Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Prevention of temporomandibular disorder-related signs and symptoms in orthodontically treated adolescents. A 3-year follow-up of a prospective randomized trial. Comparative study of 2 electric and 2 manual toothbrushes in patients with fixed orthodontic appliances. Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite. Functional appliance treatment assessed using the PAR index. Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.
In a 2-phased, parallel, randomized trial of early (preadolescent) versus later (adolescent) treatment for children with severe (>7 mm overjet) Class II malocclusions who initially were developmentally at least a year before their peak pubertal growth, favorable growth changes were observed in about 75% of those receiving early treatment with either a headgear or a functional appliance. After a second phase of fixed appliance treatment for both the previously treated children and the untreated controls, however, early treatment had little effect on the subsequent treatment outcomes measured as skeletal change, alignment, and occlusion of the teeth, or length and complexity of treatment. The differences created between the treated children and untreated control group by phase 1 treatment before adolescence disappeared when both groups received comprehensive fixed appliance treatment during adolescence. This suggests that 2-phase treatment started before adolescence in the mixed dentition might be no more clinically effective than 1-phase treatment started during adolescence in the early permanent dentition. Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment, and it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery. This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant. Recommendations about the need for occlusal adjustment after malocclusion therapy are inconclusive. A total of 123 orthodontically treated healthy adolescents (88 girls, 35 boys; 14.8 +/- 1.7 years old) agreed to participate in the present study. The subjects were interviewed and examined for signs and symptoms related to temporomandibular disorder (TMD) and were randomly allocated to intervention (n = 63) and control (n = 60) groups. At base line, occlusal adjustment was carried out for the intervention group and repeated every 6 months thereafter as needed. Mock adjustments were performed for the control group. At the end of the 3rd year 118 subjects (96%) turned up for re-examination. The number of subjects with palpatory pain of the masticatory muscles, and with occlusal centric slides decreased significantly in the intervention group but not in the control group (P < 0.001). In conclusion, occlusal adjustment therapy may prevent the occurrence of TMD signs in orthodontically treated healthy adolescents. The objective of this prospective single-blind crossover clinical trial was to evaluate the efficacy of 4 toothbrushes in 33 children undergoing fixed appliance orthodontic therapy. The toothbrushes included in this study were the Braun Oral-B 3D Plaque Remover (Kronberg, Germany), the Philips-Jordan HP 510 (Philips Domestic Appliances, Groningen, The Netherlands), the Lactona orthodontic toothbrush (Bergen op Zoom, The Netherlands), and the Oral-B Advantage Control Grip (Braun); the first 2 are electric, and the last 2 are manual. Every patient tested each type of toothbrush in a randomly designed sequence. Plaque and gingival scores were recorded at baseline and after every 4-week test period. All patients received professional prophylaxis after each clinical evaluation. The data were analyzed with the Friedman test, which showed no significant differences among the 4 brushes for any of the parameters measured. The Wilcoxon signed rank test, comparing the plaque and the gingival scores between the upper and lower jaw for each brush, indicated that plaque removal was more efficient in the lower jaw than in the upper. To evaluate the results of early interceptive grinding and also the possibility of self-correction of unilateral cross-bite, 76 4-yr-old children with this malocclusion were divided into one treated and one untreated group. In the treatment group 50% of the children exhibited a normal transverse occlusion evaluated in the mixed dentition, at the age of 9. In the untreated group only 17% showed a spontaneous correction of the cross-bite. Among the studied dental variables the "max./mand. arch width difference" especially in the canine region was found to be a valuable predictor indicating whether cross-bite can be successfully treated in preschoolchildren by selective grinding. The results of this study support early treatment of unilateral cross-bite and gives the criteria whereby successful treatment by selective grinding may be expected. The aims of this study were, first, to determine in children with Class II, division 1 malocclusions treated with functional appliances if, according to the Peer Assessment Rating (PAR) Index, lower incisor proclination affects the assessment of treatment outcome; and, second, to evaluate the effectiveness of such treatment before and after adjustment for any lower incisor proclination. Fifty-one children (32M, 19F; age and gender matched; 10 to 13 years) were randomly assigned to either an untreated group, one treated with Fränkel function regulators or one treated with Harvold activators. Study casts were assessed at the start, and after 6, 12, and 18 months of treatment/observation. The inclination of the upper and lower incisors was measured on lateral cephalometric radiographs taken at the start and 18 months later. There was wide variation in treatment response. The PAR scores decreased by more than 30% in 33% of the Fränkel group and by 75% in the Harvold group. When the score was adjusted to remove the effects of lower incisor proclination on the overjet, the treatment outcomes were "worse/no different" in 66% and "improved" in 33%, in both groups. It was concluded that functional appliances be used only on selected cases. To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 +/- 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated. The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.
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.