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The Cochrane Database of Systematic... Aug 2014A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth, the lower jaw may have to move to one side... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth, the lower jaw may have to move to one side to allow the back teeth to meet together. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth while others are directed at treating the cause of the posterior crossbite (e.g. breathing problems or sucking habits). Most treatments have been used at each stage of dental development. This is an update of a Cochrane review first published in 2001.
OBJECTIVES
To assess the effects of orthodontic treatment for posterior crossbites.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 21 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 21 January 2014), and EMBASE via OVID (1980 to 21 January 2014). We searched the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, screened the results of the electronic searches, and extracted data and assessed the risk of bias of the included studies. We attempted to contact the first named authors of the included studies for missing data and for clarification. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous (event) data, and mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models (we would have used random-effects models if we had included four or more studies in a meta-analysis) when comparisons and outcomes were sufficiently similar.
MAIN RESULTS
We included 15 studies, of which two were at low risk of bias, seven were at high risk of bias and six were unclear. Fixed appliances with mid-palatal expansionNine studies tested fixed appliances with mid-palatal expansion against each other. No study reported a difference between any type of appliance. Fixed versus removable appliancesFixed quad-helix appliances may be 20% more likely to correct crossbites than removable expansion plates (RR 1.20; 95% CI 1.04 to 1.37; two studies; 96 participants; low-quality evidence).Quad-helix appliances may achieve 1.15 mm more molar expansion than expansion plates (MD 1.15 mm; 95% CI 0.40 to 1.90; two studies; 96 participants; moderate-quality evidence).There was insufficient evidence of a difference in canine expansion or the stability of crossbite correction.Very limited evidence showed that both fixed quad-helix appliances and removable expansion plates were superior to composite onlays in terms of crossbite correction, molar and canine expansion. Other comparisonsVery limited evidence showed that treatments were superior to no treatment, but there was insufficient evidence of a difference between any active treatments.
AUTHORS' CONCLUSIONS
There is a very small body of low- to moderate-quality evidence to suggest that the quad-helix appliance may be more successful than removable expansion plates at correcting posterior crossbites and expanding the inter-molar width for children in the early mixed dentition (aged eight to 10 years). The remaining evidence we found was of very low quality and was insufficient to allow the conclusion that any one intervention is better than another for any of the outcomes in this review.
Topics: Adolescent; Child; Child, Preschool; Humans; Orthodontic Appliances; Orthodontic Retainers; Orthodontics, Corrective; Overbite; Palatal Expansion Technique; Randomized Controlled Trials as Topic; Temporomandibular Joint Dysfunction Syndrome
PubMed: 25104166
DOI: 10.1002/14651858.CD000979.pub2 -
American Journal of Orthodontics and... Jun 2023The objective of this study was to investigate the predictability of overbite correction in patients with deepbite using the clear aligners (Invisalign, Align...
INTRODUCTION
The objective of this study was to investigate the predictability of overbite correction in patients with deepbite using the clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth.
METHODS
This retrospective study included 24 deepbite patients (10 males and 14 females; aged 32.8 ± 11.9 years; an initial overbite of 5.20 ± 0.95 mm; an average treatment period of 11.04 ± 4.14 months) consecutively treated from September 2016 and completed before August 2021. SmartTrack materials were used for all patients. The initial, predicted, and achieved final models were exported from ClinCheck and superimposed via best-fit surface-based registration using Slicer CMF (version 4.9.0; cmf.slicer.org). The overbite correction, changes in vertical movement, and inclination for individual teeth were measured. Descriptive statistics and a paired t test or Wilcoxon signed-rank test were performed. P <0.05 was considered statistically significant.
RESULTS
Mean overbite correction was 33%, with a 1.15 mm improvement after the first set of aligners. All teeth demonstrated statistically significant differences between planned and achieved amounts in vertical movement and inclination change, with the largest difference in maxillary central incisors. Mandibular incisor intrusion and mandibular premolar extrusion had similar accuracies. Regarding inclination change, maxillary central incisors showed the lowest accuracy of 13.3%.
CONCLUSIONS
Clear aligner treatment showed an average of 33% overbite correction. Overcorrection and additional refinement treatments are needed in most patients with a deepbite.
Topics: Male; Female; Humans; Overbite; Retrospective Studies; Tooth Movement Techniques; Malocclusion, Angle Class II; Orthodontic Appliances, Removable
PubMed: 36681525
DOI: 10.1016/j.ajodo.2022.07.019 -
The Angle Orthodontist Jan 2024To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose,...
OBJECTIVES
To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances.
MATERIALS AND METHODS
Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated.
RESULTS
From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases.
CONCLUSIONS
Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.
Topics: Adult; Humans; Female; Male; Overbite; Retrospective Studies; Malocclusion, Angle Class II; Orthodontic Appliances, Removable; Dental Care
PubMed: 37839803
DOI: 10.2319/030923-161.1 -
American Journal of Orthodontics and... Dec 2023This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed...
INTRODUCTION
This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances.
METHODS
Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org, Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org, Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated.
RESULTS
Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors.
CONCLUSIONS
The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible.
Topics: Adolescent; Humans; Child; Cephalometry; Orthodontic Appliances, Functional; Malocclusion, Angle Class II; Overbite; Mandible; Maxilla; Orthodontic Appliance Design
PubMed: 37598337
DOI: 10.1016/j.ajodo.2023.05.031 -
Dental Press Journal of Orthodontics 2023An increase in life expectancy was observed in the past years. Consequently, the knowledge of the maturational changes in the occlusion is highly important to guide...
INTRODUCTION
An increase in life expectancy was observed in the past years. Consequently, the knowledge of the maturational changes in the occlusion is highly important to guide clinicians during treatment planning.
OBJECTIVE
In this article, the occlusal and facial aging changes occurred during almost 50 years of follow-up are described. A normal occlusion sample from Bauru Dental School, University of São Paulo, Brazil, was evaluated at 13 (T1), 17 (T2) and 60 (T3) years of age. The maturational changes observed in digital dental models and cephalometric radiographs were presented. A revision of the aging process, under the gerontology and psychology perspectives, was also explored.
DISCUSSION
Maturational changes in non-treated individuals were very delicate. Mandibular crowding, decrease in the overbite, changes in the maxillary second molar position, increase in the clinical crown length, dental wear and discoloration were observed.
CONCLUSION
Compared to the remarkable facial and skin changes during aging, the occlusion seems to be the most stable feature of the face during the aging process.
FINAL CONSIDERATIONS
An adequate oral care throughout lifetime makes the smile the best memory of youth at mature ages.
Topics: Adolescent; Humans; Malocclusion; Overbite; Malocclusion, Angle Class II; Dental Occlusion; Molar; Mandible; Cephalometry; Maxilla
PubMed: 36790248
DOI: 10.1590/2177-6709.27.6.e22spe6 -
Journal of Orofacial Orthopedics =... Jan 2018Usually, morphological parameters of the teeth are recorded to help assess the indication for orthodontic treatment. It is assumed that significant deviations from...
BACKGROUND
Usually, morphological parameters of the teeth are recorded to help assess the indication for orthodontic treatment. It is assumed that significant deviations from average values compromise the quality of life. The aim of this study is to analyse the impact of overbite and overjet on oral health-related quality of life (OHRQoL) of children and adolescents.
PATIENTS AND METHODS
A total of 748 subjects, aged 9.5-15.5 years, participated in the LIFE child project of the University of Leipzig, where they underwent a general medical and dental examination. Overbite and overjet were measured, and aberrations of the OHRQoL were recorded by the probands themselves, who completed the German version of the Child Perceptions Questionnaire (CPQ-G11-14). The OHRQoL is divided into four domains ("oral symptoms", "functional limitations", "emotional well-being" and "social well-being") and is analysed by means of a CPQ score depending on age, gender, socioeconomic status and orthodontic treatment.
RESULTS
On average, the participants listed 10.5 (±13.1) problem issues on a CPQ scale ranging from 0 to 140. Subjects with current orthodontic treatment had a CPQ score about 2.5 (±2.4) higher than those without treatment. The aberrations were mainly observed in the domains "oral symptoms" and "functional limitations". Multiple linear regression showed that deviations of the overbite had only little influence on the OHRQoL, but deviations of an overjet-especially of >6 mm increased the CPQ summary score about 6 points.
CONCLUSION
Children and adolescents with overjet deviations of >6 mm in comparison to the norm are associated with significant limitations of the OHRQoL. However, overbite deviations have only little influence.
Topics: Adolescent; Child; Female; Germany; Humans; Male; Oral Health; Orthodontics, Corrective; Overbite; Quality of Life
PubMed: 29260241
DOI: 10.1007/s00056-017-0114-0 -
American Journal of Orthodontics and... Nov 2021Control of overbite is considered essential in achieving ideal orthodontic outcomes. Questions have been raised regarding the accuracy of ClinCheck software...
INTRODUCTION
Control of overbite is considered essential in achieving ideal orthodontic outcomes. Questions have been raised regarding the accuracy of ClinCheck software (Align Technology, Santa Clara, Calif) in predicting posttreatment outcomes with Invisalign, with the paucity of well-researched literature available on this topic. This research aimed to investigate and determine the accuracy of Invisalign (Align Technology) in correcting a deep overbite by comparing the outcomes predicted by ClinCheck with achieved posttreatment outcomes.
METHODS
A retrospective study was conducted using pretreatment and posttreatment intraoral scans and predicted outcome (ClinCheck) stereolithography files of 42 adult patients consecutively treated with Invisalign from January 2014 and completed before July 2018, selected from the files of 1 experienced orthodontist. Patients included in the study were treated without extractions and with a minimum of 14 dual arch Invisalign aligners using a 2-weekly aligner change protocol. The pretreatment, posttreatment, and predicted outcome stereolithography files for each patient were imported into Geomagic Control X (3D Systems, Rock Hill, SC) software to measure overbite.
RESULTS
The deeper the patient's initial overbite and the greater the amount of programmed reduction in overbite according to ClinCheck, the greater the discrepancy in overbite expression posttreatment. ClinCheck over-predicted overbite reduction in 95.3% of patients in which, on average, only 39.2% of the prescribed overbite reduction was expressed.
CONCLUSIONS
Overbite reduction may result in suboptimal outcomes when using the Invisalign appliance unless remedial measures are employed. The deeper the initial overbite, the more challenging it is to achieve the prescribed posttreatment overbite.
Topics: Adult; Humans; Malocclusion, Angle Class II; Orthodontic Appliance Design; Orthodontic Appliances, Removable; Orthodontists; Overbite; Retrospective Studies; Tooth Movement Techniques
PubMed: 34373153
DOI: 10.1016/j.ajodo.2020.06.042 -
Orthodontics & Craniofacial Research Nov 2019The primary purpose of this study was to statistically evaluate age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions among adults.
OBJECTIVE
The primary purpose of this study was to statistically evaluate age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions among adults.
SETTING AND SAMPLE POPULATION
A random sample of 8804 untreated US adults between 17 and 46 years of age was selected from the Third National Health and Nutrition Examination Survey data.
MATERIALS & METHODS
Three ethnic (non-Hispanic White, non-Hispanic Black and Mexican Americans) and three age (17-26, 27-36 and 37-46 years) groups were evaluated. Subjects with and without clinically meaningful malocclusions were categorized based on the established cut-off values. Chi-square analyses were performed to determine differences in prevalence.
RESULTS
The prevalence of clinically meaningful mandibular incisor irregularity, overjet and overbite increased significantly (P < 0.05) with age, while posterior crossbite decreased. There were statistically significant ethnic differences in the prevalence of incisor irregularity, overbite, overjet, open bite and reverse overjet. Males had a significantly higher prevalence of clinically meaningful mandibular incisor irregularity, overbite, open bite and reverse overjet than females. One-third of US adults exhibited no clinically meaningful malocclusions.
CONCLUSIONS
There are age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions that characterize approximately two-thirds of untreated US adults.
Topics: Adolescent; Adult; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class II; Middle Aged; Nutrition Surveys; Overbite; Prevalence; Young Adult
PubMed: 31152488
DOI: 10.1111/ocr.12328 -
Clinical Oral Investigations Oct 2022This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for...
OBJECTIVES
This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for orthodontic treatment by quantifying the Discrepancy Index (DI) and Index of Orthodontic Treatment Need (IOTN).
MATERIALS AND METHODS
Dental records of 48 ASD and 49 non-ASD consecutive patients aged between 9 and 18 years (median age 13.0 years) referred for orthodontic treatment were reviewed and compared. The Discrepancy Index (DI) was quantified to determine the malocclusion complexity, and the Index of Orthodontic Treatment Need (IOTN), including the Dental Health Component (IOTN-DHC) and Aesthetic Component (IOTN-AC), was quantified to determine the orthodontic treatment need. Statistical analysis included descriptive analysis, Pearson chi-square tests, Fisher's exact test, Mann-Whitney U tests, and several univariate and multivariate regression analyses. The statistical analysis used descriptive analysis, Pearson chi-square test, Fisher's exact test, and multivariate logistic regression.
RESULTS
The results show that both malocclusion complexity (DI, p = 0.0010) and orthodontic treatment need (IOTN-DHC, p = 0.0025; IOTN-AC p = 0.0009) were significantly higher in children with ASD. Furthermore, children with ASD had a higher prevalence of increased overjet (p = .0016) and overbite (p = .031).
CONCLUSIONS
Malocclusion complexity and orthodontic treatment need are statistically significantly higher among children with ASD than children without ASD, independent of age and sex.
CLINICAL RELEVANCE
Children with autism may benefit from visits to a dental specialist (orthodontist) to prevent, to some extent, developing malocclusions from an early age.
Topics: Adolescent; Autism Spectrum Disorder; Child; Esthetics, Dental; Health Services Needs and Demand; Humans; Index of Orthodontic Treatment Need; Malocclusion; Malocclusion, Angle Class II; Orthodontics, Corrective; Overbite
PubMed: 35701552
DOI: 10.1007/s00784-022-04578-8 -
Evidence-based Dentistry Dec 2022Trial design A single-centre two-arm parallel group randomised controlled trial.Objectives To assess differences in dental stability, patient perceptions and compliance... (Review)
Review
Trial design A single-centre two-arm parallel group randomised controlled trial.Objectives To assess differences in dental stability, patient perceptions and compliance and retainer failures in adolescents treated with vacuum-formed retainers (VFR) compared with those receiving bonded canine-to canine retainers after five years in retention.Methods In total, 104 eligible adolescents treated with fixed appliances in both jaws in a Swedish orthodontic clinic were randomised to two retention protocols. The intervention protocol consisted of a VFR covering all erupted teeth in the maxilla and a VFR in the mandible covering first premolar to first premolar. The controls received a VFR in the maxilla covering all erupted teeth and a bonded retainer wire to the lingual surfaces of the canines. The primary outcomes were various dental stability measures assessed at: debond (T1); six months (T2); 18 months (T3); and after five years (T4) in retention. Generalised estimating equations were used to quantify the effect of the different interventions on these outcome measures. One operator assessed all outcomes and participants could not be blinded. For the secondary outcomes, the perception and compliance with the retention protocols were assessed and the prevalence and rationale of retainer failure at T4. The trial was registered at ClinicalTrials.gov (NCT03070444) and the research project was supported by the Centre for Research and Development, Region Gävleborg, Sweden.Results Of the 104 randomised patients, 30 were not available at T4, leaving 35 patients in the intervention and 39 in the comparator group. An intention-to-treat analysis was used to impute outcomes for the missing patients. Post-treatment changes at T4 were small in both jaws. In the maxilla, the Little's Irregularity Index (LII) increased similar in both retention groups (median difference: 0.3 mm). In the mandible, the median difference for the LLI in the bonded retainer group was 0.1 mm compared with 0.6 mm in VFR group. In both retention protocols, the overjet remained stable, the overbite increased and the arch lengths continued to decrease. Intercanine and intermolar width remained stable in the mandible. Intermolar width decreased significantly in the maxilla. No differences in satisfaction were found between retention protocols after five years. Also, 72% of patients had stopped or rarely wore the VFR appliances at T4. Besides some retainer failures in both groups, no serious adverse effects associated with the retainers were reported.Conclusions Most post-treatment changes in both retention protocols were small in both jaws, except for the anterior alignment in the mandible, which was more stable in the bonded retainer group. This difference is possibly not related to the retention technique but to the poor compliance with the VFRs and the inclusion of adolescents only. Satisfaction with both protocols was similar.
Topics: Humans; Maxilla; Orthodontic Appliance Design; Orthodontic Retainers; Orthodontics, Corrective; Overbite; Randomized Controlled Trials as Topic; Adolescent
PubMed: 36526846
DOI: 10.1038/s41432-022-0845-7