Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

762 questions · 830 findings · 43 reviews · Orthodontics

No studies found 186 · 22.4%GRADE not reported 410 · 49.4%Very low 122 · 14.7%Low 79 · 9.5%Moderate 30 · 3.6%High 3 · 0.4%

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Percentage of bleeding on probing (BOP) · Adults undergoing orthodontic treatment

No clear difference in bleeding on probing between aligners and fixed appliances in adults at 6-12 weeks (MD -0.26, 95% CI -0.77 to 0.26; very low certainty).

1 finding from 1 review

Extraction of third molars (wisdom teeth) vs No active treatment (control)

Amount of crowding · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

It is very uncertain whether extraction of third molars (wisdom teeth) changes amount of crowding (Little's Irregularity Index, change) at 5 years compared with no active treatment (control) (very low certainty).

1 finding from 1 review

Lower lingual arch vs No active treatment (control)

Size of the lower jaw (arch length) · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

Lower lingual arch led to higher size of the lower jaw (mandibular arch length) at 1 year compared with no active treatment (control); GRADE not reported.

1 finding from 1 review

Extraction of lower deciduous canines vs No active treatment (control)

Lower incisor inclination (lingual tipping and retrusion) · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

Extraction of lower deciduous canines showed no clear difference in lower incisors to mandible (inclination, degrees) at 1 year compared with no active treatment (control); GRADE not reported.

1 finding from 1 review

Double primary (canine and first molar) tooth extraction vs Single primary (canine) tooth extraction

Costs and cost‐effectiveness · Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)

The review found no eligible studies for this question.

1 finding from 1 review

Sealant (any type) vs No sealant (control/no treatment)

Initiation of white spot lesions (WSL), visual-tactile assessment · People receiving orthodontic treatment with fixed appliances (upper and/or lower full arch)

Sealant use reduced the incidence of new white spot lesions versus no sealant (very low certainty).

1 finding from 1 review

Extraction of the primary (baby) canine (single primary tooth extraction) vs No extraction (non-intervention control)

Patient-reported outcomes (pain, discomfort and analgesic use) · Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)
1 finding from 1 review

Semi-rapid maxillary expansion vs Rapid maxillary expansion

Molar expansion · Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other…

Semi-rapid maxillary expansion showed no clear difference in molar expansion compared with rapid maxillary expansion; GRADE not reported.

1 finding from 1 review

Double primary (canine and first molar) tooth extraction vs Single primary (canine) tooth extraction

Reported improvement in the position of the ectopic canine measured from radiographs · Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)

The review found no eligible studies for this question.

1 finding from 1 review

Double primary (canine and first molar) tooth extraction vs Single primary (canine) tooth extraction

Patient‐reported outcome measures (PROMs) · Young people aged 9 to 14 years diagnosed with one or both palatally displaced permanent maxillary canines (PDC)

The review found no eligible studies for this question.

1 finding from 1 review

Schwarz appliance vs No active treatment (control)

Position of the incisors (upper incisor inclination) · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

Schwarz appliance showed no clear difference in upper incisors to maxilla (inclination, degrees) at 9 months compared with no active treatment (control); GRADE not reported.

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Gingival inflammation-related index · Adolescents/teenagers undergoing orthodontic treatment

A single study reported lower simplified gingival index with aligners versus fixed appliances in adolescents at 1 month (MD -8.46, 95% CI -10.47 to -6.45; ungraded).

1 finding from 1 review

Fixed tooth-borne expansion (Hyrax) vs observation

Molar expansion · Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other…

Fixed tooth-borne expansion (Hyrax) probably leads to higher molar expansion (inter-molar distance) compared with observation (no treatment) (moderate certainty).

1 finding from 1 review

Eruption guidance appliance vs No active treatment (control)

Amount of crowding (number of children with crowding, mandible) after 1 year · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

It is very uncertain whether eruption guidance appliance changes amount of crowding (number of children with crowding, mandible)… compared with no active treatment (control) (very low certainty).

1 finding from 1 review

Bone-borne expansion vs observation

Crossbite correction · Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other…
1 finding from 1 review
  • Orthodontic treatment for posterior crossbites 2021 · Cochrane All outcomes
    Adolescents
    Alberta 2010: bone-borne expansion corrected all posterior crossbites (21/21); no self-correction in the untreated group
    1 study
    GRADE not reported

Compomer (polyacid-modified composite, fluoride-releasing) for bonding brackets vs Compomer bonding agent without fluoride release

Initiation of white spot lesions (WSL), visual-tactile assessment · Patients of any age (11-40 years) receiving comprehensive/fixed orthodontic treatment with fixed appliances

For compomer-based bonding agents, fluoride release did not significantly change WSL initiation (RR 0.71); subgroup not separately GRADE-rated.

1 finding from 1 review

Self-ligating brackets vs Conventional brackets

Lower incisor inclination (lingual tipping and retrusion) · Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth

Self-ligating brackets showed no clear difference in lower incisors to mandible (inclination, degrees) compared with conventional brackets; GRADE not reported.

1 finding from 1 review