Orthodontic treatment without surgery in children and adolescents: overview of systematic reviews
Report
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This report includes systematic reviews on the effect of orthodontic treatment without surgery on deep bite, excess space and crowding.
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Key message
This report includes systematic reviews on the effect of orthodontic treatment without surgery on deep bite, excess space and crowding. Retention and relapse treatments, as well as orthodontic treatments used across different malocclusions are also included. We have looked especially for adverse events.
Effect of orthodontic treatment on malocclusion:
- Orthodontic treatment reduces overbite compared to no treatment.
- Treatment in two phases, before and after the child is 11 years old, with functional appliances or headgear, may give a small or no difference in overbite compared to treatment in one phase treatment.
- Treatment in two phases probably decrease incisal trauma compared to one phase treatment in children with a large overbite.
- Surgical anchorage probably decreases unwanted movement of molars compared to conventional treatment.
- In maintenance therapy after the completion of the treatment phase removable appliances may result in a deviation somewhat larger than for fixed appliances.
- Removable appliances may induce less gingival bleeding than non-removable appliances in maintenance therapy.
Adverse effects of orthodontic treatment:
- Removable appliances may induce less gingival bleeding than non-removable appliances in maintenance therapy.
Summary
Background
Orthodontic treatment corrects teeth and jaws that are not in a functional alignment. The treatment varies from moving one tooth into the correct position to more extensive treatment such as moving several teeth or alter the relative position of the upper and lower jaw to obtain a functional bite. The aim is to improve function and prevent increasing malocclusion. Otrhodontic treatment varies from small interventions to interventions that could last for several years.
Mainly children and young people are referred for orthodontic treatment. A specialist in orthodontic treatment does the diagnostic assessment, prevents and treats malocclusion to improve function, reduce risk of damage to the peridontium and prevent stress on the joints in the jaw. Documentation such as X-rays, photo, bite registration and impressions are gathered in order to make models to decide the type of treatment. Treatment options included fixed and removable appliances. Fixed, where braces are fixed to the teeth, are the most common and is used to move the affected teeth to the optimal direction. Removable plates is another option as well as adjunctive treatment with headgear.
Objective
This report includes systematic reviews on the effect of orthodontic treatment on deep bite including overbite, excess space and crowding. Retention and relapse treatments, as well as orthodontic treatments used across different malocclusions are also included. We have especially looked for adverse events.
Method
We searched the following databases: the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, MEDLINE, Embase, Epistemonikos, SveMed from 2000 until March 2016.
The search terms contain subject headings and text words for orthodontics (i.e. orthodontics, dental braces, dentofacial orthopedics) and search words for systematic reviews (i.e. systematic review, meta-analysis).
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Study design |
Systematic reviews of high methodological quality including randomised controlled trials, controlled trials, interventions studies using interrupted time series design and cohorts. |
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Population: |
Children and young people under 20 years with malocclusion |
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Intervention: |
Orthodontic treatment without surgery |
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Comparison: |
Adjunctive treatment or no treatment |
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Outcome: |
Malocclusion Function (i.e chewing function and speech) Jaw joint (i.e. pain and opening ability) Quality of life (measured with validated instruments) Adverse effects (i.e. caries, gingival defects, peridontis and shortened roots of teeth) |
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Language: |
All which include an English abstract |
Title and abstracts were identified and independently reviewed against the selection criteria by two authors independently. Relevant reviews were critically appraised with standardised checklists by one or two authors. Data extracted from the included systematic review were study design, number of participants, sex, description of interventions and relevant outcomes as they were presented in the reviews by one author. If the review authors had assessed the confidence in the results for relevant outcomes these were used, if not two authors assessed the confidence in the results. The results are presented in summary of findings tables.
Results
We included six systematic reviews with high methodological quality. Four reviews include all together 57 studies while two of the reviews did not identify any studies meeting the selection criteria.
Three of the six included reviews assessed treatment of overbite, one assessed the effect of how anchorage in orthopedic treatment can be performed and two assessed prevention and retention treatment.
The four include reviews showed:
- Orthodontic treatment reduces overbite compared to no treatment.
- Treatment in two phases, before and after the child is 11 years old, with functional appliances or headgear, may give a small or no difference in overbite compared to treatment in one phase.
- Treatment in two phases probably decrease incisal trauma compared to one phase treatment in children with large overbite.
- Surgical anchorage probably decreases unwanted movement of molars compared to conventional treatment.
- In maintenance therapy, removable appliances may result in a deviation somewhat larger than for fixed appliances.
- Removable appliances may induce less gingival bleeding than non-removable appliances in maintenance therapy.
Summary of the confidence of the documentation:
The review authors reported that the included studies were small and had risk of biases. This implies that we have little or very little confidence for most of the comparisons and outcomes.
Discussion
The included systematic reviews do not cover all the treatments and outcomes we wanted to assess. The table of excluded studies gives a short description of the studies and in brief the conclusions made by the authors. All the identified overviews are published in a separate publication.
Need for further research
- None of the reviews reported long term outcomes on quality of life and malocclusion.
- No reviews were identified on orthodontic treatment of children and young persons with composite malfunctions in need of orthodontic treatment.
- We know little of side effects and complications as we found these issues to be poorly reported.
- No reviews addressed excess space and crowding.
- We know very little of adverse effects as this was not reported extensively in the studies the reviews included.
- We do not know about the effect of orthodontic treatment compared to no treatment in children with deep bite and retroclined upper front teeth.
Conclusion
Orthodontic treatment seem to improve malocclusion, but it is uncertain what kind and for how long retention treatment is needed. Treatment in two phases (before and afte 11 years) for overbite probably gives no difference in treatment effect compared to one-phase treatment, but probably decrease incisal trauma compared to one phase treatment in children with large overbite. In maintenance therapy, removable appliances may induce less gingival bleeding than non-removable appliances. The evidence base for several of the treatments are lacking, for example long-term effect of treatment of overbite and treatment and excess space and crowding. Neither do we know how quality of life is affected over time.
