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One phase or two phases orthodontic treatment for Class II division 1 malocclusion?
Evidence-Based Dentistry Pub Date : 2019-06-01 , DOI: 10.1038/s41432-019-0035-4
Analia Veitz-Keenan 1 , Nicole Liu 1
Affiliation  

Data sources Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.Study selection Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. The review included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups). The review excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.Data extraction and synthesis Review authors screened the search results, extracted data and assessed risk of bias independently. They used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes.Results From the 27 studies included in the review:Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment. Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120). Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). 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; 3 trials, 89 participants) (low quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence). Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence). Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).Conclusions Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

中文翻译:

II类1分类错牙合的一期或两期正畸治疗?

数据来源Cochrane口腔健康信息专家搜索以下数据库:Cochrane口腔健康试验注册簿(至2017年9月27日),Cochrane对照试验中央注册簿(CENTRAL)(Cochrane图书馆,2017年第8期),MEDLINE Ovid(1946年至今) 2017年9月27日)和Embase Ovid(1980年至2017年9月27日)。搜索了美国国立卫生研究院正在进行的试验注册中心(ClinicalTrials.gov)和世界卫生组织的国际临床试验注册平台,以进行正在进行的试验。搜索电子数据库时,对语言或出版日期没有任何限制。研究选择正畸治疗矫正儿童和青少年明显的上前牙(II类错牙合)的随机对照试验。该评价纳入的试验比较了在儿童(两阶段)中使用任何类型的正畸矫正器(可移动,固定,功能性)或头部矫正器的早期治疗与在青少年中(任何阶段)使用任何类型的正畸矫正器或头部矫正的早期治疗的比较-牙套,以及比较任何类型的正畸牙套或头牙套与未进行任何治疗或另一种类型的正畸牙套或矫正器(在干预组中,类似年龄开始治疗)的试验。该评价不包括涉及唇裂或,裂或其他颅面畸形/综合征的参与者的试验,以及招募先前接受过II类错牙合手术治疗的患者的试验。数据提取和综合评价作者筛选了搜索结果,提取了数据并独立评估偏见风险。他们对两分结果采用了优势比(OR)和95%置信区间(CI),对连续结果采用了平均差异(MD)和95%CI。功能矫治器与晚期治疗(过喷射,ANB和切牙创伤)的比较。在早期治疗的第一阶段后(即在另一组患者未接受任何干预之前),减少了过度喷射和减少ANB,有利于使用功能性矫治器进行治疗;但是,当两组患者均完成治疗后,最终的高射流组(MD 0.21,95%CI -0.10至0.51,P = 0.18; 343名参与者)(低质量证据)或ANB(MD -0.02, 95%CI -0.47至0.43; 347名参与者)(质量中等的证据)。与晚期治疗相比,早期使用功能性器械治疗可减少切牙创伤的发生率(OR 0.56,95%CI 0.33至0.95; 332名参与者)(中等质量的证据)。切牙创伤发生率的差异具有重要的临床意义,晚期治疗组中有30%(51/171)的受试者报告了新的创伤,而接受早期治疗的受试者中只有19%(31/161)。两项试验比较了使用头饰的早期治疗与晚期治疗的比较。在早期治疗的第一阶段后,头饰减少了过喷射和ANB;但是,当两组均完成治疗后,没有证据表明两组之间的过喷射(MD -0.22,95%CI -0.56至0.12; 238名参与者)(低质量证据)或ANB(MD -0.27,95)存在差异%CI -0.80至0.26; 231位参与者)(低质量证据)。早期(两阶段)头饰治疗降低了切牙创伤的发生率(OR 0.45,95%CI 0.25至0.80; 237名参与者)(低质量证据),新切牙创伤的发生率几乎降低了一半(24/117)与晚期治疗组相比(44/120)。七项试验比较了使用功能性器具的晚期治疗与未治疗的情况。固定功能性器械(MD -5.46 mm,95%CI -6.63至-4.28; 2个试验,61名参与者)和可移动功能性器械(MD -4.62,95%CI -5.33--3.92)的最终超喷减少; 3个试验,122名参与者)(低质量证据)。没有证据表明固定功能矫治器和未治疗的最终ANB有所不同(MD -0.53°,95%CI -1.27至-0.22; 3个试验,89名参与者)(低质量证据),但与未治疗相比,可移动功能设备似乎减少了ANB(MD -2.37°,95%CI -3.01至-1.74; 2个试验,99名参与者)(低质量证据)。六项试验比较了使用Twin Block与其他矫治器对青少年进行正畸治疗的结果,发现喷注量无差异(0.08 mm,95%CI -0.60至0.76; 4项试验,259名参与者)(低质量证据)。ANB的减少有利于使用Twin Block(-0.56°,95%CI -0.96至-0.16; 6个试验,320名参与者)(低质量证据)。三项试验比较了使用可移动功能矫正器和固定功能矫正器对青少年进行正畸治疗的情况,发现减少了偏射,有利于固定矫正器(0.74,95%CI 0.15至1.33;两项试验,154名参与者)(低质量证据),结论:低至中等质量的证据表明,提供早期正畸治疗的证据包括:-1.04°,95%CI -1.60至-0.49; 3个试验,185名参与者。与在青春期提供一疗程正畸治疗相比,对于上颌前牙突出的儿童,减少切牙创伤的发生更为有效。与后期治疗相比,提供早期治疗似乎没有其他优势。低质量的证据表明,与不进行治疗相比,使用功能矫治器对青春期进行后期治疗可有效减少上前牙的突出。结论低至中等质量的证据表明,对青春期前提供一疗程正畸治疗的儿童,对上前牙突出的儿童进行早期正畸治疗比减少一疗程的正畸治疗更为有效。与后期治疗相比,提供早期治疗似乎没有其他优势。低质量的证据表明,与不进行治疗相比,使用功能矫治器对青春期进行后期治疗可有效减少上前牙的突出。结论低至中等质量的证据表明,对青春期前提供一疗程正畸治疗的儿童,对早期上颌前牙突出的儿童提供早期正畸治疗对减少切牙创伤的发生更为有效。与后期治疗相比,提供早期治疗似乎没有其他优势。低质量的证据表明,与不进行治疗相比,使用功能矫治器对青春期进行后期治疗可有效减少上前牙的突出。
更新日期:2019-11-18
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