Incisor Trauma Research Articles

Impact of maxillary incisor trauma on child psychology in patients with Class II Div 1 malocclusion in urban population of India

Traumatic injuries to maxillary incisors can occur at any age, but its prevalence is high among children. Earlier studies also suggested that patients with increased overjet and lip incompetence were more prone to have trauma to maxillary incisors. The effect of Traumatic dental injuries is not only physical damage but also psychological damage as aesthetic issues are involved. Measures of oral-health-related quality of life (OHRQoL) provide essential information when assessing the treatment needs of individuals and populations. A total of 300 patients with age group 11-14 years with Class II div 1 malocclsion were included in the study. Patients were further subdivider into three group depending upon the severity of maxillary incisal trauma and no trauma group, further to that the psychological evaluation of all the patients were done using short-form of the Child Perceptions Questionnaire to ascertain the impact of oral health conditions (incisal trauma) on their quality-of-life. Mean functional limitation score was lowest for group 1 and highest with group 3 with 0.46, 0.626 and 4.191.405 respectively. Mean emotional wellbeing score was lowest in group 1 and highest in group 3 with 1.381.14 and 6.101.46 respectively Overall statistically significant differences were found between three groups w.r.t oral symptoms, functional limitation, emotional wellbeing and social wellbeing with p=0.001.Traumatic dental injury to maxillary incisors is associated with significant impairment of functionality and significant psychological implications with overall CPQ index scoring being highest in patients with more severe maxillary incisor trauma.

3D printed removable functional appliances for early orthodontic treatment – Possibilities and limitations

The early treatment of certain malocclusions, such as class II division 1, is recommended to decrease the likelihood of upper incisor trauma. However, the lack of skilled technicians and economic constraints prevent the availability of well-known removable functional appliances. The orthodontic profession is undergoing changes, and automation may offer a solution to these challenges. This article discusses the potential for automating the production of two commonly used removable orthodontic appliances. While CAD-CAM systems have streamlined dental manufacturing, 3D printing is a popular option for certain manufacturing processes. However, the adoption of 3D printing for orthodontic devices faces hurdles, such as redesigning devices for this new manufacturing process, material considerations, and necessary certifications. To showcase the potential design and manufacturing process of 3D printed devices that fall under the category of appliances similar in type and style to FR II and Sander II, the article centers on these two widely recognized appliances. As it is currently not possible to replicate all analog features in 3D, it may be appropriate to use a more general name for the FR II and Sander II appliances. In summary, the article examines the potential and limitations of automation in orthodontic appliance manufacturing.

Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana.

To assess the impact of upper incisor trauma on the quality of life (QoL) in young children studying between the age group 8 and 13 years in Faridabad, Haryana. A cross-sectional, prospective study was conducted to assess the visible permanent maxillary incisor traumas according to the classification of traumatic dental injuries (TDI) and to determine the predisposing risk factors that affect TDI and their impact on QoL in children aged 8-13 years. Questionnaires were made to gather information on demographic and socioeconomic characteristics like age, gender, and the father's and mother's education. Data on dental caries in anterior teeth were also collected using current World Health Organization criteria. There were a total of 66 males and 24 females. The total decayed, missing, and filled permanent teeth (DMFT) prevalence observed was 8.9%. The main reason for trauma was found to be an accident or accidental fall (36.7%). The most common place for trauma followed by road (21.1%). Time lapsed from the injury reported was >1 year in males (34.8%), while it was within 1 year (41.7%) in females (p = 0.014). The most prevalent and impacted performance was smiling (80.0%; m = 8.7778 ± 8.658), and the least affected was speaking (4.4%; m = 0.5111 ± 3.002). A number of risk factors need to be considered when assessing TDIs, as TDIs can have a negative impact on the functional, social, and psychological well-being of young children. As they are frequent in children, affecting teeth, their supporting structures, and adjacent soft tissues, they may cause both functional and esthetic problems. When injuries to incisor(s) produce pain, disfigurement, poor aesthetics, or other psychological effects, children may avoid laughing or smiling, and this can affect their social relationships. So, it is important to address the risk factors that predispose upper front teeth to TDIs. Elizabeth S, Garg S, Saraf BG, et al. Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana. Int J Clin Pediatr Dent 2022;15(6):652-659.

Traumatic injuries on teeth

Dental traumatic injuries is one of the most common dental problems faced by the masses, yet little is known about the prevalence of dental trauma at the national level. Sports, accidents, falling, fight and hitting items or people are among common etiologic factors. In both younger and older age groups, males have a higher prevalence of maxillary and mandibular incisal trauma than females. Trauma to the dentoalveolar region is common, and it can result in tooth displacement and fracture, bone crushing or fracturing, and soft tissue injuries such as contusions, abrasions, and lacerations. Traumatic dental injuries are medical emergencies that must be treated as soon as possible to relieve pain and restore function and aesthetics. Unmet treatment demands and insufficient emergency management of TDIs have recently surfaced in dental literature, revealing that some TDIs come late for treatment, potentially creating complications in treatment.

Influence of lip posture and malocclusion type on incisor trauma

The aim of our study was to establish the relationship between the severity of the maxillary incisors’ trauma, the type of malocclusion and the lip posture. This retrospective descriptive survey was conducted over a period of 3 months on 54 complete orthodontic files, at the dento-facial orthopedic department of the Dental Care Center of Casablanca (CCTD). The aesthetic analysis of RICKETTS was performed on pre-treatment lateral cephalograms. The data were collected through a questionnaire containing socio-demographic variables, clinical variables related to the trauma, type of dental malocclusion and lip posture. The Chi2 test was used to evaluate the different variables, the difference was found to be significant when p ⩽ 0.05. According to our study, patients between 13 and 18 years of age appear to have an increased risk of trauma. Class II division 1 was the most frequent in the traumatized population (56%) and overjet greater than 3 mm was the most common (48%) with a highly significant difference. Lip incompetence was most frequent in the traumatized population (68%) and the reduced length of the upper lips was frequent (50%) with a significant difference. Dental trauma, especially in the anterior sector, is frequent in adolescent patients. Increased overjet and inadequate lip posture are two major risk factors for incisor trauma. Early orthodontic treatment might prevent dental trauma in these patients.

Dental trauma in the anterior sector: an analysis of the predisposing factors in a group of orthodontic patients.

The aim of this study was to analyze the predisposing factors of upper incisal trauma in children candidates for orthodontic treatment. This is a retrospective study involving 102 consecutive patients who requested orthodontic therapy at Pediatric Dentistry Clinic of Bari University's Dental School during the time frame 2012-2019. The distribution of reported dental trauma was analyzed according to gender, type of trauma, etiology, overjet and labial competence. No substantial association between gender and trauma emerged from our study. Patients between the age range of 11-15 years appear to be at increased risk. A statistically significant correlation between increase in overjet and traumatic events was found. A link was discovered between labial incompetence and trauma, since this condition increases the risk of trauma by exposing part of the surface of the upper incisors. A correlation also emerged between Skeletal Class II and the increased risk of traumatic injury. Dental trauma, especially in the anterior sector, is a fairly frequent occurrence in pediatric and adolescent patients and is linked to several factors. In our study subjects with Skeletal Class II division I malocclusion with elevated overjet are more predisposed to dental trauma. The limitations of our study are the low number of subjects in the examined sample, and the heterogeneity of the trauma presentation.

The mean overjet in libyan children and the relationship between increased overjet and incisors trauma.

The aim of this study was to assess the mean overjet in school-going Libyan children and to examine the relationship between increased overjet and permanent incisor's trauma. This study is a part of a cross-sectional investigation of aspects of dental health of 2015 school going Libyan children aged between 6 and 16 years old of both genders from both rural and urban areas. Overjet was measured as the horizontal distance in millimetres between the upper and lower incisors. Trauma to permanent incisors was assessed according to Elli's Classification. SPSS version 20.0 for percentages was used for statistical analysis. The relationship between increased overjet and incisor trauma was tested using the Chi-square test at 0.05 significance level. The overjet measurement ranged from -2 mm to 8 mm with the mean overjet of 3.062 (1.23, SD). The prevalence of incisor trauma was statistically significantly higher in children with increased overjet (P < 0.0001). The average mean overjet value in Libyan children is between 2 mm and 3 mm and below or above these values, considered decreased or increased, respectively. Traumatic injuries to permanent incisors significantly increased with increased overjet.

One phase or two phase orthodontic treatment for Class II division 1 malocclusion ?

Data sources Numerous online databases were searched including:, the Cochrane Central Register of Controlled Trials, the Cochrane Library, MEDLINE Ovid and Embase Ovid). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials. No restrictions were placed on the language or date of publication when searching the electronic databases.Study selection The review included only randomised clinical trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. The review selected studies that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces/headgear versus late (one-phase) treatment in adolescents with any type of orthodontic braces or head-braces/headgear, and studies that compared any type of orthodontic braces or head-braces/headgear versus no treatment or another type of orthodontic brace/treatment or appliance (where treatment started at a similar age in the intervention groups). The review excluded studies involving participants with craniofacial deformities/syndromes or a cleft lip or palate, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.Data extraction and synthesis The review authors screened the search results, extracted data and assessed risk of bias independently, and used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes (incisal trauma), and mean differences (MDs) and 95% CIs for continuous outcomes (overjet and ANB angle).Results Twenty-seven studies were included and analysed in the review. Out of the 27 trials , three trials (343 patients - low /moderate quality evidence ) compared early/ two stage orthodontic treatment with functional appliances versus late two phases orthodontic treatment assessing all changes in overjet, cephalometric changes (antero-posterior relationship of the mandible to the maxilla or ANB angle) and incisal trauma in the upper anterior teeth.Firstly the results showed a reduction in the overjet and ANB angle after phase one of early treatment in patients using functional appliances, before the other group had received any treatment; the results changed when both groups underwent treatment, resulting in a non-statistical difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; or ANB (MD -0.02, 95% CI -0.47 to 0.43).Incidence of new incisal trauma: the results favoured initial or early treatment with functional appliances. The odds of incisal trauma using early functional appliances were reduced compared to late treatment: OR 0.56 (95% CI 0.33 to 0.95). The incidence of front teeth trauma was 30% in the participants of the late treatment group/ one phase compared to 19% in the participants who received the early/two phase orthodontic treatment ( 332 patients - moderate quality evidence).Headgear versus late treatment: early (two-phase) treatment with headgear reduced roughly half the incidence of new front teeth trauma (OR 0.45, 95% CI 0.25 to 0.80) compared to the late treatment group . The use of headgear reduced overjet and ANB, however, when both groups finalised the treatment, there was no statistically significant difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; or ANB (MD -0.27°, 95% CI -0.80 to 0.26) (low quality evidence).Fixed functional appliances versus no treatment (low quality evidence): the analysis of seven trials that compared late treatment with functional appliances versus no treatment concluded that there was a reduction in final overjet with fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28 ).There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53, 95% CI -1.27 to -0.22 ).Removable functional appliances to reduce ANB compared to no treatment: the results ( low quality evidence) showing a MD of -2.37° (95% CI -3.01 to -1.74 ), favouring the functional appliances.Twin block appliance versus other appliances in adolescents: six studies found no difference in changes in overjet (0.08 mm, 95% CI -0.60 to 0.76) . The reduction in ANB favoured treatment with a twin block (-0.56°, 95% CI -0.96 to -0.16).Removable functional appliances versus fixed appliances: the data combination of three trials concluded that there is a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33), and a reduction in ANB in favour of removable appliances (-1.04° , 95% CI -1.60 to -0.49).Conclusions Evidence classified as low to moderate quality suggests that providing early orthodontic treatment/two stages for children with prominent upper front teeth is more effective for reducing the incidence of upper front teeth trauma ( incisal trauma) than providing one course of orthodontic treatment in adolescence. However, it appears that there is no other benefit of providing early treatment when compared to late treatment. Low-quality evidence proposes that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

One phase or two phases orthodontic treatment for Class II division 1 malocclusion?

One phase or two phases orthodontic treatment for Class II division 1 malocclusion?

Class II division 1 malocclusions: comparisons between one- and two-step treatment.

The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients. Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated. The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London. We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Executive Function as a Risk Factor for Incisor Trauma.

Executive function is the ability to guide behavior to achieve goals or complete tasks. This study explored the relationship between executive function, as assessed by the Behavior Rating Inventory of Executive Function Parent Form Questionnaire (BRIEF® ) and incisor trauma. This study included children in the mixed dentition with recent incisor trauma (n=28) and a control group (n=30) without recent incisor trauma. Subjects' parents completed the BRIEF® , while a clinical examination assessed subjects' occlusal relationships. Parents also completed a custom questionnaire that investigated their child's medical history and daily activities. Fisher Exact and unpaired t-tests compared BRIEF® scores, occlusal characteristics, medical history, and reported daily activities of the two groups. The trauma group had a greater percentage of participants with a Class II dental relationship (p=0.01). There was no significant difference between groups with respect to mean BRIEF® t-scores within the Global Executive Composite. There was a statistically significant difference between groups with respect to the percentage of subjects with clinically significant (≥65) BRIEF® t-scores within the Inhibit (p=0.05) and Emotional Control (p=0.02) subscales and Behavioral Regulation Index (p=0.02). There were no statistically significant differences between groups with respect to age, gender, overbite, overjet, medical history, body mass index, or daily activities. Children in the mixed dentition with a Class II dental relationship are at greater risk for incisor injury, as well as those involved in outdoor activities. Specific executive dysfunctions such as impulsivity and poor emotional control may increase the risk for incisor trauma. This article is protected by copyright. All rights reserved.

Combined orthodontic-periodontal-prosthodontic treatment for the maxillary incisor trauma: a multidisciplinary case report

Combined orthodontic-periodontal-prosthodontic treatment for the maxillary incisor trauma: a multidisciplinary case report

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

The Effect of Socio-economic status on the Oral Hygiene of Elementary School Children in the City of Dammam, Saudi Arabia

The purpose of this paper was to determine the status of the oral health of children compared to the socioeconomic status (SES) of the parents in the city of Dammam, Saudi Arabia. Three schools were targeted based on the SES levels; two private schools and one governmental school. The sample size was 40 boys from each school all of them 5 th grade students. The dependent variable was the oral hygiene status of the children and the independent variables were the school type (governmental or private), parents’ education and socioeconomic status. Community SES was significantly related to oral hygiene status. Overall, oral health was significantly worse for low SES communities. There is a direct relationship between SES and oral hygiene status of children in elementary schools in the community of Dammam, Saudi Arabia. In which high caries prevalence was seen with children attending public school. KeywordsOral Hygiene, Dental, Socio-economic. INTRODUCTION Good oral health is a goal that is only achieved by having all the “correct” items to fulfill that goal. These items that are highly related to having a good oral health are proper oral hygiene practice, welleducated people and neighborhood of residency. Moreover, Socio-economic status (SES) is a description of a person’s societal status using factors or measurements such as income level, relationship to the national poverty line, educational achievement and neighborhood of residency. 1 Poor SES has been a known risk factor to poor oral health. Numerous studies were conducted, In which Gillcrist, Brumley and Blackford concluded that community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for mediumand high-SES communities. 2 Also, Reisine and Poster said that underlying mechanisms may not be well understood, low SES may serve clinicians as a marker for increased risk of caries. 3 In addition, Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviors and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care. 4 Moreover, Rosa said that the higher SES receives more dental care than the low SES. www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 5.88 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i6.65

Maxillary incisor trauma in patients with class II division 1 dental malocclusion: associated factors.

The aim of this study was to assess the association between the presence of maxillary incisor trauma (MIT) with age, gender, dentition type, the degree of overjet (OJ), lip form, respiratory type and dental arch form in patients with Class II division 1 dental malocclusion. 256 patients (mean age: 15.80 ± 2.2) were included in this study. The patients' gender, dentition type, superior lip form, dental arch form and respiratory type were recorded. Participants were divided into four groups according to the severity of OJ: 3.5 mm<Group 1 (OJ I) ≤6 mm with competent lip, 3.5 mm<Group 2 (OJ II) ≤ 6 mm with incompetent lip, 6 mm<Group 3 (OJ III) ≤9mm, 9 mm<Group 4 (OJ IV). Mann Whitney-U test was used to examine the group differences for trauma and non-trauma groups. Logistic regression analysis was used to assess the factors for trauma and their risk indicators. 3.5 mm<OJ II≤ 6 mm with incompetent lip had the highest odds of experiencing MIT among the OJ groups with an odds ratio (OR) of 3.143 and 95% confidence interval (CI) 1.125-2.779. The odds were 3.572 times higher in the group with short lip form than found in the group with normal lip form (OR 3.572, 95% CI 1.130-2.340). The age, gender, respiratory type and dental arch form were not significantly associated the risk of MIT. OJ between 3.5 mm and 6 mm (with incompetent lip) and short lips increased the risk of having maxillary incisor trauma in patients with Class II division 1 malocclusion.

Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review.

In this article, we summarize the most clinically relevant findings of our recently updated Cochrane systematic review into the treatment of Class II Division 1 malocclusion. A systematic review of the databases was performed to identify all randomized controlled trials evaluating early treatment with functional appliances to correct Class II Division 1 malocclusion. Three early treatment studies with data from 353 participants were included in this review. The results showed no significant difference for any outcomes, except new incidence of incisor trauma, which was significantly less for the early treatment group. The risk ratio analysis for new incisor trauma showed that providing early treatment reduced the risk of trauma by 33% and 41% in the functional and headgear groups, respectively. However, when the numbers needed to treat were calculated, early treatment with functional appliances prevents 1 incidence of incisal trauma for every 10 patients (95% CI, 5-174), and headgear treatment prevents 1 incidence of incisal trauma for every 6 patients (95% CI, 3-23). Orthodontic treatment for young children, followed by a later phase of treatment when the child is in early adolescence, appears to reduce the incidence of new incisal trauma significantly compared with treatment that is provided in 1 phase when the child is in early adolescence. However, these data should be interpreted with caution because of the high degree of uncertainty. There are no other advantages in providing 2-phase treatment compared with 1 phase in early adolescence.

Social judgments made by children (10-15 year old) in relation to visible incisors trauma: School-based cross-sectional study in Khartoum state, Sudan.

Background:Dento-alveolar trauma is a very common occurrence in childhood; however, there is a paucity of data about children's judgments in relation to dental status. There is a significant correlation between the children's incisor teeth status and the social judgments made by their peers.Aim:The purpose of this study was to determine whether the social attributes of a school child would be influenced by his or her incisor teeth status. Also, it is aimed to determine the judgment between male and female children and different age groups within the same class.Setting and Design:A descriptive cross-sectional study conducted among 178 male and female children from year 5 (age 10–11 years) of primary school and year 2 of secondary school (age 14–15 years) within Khartoum state.Materials and Methods:Students were invited to look at colored photographs of four different children's faces and to make a social judgment about these children's photographs. Using a previously validated child-centered questionnaire, participants rated subjects using a four-point Likert scale for three negative and six positive attributes.Statistical Analysis:Total attribute scores were tested for significant differences, according to whether the subject had visible incisor trauma or not, using t-test and analysis of variance (ANOVA) test with the level of significance set at P ≤ 0.05.Results:Children with visible incisor trauma were given more negative attributes than children without incisor trauma (P = 0.05). Results were similar in both genders and both school years. Younger students within the same class gave more negative attributes toward children with visible incisor trauma than their older peers, with P = 0.04 and P = 0.9 for children aged 10 years and 11 years, respectively.Conclusion:The data confirmed results of previous studies that children with visible incisor trauma are seen more negatively than those without visible incisor trauma.

Upper incisor trauma and the orthodontic patient—Principles of management

A proportion of children referred for orthodontic treatment have a history of previous trauma to their anterior teeth. Some can suffer trauma whilst undergoing fixed appliance therapy. The aim of this article is to familiarise the reader with some common dentoalveolar traumatic injuries that can have important implications for orthodontic treatment. Multidisciplinary care for long-term management of such cases with the involvement of orthodontists and paediatric dentists working in a team is also discussed.

Early orthodontic treatment reduced incisal trauma in children with class II malocclusions.

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase. Randomised controlled trials (RCTs) of orthodontic treatments (either one- or two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces compared with late treatment with any type of orthodontic braces or head-braces; or, on any type of orthodontic braces or head-braces compared with no treatment or another type of orthodontic brace or appliance to correct prominent upper front teeth. Study selection, risk of bias assessment and data extraction were carried out independently by at least two reviewers. The primary measure of effect was over jet measured in millimetres or by any index of malocclusion. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for dichotomous outcomes, mean differences (MDs) and 95% CIs for continuous outcomes and a fixed- effect model for meta-analyses as there were fewer than four studies. Seventeen studies involving 791 patients were included. The overall quality of the evidence was low with only two of the 17 studies being assessed as at low risk of bias. Three trials (n = 343) compared early (two-phase) treatment (7-11 years of age) with a functional appliance with adolescent (one-phase) treatment.Statistically significant differences in over jet, ANB and PAR scores were found in favour of functional appliance when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, there was no evidence of a difference in the over jet between the groups at the end of treatment. A statistically significant reduction in the incidence of incisal trauma (OR 0.59, 95% CI 0.35 to 0.99, P = 0.04) in favour of two-phase treatment with functional appliance was seen. The incidence of incisal trauma was clinically significant with 29% (54/185) of patients reporting new trauma incidence in the adolescent (one-phase) treatment group compared to only 20% (34/172) of patients receiving early (two-phase) treatment.Two trials (n = 285) compared early (two-phase) treatment using headgear, with adolescent (one-phase) treatment. Statistically significant differences in over jet and ANB were found in favour of headgear when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, there was no evidence of a difference in the over jet between the groups at the end of treatment. The incidence of incisal trauma was, however, statistically significantly reduced in the two-phase treatment group, the adolescent treatment group having twice the incidence of incisal trauma (47/120) compared to the young children group (27/117).Two trials (n = 282) compared different types of appliances (headgear and functional appliance) for early (two-phase) treatment. At the end of the first phase of treatment statistically significant differences, in favour of functional appliances, were shown with respect to final over jet only. At the end of phase two, there was no evidence of a difference between appliances with regard to over jet, PAR score or the incidence of incisal trauma.Late orthodontic treatment for adolescents with functional appliances showed a statistically significant reduction in over jet of -5.22 mm (95% CI -6.51 to -3.93, P < 0.00001) and ANB of -2.37° (95% CI -3.01 to -1.74, P < 0.00001) when compared to no treatment (very low quality evidence).There was no evidence of a difference in over jet when Twin Block was compared to other appliances. However, a statistically significant reduction in ANB (-0.63°, 95% CI -1.17 to -0.08, P = 0.02) was shown in favour of Twin Block. There was no evidence of a difference in any reported outcome when Twin Block was compared with modifications of Twin Block. The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective in reducing the incidence of incisal trauma than providing one course of orthodontic treatment when the child is in early adolescence. There appear to be no other advantages for providing treatment early when compared to treatment in adolescence.

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children