the inclusion criteria. Most were case series, with considerable potential for bias. The significant heterogeneity of the studies precluded meta-analyses, and only descriptive statistics and stratified comparisons were reported. On average, patients underwent significant overbite improvement during treatment, and most of the correction was maintained long-term. Across all studies, the mean initial overbite, posttreatment overbite, and long-term overbite were 5.3, 2.6, and 3.4 mm, respectively. Initial severity appeared to be related to long-term stability. However, this relationship was difficult to isolate from other factors. The length of follow-up did not appear to be related to the amount of relapse. Although the quality of the current evidence is not high, patients with deep-bite malocclusion appear to undergo relatively successful treatment, and most of the correction appears to be stable.
    Journal of the World Federation of Orthodontists 09/2012; 1(3):e89-e86. DOI:10.1016/j.ejwf.2012.09.001
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    ABSTRACT: This paper reports a Class II, division 2 malocclusion case successfully treated at an early age and in a relatively short period of time using the Trainer for Kids (T4K), a prefabricated functional appliance. Skeletal changes observed in the before and after treatment cephalic radiographs were compared with the expected changes produced by the patient's natural growth. The functional appliance's effects resulting in the outcomes observed in this clinical case, as well as the importance of identifying the etiological factors when treating a malocclusion will be discussed.
    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: Introduction La Collaboration Cochrane est une organisation internationale scientifique à but non lucratif, dont l’objet est de produire et de diffuser des revues systématiques d’essais cliniques randomisés. L’objectif de ce travail est de lister les différentes revues systématiques Cochrane existantes en orthopédie dentofaciale, et d’analyser leurs principales caractéristiques. Matériel et méthodes La sélection des revues systématiques Cochrane en rapport avec l’orthopédie dento-faciale est effectuée à partir de la liste exhaustive publiée par le Groupe Cochrane pour la santé buccodentaire. Résultats Un total de 12 revues systématiques Cochrane en rapport avec l’orthopédie dento-faciale est recensé. Toutes concluent à la nécessité de conduire des essais cliniques randomisés avec une méthodologie plus adaptée, et réalisés sur des effectifs plus importants. Aucune de ces revues systématiques n’apporte des éléments de preuve solides en faveur de tel ou tel traitement ou modalité de traitement. Discussion Malgré l’absence de conclusions pertinentes issues des revues systématiques Cochrane encore peu nombreuses en ODF, leur consultation régulière s’avère un outil indispensable pour l’orthodontiste dans le cadre d’une démarche de pratique clinique quotidienne factuelle, mais aussi pour l’orthodontiste chercheur. En effet, la recherche clinique en ODF doit se développer, et permettre la mise en œuvre d’essais cliniques randomisés méthodologiquement indiscutables. Cependant, des études alternatives aux essais cliniques randomisés existent, à moindre niveau de preuves, mais peut-être plus adaptées à la spécificité de l’orthopédie dento-faciale.
    International Orthodontics 09/2010; 8(3):278-292. DOI:10.1016/j.ortho.2010.07.013
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