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

Klaus Batista, Badri Thiruvenkatachari, Jayne Harrison, Kevin O'Brien

Plain language summary: Orthodontic treatment for prominent upper front teeth in children

Review question
This review, carried out by authors working with Cochrane Oral Health, has been produced to assess the effects of orthodontic treatment (treatment by dentists who specialise in the growth, function and position of teeth and jaws) for prominent upper front teeth in children.

The review looks at whether this treatment is best initiated at seven to 11 years old (early treatment in two phases), or in adolescence, at around age 12 to 16 years (late treatment in one phase). The use of different types of braces was also assessed.

Prominent (or sticking out) upper front teeth are a common problem in children around the world. For example, this condition affects 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 (dentists who specialise in the growth, function and position of teeth and jaws). This condition develops when the child's permanent teeth erupt.

Children are often referred to an orthodontist, for treatment with dental braces, to reduce the prominence of the teeth. Prominent upper front 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 adolescence.

In 'early treatment', treatment is given in two phases: first at an early age (seven to 11 years old) and again in adolescence (around 12 to 16 years old). In 'late treatment' (one phase), there is only one course of treatment in adolescence.

As well as the timing of treatment, this review also looked at the different types of braces used: removable, fixed, functional, or head-braces.

Study characteristics
This review is based on 27 studies including 1251 participants. Participants were children and adolescents aged under 16 years who had prominent upper front teeth (Class II Division 1 malocclusion). The evidence in this review is up to date as of 27 September 2017.

Key results
The evidence suggests that providing orthodontic early treatment to children with prominent upper front teeth reduces the incidence of damage to upper incisor teeth significantly (middle four teeth at the top) as compared to treatment that is provided in one phase in adolescence. There are no other advantages of providing a two-phase treatment (i.e. between age seven to 11 years and again in adolescence) compared to treatment in one phase in adolescence.

The evidence also suggests that providing treatment with functional appliances for adolescents with prominent upper front teeth, significantly reduces their prominence when compared to adolescents who did not receive any treatment. The studies did not suggest that any particular appliance was better than any other for reducing teeth prominence.

Quality of the evidence
The overall quality of the evidence is low for most comparisons and outcomes, therefore further research is needed and may change the findings.

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Citation: Batista KBSL, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD003452. DOI: 10.1002/14651858.CD003452.pub4.