Orthodontic and orthopaedic treatment for anterior open bite in children (Review)

Background: Anterior open bite occurs when there is a lack of vertical overlap of the upper and lower incisors. The aetiology is multifactorial including: oral habits, unfavourable growth patterns, enlarged lymphatic tissue with mouth breathing. Several treatments have been proposed to correct this malocclusion, but interventions are not supported by strong scientific evidence. Objectives: The aim of this systematic review was to evaluate orthodontic and orthopaedic treatments to correct anterior open bite in children. Search methods: The following databases were searched: the Cochrane Oral Health Group's Trials Register (to 14 February 2014); the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2014, Issue 1); MEDLINE via OVID (1946 to 14 February 2014); EMBASE via OVID (1980 to 14 February 2014); LILACS via BIREME Virtual Health Library (1982 to 14 February 2014); BBO via BIREME Virtual Health Library (1980 to 14 February 2014); and SciELO (1997 to 14 February 2014). We searched for ongoing trials via ClinicalTrials.gov (to 14 February 2014). Chinese journals were handsearched and the bibliographies of papers were retrieved. Selection criteria: All randomised or quasi-randomised controlled trials of orthodontic or orthopaedic treatments or both to correct anterior open bite in children. Data collection and analysis: Two review authors independently assessed the eligibility of all reports identified. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated for dichotomous data. The continuous data were expressed as described by the author. Main results: Three randomised controlled trials were included comparing: effects of Frankel's function regulator-4 (FR-4) with lip-seal training versus no treatment; repelling-magnet splints versus bite-blocks; and palatal crib associated with high-pull chincup versus no treatment.The study comparing repelling-magnet splints versus bite-blocks could not be analysed because the authors interrupted the treatment earlier than planned due to side effects in four of ten patients.FR-4 associated with lip-seal training (RR = 0.02 (95% CI 0.00 to 0.38)) and removable palatal crib associated with high-pull chincup (RR = 0.23 (95% CI 0.11 to 0.48)) were able to correct anterior open bite.No study described: randomisation process, sample size calculation, there was not blinding in the cephalometric analysis and the two studies evaluated two interventions at the same time. These results should be therefore viewed with caution. Authors' conclusions: There is weak evidence that the interventions FR-4 with lip-seal training and palatal crib associated with high-pull chincup are able to correct anterior open bite. Given that the trials included have potential bias, these results must be viewed with caution. Recommendations for clinical practice cannot be made based only on the results of these trials. More randomised controlled trials are needed to elucidate the interventions for treating anterior open bite

Treatments for adults with prominent lower front teeth

BackgroundProminent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. the individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth.ObjectivesThe purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults.Search methodsThe following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012).Selection criteriaAll randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included.Data collection and analysisThree review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. the mean differences with 95% confidence intervals were calculated for continuous data.Main resultsTwo randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. the trials did not provide adequate data for assessing effectiveness of the techniques described.Authors' conclusionsThere is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. the included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required.Brazilian Cochrane Center, BrazilBritish Orthodontic Society (BOS), UKBOSBritish Society of Paediatric Dentistry (BSPD), UKBSPDUniversidade Federal de São Paulo, Dept Neurol, Neurosono Sleep Ctr, BR-08210090 São Paulo, BrazilUniv São Paulo, Fac Odontol Bauru, Dept Surg, São Paulo, BrazilSanta Casa de Campo Mourao, Dept Med, Campo Mourao, BrazilUniversidade Federal de São Paulo, Dept Neurol, Neurosono Sleep Ctr, BR-08210090 São Paulo, BrazilWeb of Scienc