Cochrane · intervention · CD000979
Orthodontic treatment for posterior crossbites
Ugolini, A, Agostino, P, Silvestrini-Biavati, A, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
55
current version
GRADE rated
18
No studies
7
Included studies
31
as reported
No studies 7 · 12.7%Ungraded 30 · 54.5%Very low 0 · 0%Low 6 · 10.9%Moderate 9 · 16.4%High 3 · 5.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies | 1467 participants aged 5 to 17 years (children and adolescents); 13 studies in children (7-11), 12 in adolescents (12-16), 6 in both; no studies in adults |
| Intervention | Any orthodontic or dentofacial orthopedic (non-surgical) treatment used to correct posterior crossbites or expand the top back teeth, or both | Removable tooth-borne expansion plate (n=3); Fixed quad-helix (n=3); Fixed Hyrax (n=4); Fixed Haas (n=3); Tooth-bone-borne expansion (n=3); Bone-borne expansion (n=2); Bonded acrylic splint expander (n=1); Hyrax + U-bow activator (n=1); Grinding +/- plate (n=1); Damon System self-ligating (n=1); Fan-type expander (n=1); Differential opening expansion (n=1); Conventional screw (n=1); Spring-loaded screw (n=1); NiTi memory screw (n=1); Four-point appliance (n=1); Two-point appliance (n=1); Bonded/Banded Minne (n=1); Semi-rapid/Rapid expansion (n=1) |
| Comparison | Another such treatment; no treatment | Observation/no treatment (n=9); Hyrax (n=4); Haas (n=3); Tooth-bone-borne expansion (n=3); Bone-borne expansion (n=2); Expansion plate (n=5); Bonded expander plate (n=1); Two-point appliance (n=1); Rapid expansion (n=1); Expansion arch + multi-bracket (n=1); Spring-loaded screw (n=1); Fan-type expander (n=1); Permanent-molar anchorage (n=1); Composite onlays (n=1) |
| Outcomes | Correction of the posterior crossbite; Expansion of the upper jaw or teeth (inter-molar and/or inter-canine width); Stability of crossbite correction; Signs and symptoms of temporomandibular joint dysfunction; Signs and symptoms of respiratory disease; Quality of life; Length of treatment; Costs of treatment | Crossbite correction (n=8); Molar expansion / inter-molar distance (n=25); Canine expansion / inter-canine distance (n=8); Stability of crossbite correction (n=2); Length of treatment (n=3); Cost-benefit (n=2); Nasal airflow/respiratory effects (n=2) |
| Study designs | Randomised controlled trials (RCTs) of parallel design | RCTs (n=31) |
| Timing | Post-treatment and, where available, post-retention | Post-treatment and, where available, post-retention |
Search date: 2021-04. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO ICTRP; handsearch of six orthodontic journals (1970-2020)
Questions and results
Show all 3 versionsBanded Hyrax (tooth-borne) vs Bonded Hyrax (tooth/tissue-borne)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar expansion 3 months after completion of expansion | Asanza 1997: banded 6 mm (min 4.3-max 7.2) vs bonded 5.9 mm (min 3.2-max 7.7); P=NS (no SD reported); no significant difference in tipping or symmetrical expansion | 1 study | Ungraded |
Bonded Minne appliance (slow maxillary expansion) vs Banded Minne appliance (slow maxillary expansion)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion 7 to 15 weeks after start of treatment | Bonded Minne 6.4 mm (SD 1.1) vs Banded Minne 5.3 mm (SD 1.9); P=NS | 1 study | Ungraded |
Stability of crossbite correction (relapse of canine expansion) 24 weeks after completion of expansion | Bonded Minne 1.6 mm (SD 0.5) vs Banded Minne 1.2 mm (SD 0.3); P=NS | 1 study | Ungraded |
Stability of crossbite correction (relapse of molar expansion) 24 weeks after completion of expansion | Bonded Minne 2.3 mm (SD 0.8) vs Banded Minne 2.5 mm (SD 0.6); P=NS | 1 study | Ungraded |
Molar expansion 7 to 15 weeks after start of treatment | Bonded Minne 7.9 mm (SD 1.5) vs Banded Minne 8.3 mm (SD 1.1); P=NS | 1 study | Ungraded |
Fixed tooth-borne expansion (quad-helix) vs Removable tooth-borne expansion (expansion plate)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Length of treatment Children (7 to 11 years) | MD -3.15 [-4.04, -2.25] Expansion plate 6.12 to 11.4 months vs Quad-helix 3.15 months lower (4.04 to 2.25 lower) | 3 studies · 148 participants | Moderate Downgraded: inconsistency |
Stability of crossbite correction (relapse) 12 months after correction | Relapse occurred in 9.1% of both quad-helix and expansion plate groups after one year of follow-up (Godoy 2011) | 1 study · 66 participants | Ungraded |
Canine expansion (inter-canine distance) Children (7 to 11 years) | MD 0.59 [0.09, 1.08] Expansion plate 1.43 to 3.3 mm vs Quad-helix 0.59 mm higher (0.09 to 1.08 higher) | 3 studies · 151 participants | Low Downgraded: inconsistency |
Molar expansion (inter-molar distance) Children (7 to 11 years) | MD 1.48 [0.91, 2.04] Expansion plate 3.09 to 3.5 mm vs Quad-helix 1.48 mm higher (0.91 to 2.04 higher) | 3 studies · 151 participants | High |
Crossbite correction Children (7 to 11 years) | RR 1.29 [1.13, 1.46] 763 per 1000 vs 984 per 1000 | 3 studies · 151 participants | Moderate Downgraded: inconsistency |
Four-point expansion appliance (Hyrax) vs Two-point expansion appliance
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion 3 months after completion of expansion | Lamparski 2003: 4-point 3.034 mm vs 2-point 1.7 mm; P=0.331 (NS, no SD) | 1 study | Ungraded |
Molar expansion 3 months after completion of expansion | Lamparski 2003: not reported by group; 'no significant differences were found' | 1 study | Ungraded |
Fixed tooth-borne expansion (Hyrax) vs Fixed tooth-tissue-borne expansion (Haas)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion (inter-canine distance) | Not measured (SoF 5) | 0 studies | No studies |
Crossbite correction Children | RR 1.05 [0.94, 1.18] Haas 976 per 1000 vs Hyrax 1000 per 1000 (918 to 1000) | 3 studies · 83 participants | Moderate Downgraded: risk of bias |
Molar expansion (inter-molar distance) Children | MD -0.15 [-0.86, 0.56] Haas 5.49 to 8.49 mm vs Hyrax 0.15 mm lower (0.86 lower to 0.56 higher) | 2 studies · 46 participants | Moderate Downgraded: risk of bias |
Bone-borne expansion vs Fixed tooth-borne expansion (Hyrax)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction Adolescents | RR 1.00 [0.94, 1.07] Hyrax 1000 per 1000 vs Bone-borne 1000 per 1000 (940 to 1000) | 2 studies · 81 participants | Low Downgraded: risk of bias |
Molar expansion (inter-molar distance) Children and adolescents | MD -0.14 [-0.85, 0.57] Hyrax 4.2 to 5.83 mm vs Bone-borne 0.14 mm lower (0.85 lower to 0.57 higher) | 2 studies · 81 participants | Low Downgraded: risk of bias |
Canine expansion (inter-canine distance) | Not measured (SoF 7) | 0 studies | No studies |
Two-band palatal expander with slow expansion vs Two-band palatal expander with rapid expansion
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction | Martina 2012: slow 12/12 vs rapid 14/14; NS (all corrected in both groups) | 1 study · 26 participants | Ungraded |
Molar expansion 7 months after start of treatment | Martina 2012: slow 6.3 mm (SD 2.1) vs rapid 5.7 mm (SD 1.6); reported as no statistically significant difference in text (PUB2 MD 0.60, 95% CI -0.85 to 2.05); Table 1 lists P<0.001 (discrepant) | 1 study · 26 participants | Ungraded |
Semi-rapid maxillary expansion vs Rapid maxillary expansion
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar expansion | MD 0.60 [-0.55, 1.75] | 1 study · 35 participants | Ungraded |
Canine expansion | MD 0.36 [-0.64, 1.36] | 1 study · 35 participants | Ungraded |
Fixed bonded Hyrax appliance followed by U-bow activator therapy vs No treatment
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion 12 months after start of treatment | U-bow activator 3.6 mm vs untreated 1 mm; P<0.001 (no SD reported); significant in favour of treatment | 1 study · 66 participants | Ungraded |
Molar expansion 12 months after start of treatment | U-bow activator 5.1 mm vs untreated 0.8 mm; P<0.001 (no SD reported); significant in favour of treatment | 1 study · 66 participants | Ungraded |
Quad-helix plus multi-bracket appliance vs Expansion arch plus multi-bracket appliance
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion 12 weeks after start of treatment | MD -0.72 [-1.52, 0.08] | 1 study · 52 participants | Ungraded |
Molar expansion 12 weeks after start of treatment | MD -0.55 [-1.34, 0.24] | 1 study · 55 participants | Ungraded |
Expansion plate with conventional expansion screw vs Expansion plate with spring-loaded expansion screw
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar and canine expansion | Oshagh 2012: no significant differences in discomfort and arch size changes; results inadequately reported (no usable data) | 1 study | Ungraded |
Removable tooth-borne expansion (expansion plate) vs Observation (no treatment)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction Children (7 to 11 years) | OR 25.26 [13.08, 48.77] 14 per 1000 vs 260 per 1000 | 3 studies · 148 participants | High |
Molar expansion (inter-molar distance) Children (7 to 11 years) | MD 3.30 [2.88, 3.73] Observation 0.15 to 0.5 mm vs Expansion plate 3.3 mm higher (2.88 to 3.73 higher) | 3 studies · 145 participants | Moderate Downgraded: inconsistency |
Canine expansion (inter-canine distance) Children (7 to 11 years) | MD 2.59 [2.18, 3.01] Observation -0.17 to 0.3 mm vs Expansion plate 2.59 mm higher (2.18 to 3.01 higher) | 3 studies · 145 participants | Moderate Downgraded: inconsistency |
Fixed tooth-borne expansion (quad-helix) vs Observation (no treatment)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction Children (7 to 11 years) | OR 50.59 [26.77, 95.60] 14 per 1000 vs 413 per 1000 | 3 studies · 149 participants | High |
Canine expansion (inter-canine distance) Children (7 to 11 years) | MD 3.15 [2.77, 3.53] Observation -0.17 to 0.3 mm vs Quad-helix 3.15 mm higher (2.77 to 3.53 higher) | 3 studies · 146 participants | Low Downgraded: inconsistency |
Molar expansion (inter-molar distance) Children (7 to 11 years) | MD 4.71 [4.31, 5.10] Observation 0.15 to 0.5 mm vs Quad-helix 4.71 mm higher (4.31 to 5.10 higher) | 3 studies · 146 participants | Moderate Downgraded: inconsistency |
Fixed tooth-borne expansion (Hyrax) vs Observation (no treatment)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion (inter-canine distance) | Not measured (SoF 3) | 0 studies | No studies |
Crossbite correction Children and adolescents | OR 48.02 [21.58, 106.87] 21 per 1000 vs 511 per 1000 | 3 studies · 93 participants | Moderate Downgraded: risk of bias |
Molar expansion (inter-molar distance) Children | MD 5.80 [5.15, 6.45] Observation -0.07 to 0.91 mm vs Hyrax 5.80 mm higher (5.15 to 6.45 higher) | 2 studies · 71 participants | Moderate Downgraded: risk of bias |
Fixed tooth-bone-borne expansion vs Fixed tooth-borne expansion (Hyrax)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction Children | RR 1.02 [0.92, 1.12] Hyrax 950 per 1000 vs Tooth-bone-borne 969 per 1000 (874 to 1000) | 3 studies · 120 participants | Low Downgraded: risk of bias |
Molar expansion (inter-molar distance) Children | MD 0.66 [-0.04, 1.36] Hyrax 4.8 to 8.6 mm vs Tooth-bone-borne 0.66 mm higher (0.04 lower to 1.36 higher) | 2 studies · 65 participants | Low Downgraded: risk of bias |
Canine expansion (inter-canine distance) | Not measured (SoF 6) | 0 studies | No studies |
Hyrax with conventional expansion screw vs Hyrax with NiTi memory expansion screw
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar expansion after 6-month retention period | Halicioglu 2014: conventional Hyrax 8.41 (SD 2.09) mm vs NiTi Hyrax 8.94 (SD 1.73) mm; no statistically significant differences for any outcome | 1 study | Ungraded |
Fixed Hyrax maxillary expander vs Fixed fan-type maxillary expander
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion post-treatment 3 weeks | Gopalakrishnan 2017: Hyrax 6.00 (SD 0.63) mm vs fan-type 7.33 (SD 2.5) mm; P=0.235 (NS) | 1 study · 12 participants | Ungraded |
Molar expansion post-treatment 3 weeks | Gopalakrishnan 2017: Hyrax 8.00 (SD 2.19) mm vs fan-type 1.83 (SD 0.41) mm; P<0.001 (greater intermolar expansion with Hyrax) | 1 study · 12 participants | Ungraded |
Fixed expander with differential opening expansion (DOE) vs Fixed fan-type expander
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion | Massaro 2020: DOE 7.76 (SD 1.23) mm vs fan-type 8.80 (SD 1.33) mm; P=0.008 (favours fan-type) | 1 study | Ungraded |
Molar expansion | Massaro 2020: DOE 5.10 (SD 1.17) mm vs fan-type 2.23 (SD 0.75) mm; P<0.001 (favours differential opening) | 1 study | Ungraded |
Crossbite correction | Massaro 2020: differential opening 24/24 vs fan-type 18/24 crossbites corrected | 1 study | Ungraded |
Self-ligating brackets (Damon System) vs Fixed tooth-borne Hyrax expander
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction | Nam 2020: Damon 41/41 vs Hyrax 41/41; NS (no difference in crossbite correction; greater transverse molar/premolar expansion with Hyrax) | 1 study · 82 participants | Ungraded |
Haas expander anchored on deciduous second molars vs Haas expander anchored on permanent first molars
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar expansion after 5-month retention period | Ugolini 2015: deciduous 4.3 mm vs permanent 5.8 mm; P<0.01 (favours permanent-molar anchorage) | 1 study | Ungraded |
Canine expansion after 5-month retention period | Ugolini 2015: deciduous 4.2 mm vs permanent 3.3 mm; P<0.01 (more stable anterior expansion with deciduous anchorage) | 1 study | Ungraded |
Fixed tooth-borne Hyrax expander vs Bonded expander plate (acrylic)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Molar expansion 1 week after completion of expansion | MD 0.36 [-0.72, 1.44] | 1 study | Ungraded |
Fixed bonded acrylic splint expander vs No treatment
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Canine expansion (maxillary intercanine width) | MD 2.288 | 1 study | Ungraded |
Molar expansion (maxillary intermolar width) | MD 6.265 | 1 study | Ungraded |
Bone-borne expansion appliance vs No treatment (observation)
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crossbite correction Adolescents | Alberta 2010: bone-borne expansion corrected all posterior crossbites (21/21); no self-correction in the untreated group | 1 study | Ungraded |
Any orthodontic (non-surgical) treatment to correct posterior crossbite or expand the top teeth vs No treatment or another orthodontic treatment
Population: Children and adults with a posterior crossbite, without a Class III skeletal relationship, cleft lip or palate (or both), or other syndrome associated with craniofacial anomalies (included studies were children and adolescents aged 5 to 17 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Signs and symptoms of respiratory issues | no estimate extracted | 0 studies | No studies |
Quality of life | no estimate extracted | 0 studies | No studies |
Signs and symptoms of temporomandibular joint dysfunction | no estimate extracted | 0 studies | No studies |