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Title: Orthodontic treatment for prominent lower front teeth (Class III incisors) in children : a Cochrane systematic review
Author: Watkinson, Simon
ISNI:       0000 0004 5356 2146
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2014
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Objectives: To assess the effects of orthodontic treatment for Class III incisors in children and adolescents. Design: A Cochrane systematic review. Method: The following databases were searched up to 7th January 2013: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID. Selection criteria: All randomised controlled trials of orthodontic treatments to correct Class III incisors. Trials were eligible for inclusion in the review if they recruited children and/or adolescents (aged 16 or less) receiving orthodontic treatment to correct Class III incisors. Trials including patients with a cleft lip and/or palate or other cranio-facial deformity/syndrome were excluded as were trials that had recruited less than 80% children or adolescents or patients who had previously received surgical orthognathic treatment. Active interventions included: orthodontic braces, chin cups, facemasks, reverse headgear, bone-anchored appliances or any other intra or extra-oral appliance aiming to correct Class III incisors. Controls included: No treatment, delayed treatment, other active intervention. Types of Outcome Measures - Primary: Prominence of the lower front teeth (measured in mm or by any index of malocclusion). Secondary: Relationship between upper and lower jaw; psychosocial measures; patient satisfaction; jaw joint problems. Adverse effects: Health of the gums; damage to the teeth e.g. tooth decay. Outcomes were recorded at all ages reported. The results were reported according to the most common endpoints. Adverse effects were recorded and the results reported in descriptive terms. Data collection and analysis: The titles and abstracts of the search results were examined to exclude obviously irrelevant reports. Full text reports of potentially eligible studies were examined for compliance with the eligibility criteria. Screening of references, data extraction and assessment of the risk of bias of included studies, was performed independently and in duplicate by two review authors. The mean differences, with 95% confidence intervals, were calculated for continuous data. Meta-analysis was only used when studies of similar comparisons were reporting comparable outcome measures. A fixed-effect model was used. I2 statistics were used as measures of statistical heterogeneity. Results: Seven randomised controlled trials were included in this review. Of these, four reported on the use of a facemask, two on the chin cup, one on the tandem traction bow appliance and one on mandibular headgear. One study reported on both the chin cup and mandibular headgear appliances. Three trials (n=155) reported ANB differences immediately after treatment with a facemask when compared to an untreated control. The pooled data, for ANB difference, showed a statistically significant mean difference of 3.93 degrees (95%CI 3.46 to 4.39; P<0.0001) in favour of the facemask. There was significant heterogeneity between these studies (I2=82%). One well designed trial, with a low risk of bias, reported outcomes of the use of the facemask compared to an untreated control at 3 years’ follow-up. This showed that improvements in overjet and ANB were still present at 3 years. However, there was no evidence of improved self-concept. The remaining trials each evaluated a different comparison and reported different outcomes so no meta-analysis was possible. Conclusions: There is some evidence that the use of a facemask, to correct prominent lower front teeth in children, is effective when compared to no treatment on a short term basis. However, in view of the general poor quality of the included trials, these results should be interpreted with caution. Further randomised controlled trials, with long follow-up, are required.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.D.Sc.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RK Dentistry