Early-phase treatment of prominent upper front teeth in children may have benefits

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. Continue reading

No evidence from RCTs on effectiveness of orthodontic treatment for deep bite and retroclined teeth

Orthodontics is concerned with growth of the jaws and face, development of the teeth, and the way teeth and jaws bite together. Ideally, the lower front teeth bite in the middle of the back surface of the upper front teeth. When the lower front teeth bite further behind the upper front teeth than ideal, this is known as a Class II malocclusion. A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (vertical overlap of the front teeth), which can cause oral problems and may affect appearance. This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. These braces can be removed from the mouth and this approach does not usually require removal of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.

An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth. If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed arch placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).

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Two-phase orthodontic treatment can significantly reduce damage to incisor teeth

Malocclusion Class IIProminent (or sticking out) upper front teeth are a common problem affecting about a quarter of 12 year-old children in the UK.  This condition can develop when a child’s permanent (adult) teeth erupt, and children are often referred 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 distress.  In two phase treatment, treatment is given first at an early age (7-11) and then again in adolescence (11-16). In one phase treatment, there is only one course of treatment, in adolescence. This review looks at whether one or two stage treatment is more effective, and also looks at the different types of braces used. Continue reading