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Title Orthodontic Treatment of Class II Malocclusion During Early Childhood Does Not Produce Better Clinical Outcomes, Compared to Treatment During Adolescence
Clinical Question In children with class II malocclusion, does treatment with orthodontics during childhood produce better clinical outcomes compared to later treatment during adolescence?
Clinical Bottom Line Treating children with class II malocclusion at a younger age versus during adolescence does not produce better clinical outcomes; however it might reduce trauma to the upper incisors.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24226169Thiruvenkatachari/2013721 children or adolscents in 17 studiesMeta-Analysis
Key resultsFor orthodontic treatment during childhood the mean difference of the final overjet was -4.17 [-4.61, -3.73], 95% CI, and P value < 0.00001. The mean difference of the final overjet after treatment only during adolescents was -5.22 [-6.51, -3.93], 95% CI, and P value < 0.00001. Therefore, both approaches to treatment produce statistically significant but similar reduction in final overjet. However, there is a significant reduction in the incidence of trauma to the upper incisors in the group treated during childhood versus the group that was treated during adolscence. Early treatment did not show statistically significant results of new trauma. However, there was increased trauma in patients treated during adolescence.
Evidence Search (early[All Fields] AND orthodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND Meta-Analysis[ptyp]
Comments on
The Evidence
Validity: This article is a meta-analysis of 17 random controlled trials with 721 patients involved. The authors used multiple databases to search for trials that appertained to children or adolescents below 16 years of age, and on treatment with any type of orthodontic appliance; compared to late treatment with any type of orthodontic appliance to correct prominent upper incisors. Researchers assessed the risk of bias in the trials independently. Perspective: The randomized controlled trials were from all over the world. Many articles included in the study were considered to be high risk of bias, so this could affect the validity. Furthermore, the risk of bias increases in childhood orthodontic treatment studies where patients have to be treated and followed in two phases for many years. This makes it difficult to obtain unbiased results.
Applicability Many parents are concerned about their children’s prominent upper front teeth. They have to decide whether their child undergoes orthodontic treatment at a young age or later as an adolescent. There are many things to take into consideration when deciding to put a young child through orthodontic treatment, including poor oral hygiene, increased caries risk, trauma, and costs. There is no evidence to support the thesis that starting orthodontic treatment during childhood will produce better clinical outcomes, compared to foregoing treatment until adolescence. However, there is evidence that supports the fact that treatment initiated during childhood decreases the risk of trauma to the upper incisor teeth.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Incisal trauma, class two malocclusion, adolescent orthodontic treatment, treatment of children, early orthodontic treatment, prominent incisors
ID# 3021
Date of submission: 03/11/2016spacer
E-mail kellerk@livemail.uthscsa.edu
Author Keri Keller
Co-author(s) e-mail
Faculty mentor/Co-author Peter Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail gakunga@uthscsa.edu
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