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Orthodontic treatment for prominent upper front teeth in children

  • Review
  • Intervention

Authors


Abstract

Background

Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. 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 early adolescence. When treatment is provided during adolescence the orthodontist may provide treatment with various orthodontic braces, but there is currently little evidence of the relative effectiveness of the different braces that can be used.

Objectives

To assess the effectiveness of orthodontic treatment for prominent upper front teeth, when this treatment is provided when the child is 7 to 9 years old or when they are in early adolescence or with different dental braces or both.

Search methods

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. The handsearching of the key international orthodontic journals was updated to December 2006. There were no restrictions in respect to language or status of publication.
Date of most recent searches: February 2007.

Selection criteria

Trials were selected if they met the following criteria:
design - randomised and controlled clinical trials;
participants - children or adolescents (age < 16 years) or both receiving orthodontic treatment to correct prominent upper front teeth;
interventions - active: any orthodontic brace or head-brace, control: no or delayed treatment or another active intervention;
primary outcomes - prominence of the upper front teeth, relationship between upper and lower jaws;
secondary outcomes: self esteem, any injury to the upper front teeth, jaw joint problems, patient satisfaction, number of attendances required to complete treatment.

Data collection and analysis

Information regarding methods, participants, interventions, outcome measures and results were extracted independently and in duplicate by two review authors.
The Cochrane Oral Health Group's statistical guidelines were followed and mean differences were calculated using random-effects models. Potential sources of heterogeneity were examined.

Main results

The search strategy identified 185 titles and abstracts. From this we obtained 105 full reports for the review. Eight trials, based on data from 592 patients who presented with Class II Division 1 malocclusion, were included in the review.

Early treatment comparisons: Three trials, involving 432 participants, compared early treatment with a functional appliance with no treatment. There was a significant difference in final overjet of the treatment group compared with the control group of -4.04 mm (95% CI -7.47 to -0.6, Chi2 117.02, 2 df, P < 0.00001, I2 = 98.3%). There was a significant difference in ANB (-1.35 mm; 95% CI -2.57 to -0.14, Chi2 9.17, 2 df, P = 0.01, I2 = 78.2%) and change in ANB (-0.55; 95% CI -0.92 to -0.18, Chi2 5.71, 1 df, P = 0.06, I2 = 65.0%) between the treatment and control groups.
The comparison of the effect of treatment with headgear versus untreated control revealed that there was a small but significant effect of headgear treatment on overjet of -1.07 (95% CI -1.63 to -0.51, Chi2 0.05, 1 df, P = 0.82, I2 = 0%). Similarly, headgear resulted in a significant reduction in final ANB of -0.72 (95% CI -1.18 to -0.27, Chi2 0.34, 1 df, P = 0.56, I2 = 0%).
No significant differences, with respect to final overjet, ANB, or ANB change, were found between the effects of early treatment with headgear and the functional appliances.

Adolescent treatment (Phase II): At the end of all treatment we found that there were no significant differences in overjet, final ANB or PAR score between the children who had a course of early treatment, with headgear or a functional appliance, and those who had not received early treatment. Similarly, there were no significant differences in overjet, final ANB or PAR score between children who had received a course of early treatment with headgear or a functional appliance.
One trial found a significant reduction in overjet (-5.22 mm; 95% CI -6.51 to -3.93) and ANB (-2.27 degrees; 95% CI -3.22 to -1.31, Chi2 1.9, 1 df, P = 0.17, I2 = 47.3%) for adolescents receiving one-phase treatment with a functional appliance versus an untreated control.
A statistically significant reduction of ANB (-0.68 degrees; 95% CI -1.32 to -0.04, Chi2 0.56, 1 df, P = 0.46, I2 = 0%) with the Twin Block appliance when compared to other functional appliances. However, there was no significant effect of the type of appliance on the final overjet.

Authors' conclusions

The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence.

摘要

背景

針對上顎前齒前突之孩童的矯正治療

以矯正學的觀點來看,前突的上顎前齒是容易遭來受傷的。這個情形常見於小孩長牙時期,也常常因此轉診至矯正醫師,利用矯正器來改善過於前突的牙齒。如果小孩在很小的時候就被轉診過來,矯醫師就面面臨一個難題:到底應該早期介入治療?還是應該等到小孩年紀到青春期,可接受不同方式的治療時,再介入呢?但是目前對於使用何種矯正方式較有效率的議題,仍沒有足夠的證據。

目標

為了去評估矯正治療對前突上顎門齒的效率,收集的樣本是包括有做治療且介於7到9歲的小朋友,或者是在青春期早期或使用不同矯正器,或者包括上述兩者。

搜尋策略

作者搜尋了Cochrane Oral Health Group's Trials Register、 CENTRAL、MEDLINE及EMBASE,另外也手動搜尋了2006年12月前的international orthodontic journals的關鍵字。並且排除了語言或發表形式的困難,而最近的一次搜尋是2007年2月。

選擇標準

而納入參考文獻的條件包括以下幾點:首先是實驗設計,必須是隨機且有對照組的臨床試驗。而樣本必須是小孩或小於16歲的青少年,或者接受過矯正治療改善前牙前突者。 而治療方式則包括接受治療組與對照組,接受治療組則包含有上矯正器或頭帽者,對照組則是未接受治療,延後治療,或接受其他種治療方式者。 初部評估前牙前突程度及上下顎骨相對關係。而後再評估包括自信心,前牙受傷與否,顎關節情形,患者滿意度,所需回診次數等等。

資料收集與分析

將所需資料拮取出來,包括實驗方法,樣本,治療方式,結果評估等,以獨立地複製給兩位作者,並遵照Cochrane Oral Health Group的統計準則,以隨機模式計算出平均差。並且考慮可能產生異質性的原因。

主要結論

總共搜尋到185個相關標題及摘要,由其中取得105個完整報告做為回顧,其中包括了8篇文章是由592位Class II Division 1 malocclusion的患者呈現的資料。早期治療方面,有3篇文章,共有432位受試者,比較了功能性咬合裝置及未接受治療。發現在最終水平覆咬部份,實驗組與對照組有顯著差異,約 −4.04mm(95%信賴區間: −7.47到 −0.6,卡氏平方為117.02,自由度為2,p值小於0.00001,I2為98.3%)。而在ANB角度有顯著差異,為 −1.35(95%信賴區間: −2.57到0.14,卡氏平方為9.17,自由度為2,p值為0.01,I2為78.2%),另外在ANB角度變化也有顯著差異,為 −0.55(95%信賴區間: −0.92到 −0.18,卡氏平方為5.71,自由度為1,p值為0.06,I2為65.0%)。 而若比較頭帽組及對照組,則發現有少許卻顯著的差異,在水平覆咬部份為 −1.07mm(95%信賴區間: −1.63到 −0.51,卡氏平方為0.05,自由度為1,p值為0.82,I2為0%)。同樣地,接受頭帽治療的組別在最終ANB角度有顯著差異,為 −0.72(95%信賴區間:1.18到 −0.27,卡氏平方為0.34,自由度為1,p值為0.56,I2為0%),而在最終水平覆咬,ANB角度變化,則是沒有顯著相關。 而青春期的治療(第二階段治療),在治療最終時的ANB及巴氏評分與有無接受過治療的孩童無顯著差異,相同地,在有接受過治療的孩童的最終ANB角度及巴氏評分與無接受過治療的孩童無顯著差異。 有一篇研究則是針對青春期患者接受一階段治療與未接受治療的比較中,指出在水平覆咬減少量為 −5.22mm(95%信賴區間: −6.51到 −3.93)及ANB角度為 −2.27度(95%信賴區間: −23.22到 −1.31,卡氏平方為1.9,自由度為1,p值為0.17,I2為47.3%)是有顯著差異的。而在win Block與其他功能性矯裝置比較,發現ANB角度有顯著差異為 −0.68度(95%信賴區間為 −1.32到 −0.04,卡氏平方為0.56,自由度為1,p值為0.46,I2為0%)。但是在使用何種治療方裝置與最終水平覆咬並無明顯相關。

作者結論

本篇提供的證據顯示,相對於一階段治療,對有前突上顎門齒的年紀尚小的孩童進行治療,早期治療並非較有效率。

翻譯人

本摘要由臺灣大學附設醫院王簾綺翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於兒童前突上顎門齒的矯正治療 前突的上顎門齒是容易導致受傷的,因此需要進行矯正治療。常見的情況是在恒牙剛萌發出來的孩童,即被帶往矯正門診評估矯正治療。當孩童來診時年紀尚小,矯正醫師則面臨兩難的問題,到底是早期治療或者等孩童年紀再大一點時才介入?而本篇提供的證據顯示,對有前突上顎門齒的年紀尚小的孩童進行治療,分成二階段治療,相對於一階段治療,並無較優勢。

Plain language summary

Orthodontic treatment for prominent upper front teeth in children

Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. 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 early adolescence.
The evidence suggests that providing orthodontic treatment, for children with prominent upper front teeth, in two stages does not have any advantages over providing treatment in one stage, when the children are in early adolescence.

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