Cochrane · intervention · CD003453
Orthodontic treatment for crowded teeth in children
Turner, S, Harrison, JE, Sharif, FNJ, 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
44
current version
GRADE rated
15
No studies
0
Included studies
24
as reported
No studies 0 · 0%Ungraded 29 · 65.9%Very low 15 · 34.1%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
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 (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth; studies with cleft lip/palate or other craniofacial syndromes excluded; studies with <80% of participants aged 16 or under excluded | 1512 participants randomised, 1314 analysed; mean age 7.6 to 15.3 years; 15 studies reported gender (male 23.3% to 58.8%) |
| Intervention | Fixed appliances and auxiliaries; removable appliances and auxiliaries; extractions (any intervention or combination, at any time during treatment) | Fixed appliances and auxiliaries (n=20); Removable appliances and auxiliaries (n=2); Extractions (n=2) |
| Comparison | No treatment, delayed treatment, placebo, or another active intervention | No active treatment (n=17); Minor interceptive procedures (n=1); Conventional brackets (n=5); Nickel-titanium archwires (n=3); Fixed appliances only (n=3); Passive self-ligating brackets (n=2); Multistranded stainless steel archwires (n=2); Stainless steel archwires (n=2) |
| Outcomes | Primary: Amount of crowding (mm or any index of malocclusion). Secondary: Size of the upper jaw (arch length); Size of the lower jaw (arch length); Upper incisors to maxilla; Lower incisors to mandible; Lower molars to mandible; Time to alignment; Time for ligation; Self-esteem; Participant satisfaction; Jaw joint problems. Other: Harms (health of the gums; damage to the teeth; pain including use of analgesia) | Amount of crowding (n=24); Arch length (n=7); Time to alignment (n=8); Ligation time (n=1); Upper incisors to maxilla (n=3); Lower incisors to mandible (n=6); Lower molars to mandible (n=2); Harms (n=6) |
| Study designs | Randomised controlled trials (RCTs) of orthodontic treatments to prevent or correct crowded teeth, comparing one intervention to placebo, no intervention or another crowding method | Randomised controlled trials (n=24) |
| Timing | Clinically important outcomes recorded at the most common endpoints reported for all ages | 19 different time points recorded across studies, from pre-treatment to 13-year follow-up |
Search date: 2021-01. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Current version onlyLower lip bumper vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Lower incisors to mandible at 6 months 6 months | MD 3.14 [1.73, 4.55] | 1 study · 34 participants | Ungraded |
Amount of crowding (change in mandibular incisor crowding) at 6 months 6 months | MD -4.39 [-5.07, -3.71] -4.39 [-5.07, -3.71] mm | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Size of the lower jaw (mandibular arch length) at 6 months 6 months | MD 3.34 [2.71, 3.97] | 1 study · 34 participants | Ungraded |
Lower molars to mandible at 6 months 6 months | MD -0.91 [-1.58, -0.24] | 1 study · 34 participants | Ungraded |
Cervical pull headgear vs Minor interceptive procedures (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Size of the jaws (maxillary and mandibular arch length) 2 to 8 years | MD 1.98 [1.80, 2.16] | 1 study · 64 participants | Ungraded |
Amount of crowding (lower incisor crowding) at 2 years 2 years | MD 0.33 [-0.60, 1.26] 0.33 [-0.60, 1.26] mm | 1 study · 64 participants | Very low Downgraded: risk of bias, imprecision |
Upper incisors to maxilla at 2 years 2 years | MD 4.5 [1.36, 7.64] | 1 study · 64 participants | Ungraded |
Lower incisors to mandible at 2 years 2 years | MD 1.4 [-0.42, 3.22] | 1 study · 64 participants | Ungraded |
Lower lingual arch vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Size of the lower jaw (mandibular arch length) at 1 year 1 year | MD 2.61 [1.83, 3.39] | 1 study · 30 participants | Ungraded |
Amount of crowding 1 year | SoF1: Amount of crowding - Not measured. The single study (Rebellato 1997) did not report the amount of crowding for this comparison. | 1 study | Ungraded |
Lower incisors to mandible at 1 year 1 year | MD 3.01 [1.71, 4.31] | 1 study · 30 participants | Ungraded |
Lower molars to mandible at 1 year 1 year | MD -1.11 [-1.51, -0.71] | 1 study · 30 participants | Ungraded |
Self-ligating brackets vs Conventional brackets
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Lower incisors to mandible (inclination, degrees) post-treatment | MD 1.29 [-1.77, 4.35] | 1 study · 33 participants | Ungraded |
Time to alignment (days) alignment | MD 89.64 [-45.89, 225.17] | 2 studies · 148 participants | Ungraded |
Amount of crowding (lower incisor crowding) at 10 weeks 10 weeks | MD -0.40 [-0.93, 0.13] -0.40 [-0.93, 0.13] mm | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Time for ligation (seconds, to ligate six brackets) during treatment | MD -78.8 [-81.86, -75.74] | 1 study · 60 participants | Ungraded |
Harms (discomfort, periodontal/gingival health, root resorption) up to 9 months | No evidence of differences between self-ligating and conventional brackets for discomfort (Atik 2014, Miles 2010), plaque/gingival index and probing depth (Atik 2014), or maxillary incisor root resorption (Aras 2018).… | 3 studies | Ungraded |
Active self-ligating brackets vs Passive self-ligating brackets
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to alignment (days) alignment | MD -13.11 [-28.76, 2.53] | 2 studies · 144 participants | Ungraded |
Amount of crowding (upper anterior crowding) baseline | Only baseline upper anterior crowding reported (Pandis 2010a, n=70); evidence of baseline imbalance between groups (P=0.04); no post-treatment between-group crowding estimate reported. | 1 study | Ungraded |
Copper nickel-titanium archwire vs Nickel-titanium archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (Little's Irregularity Index) at 12 weeks 12 weeks | MD 0.49 [0.35, 0.63] 0.49 [0.35, 0.63] mm | 1 study · 66 participants | Very low Downgraded: risk of bias, imprecision |
Harms (discomfort) after archwire change | No difference in overall discomfort levels between copper NiTi and NiTi archwire sequences (Ong 2011, 7-point Likert). Narrative; no pooled estimate. | 1 study | Ungraded |
Time to alignment (days) alignment | MD -2.63 [-14.50, 9.24] | 2 studies · 191 participants | Ungraded |
Coaxial nickel-titanium archwire vs Nickel-titanium archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of tooth movement / reduction in crowding at 12 weeks 12 weeks | MD 6.77 [5.55, 7.99] 6.77 [5.55, 7.99] mm | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Nitinol archwire vs Titinol archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (change) up to 37 weeks up to 37 weeks | MD -0.28 [-0.89, 0.33] -0.28 [-0.89, 0.33] mm | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Nickel-titanium archwire vs Multistranded stainless steel archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Harms (pain) first days | No difference in overall pain, but more pain with nickel-titanium at 12 hours and day 1 (morning, afternoon, bedtime) vs multistranded stainless steel (Sandhu 2013). Narrative; no pooled estimate. | 1 study | Ungraded |
Amount of crowding (change in mandibular crowding) at 8 weeks 8 weeks | MD 1.60 [-22.16, 25.36] 1.60 [-22.16, 25.36] mm | 1 study · 25 participants | Very low Downgraded: risk of bias, imprecision |
Nickel-titanium archwire vs Stainless steel archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (change in mandibular crowding) at 8 weeks 8 weeks | MD -16.80 [-42.79, 9.19] -16.80 [-42.79, 9.19] mm | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Multistranded stainless steel archwire vs Stainless steel archwire
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (change in mandibular crowding) at 8 weeks 8 weeks | MD -18.40 [-47.12, 10.32] -18.40 [-47.12, 10.32] mm | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Lacebacks with fixed appliances vs Fixed appliances only (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Size of the lower jaw (arch length) 6 months | MD 0.83 [-6.41, 8.07] | 1 study · 62 participants | Ungraded |
Amount of crowding (change) at 6 months 6 months | MD -0.33 [-5.90, 5.24] -0.33 [-5.90, 5.24] mm | 1 study · 62 participants | Very low Downgraded: risk of bias, imprecision |
Vibrational appliance with fixed appliances vs Fixed appliances only / no vibrational appliance (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Harms (discomfort, pain intensity, analgesia use) first week | No clear difference in discomfort/pain intensity or analgesia consumption between vibrational appliance and control (Miles 2012, Miles 2016, Woodhouse 2015; 100 mm VAS). Narrative; no pooled estimate. | 2 studies | Ungraded |
Amount of crowding (change in mandibular crowding) at 10 to 30 weeks 10 to 30 weeks | MD 0.24 [-0.81, 1.30] 0.24 [-0.81, 1.30] mm | 2 studies · 119 participants | Very low Downgraded: risk of bias, imprecision |
Time to alignment (days) alignment | MD -3.70 [-26.29, 18.89] | 2 studies | Ungraded |
Harms (orthodontically-induced inflammatory root resorption) end of alignment | Using a vibrational appliance did not affect amount of root resorption vs control (Woodhouse 2015; 72 participants analysed). Narrative; no pooled estimate. | 1 study · 72 participants | Ungraded |
Schwarz appliance vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Upper incisors to maxilla (inclination, degrees) at 9 months 9 months | MD 0.33 [-2.26, 2.92] | 1 study · 28 participants | Ungraded |
Size of the lower jaw (mandibular arch length, change) at 9 months 9 months | MD 0.11 [-0.46, 0.68] | 1 study · 28 participants | Ungraded |
Amount of crowding (lower arch crowding, change) at 9 months 9 months (after 6 months treatment) | MD -2.14 [-2.79, -1.49] -2.14 [-2.79, -1.49] mm | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Lower incisors to mandible (position, mm) at 9 months 9 months | MD 0.39 [0.11, 0.67] | 1 study · 28 participants | Ungraded |
Eruption guidance appliance vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (number of children with crowding, mandible) after 1 year 1 year | OR 0.19 [0.05, 0.68] 14 out of 22 children (control) vs 6 out of 24 children (experimental) | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Extraction of lower deciduous canines vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Lower incisors to mandible (inclination, degrees) at 1 year 1 year | MD 0.08 [-0.55, 0.71] | 1 study · 83 participants | Ungraded |
Amount of crowding (lower incisor crowding, change) at 1-2 years 1 to 2 years | MD -4.76 [-6.24, -3.28] -4.76 [-6.24, -3.28] mm | 1 study · 83 participants | Very low Downgraded: risk of bias, imprecision |
Size of the lower jaw (arch length, change) at 1 year 1 year | MD -2.73 [-3.69, -1.77] | 1 study · 83 participants | Ungraded |
Extraction of third molars (wisdom teeth) vs No active treatment (control)
Population: Children or adolescents (aged 16 years old or under) receiving orthodontic treatment to prevent or correct crowded teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of crowding (Little's Irregularity Index, change) at 5 years 5 years | MD -0.30 [-1.30, 0.70] -0.30 [-1.30, 0.70] mm | 1 study · 77 participants | Very low Downgraded: risk of bias, imprecision |
Size of the lower jaw (arch length, change) 5 years | MD 1.03 [0.56, 1.50] | 1 study · 77 participants | Ungraded |
Orthodontic treatment (any: removable, fixed or functional braces, head-braces, or extractions) vs No treatment / delayed treatment / another active intervention
Population: Children and/or adolescents (aged 16 years or less) receiving orthodontic treatment to correct or prevent crowding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self-esteem | no estimate extracted | NR | No studies |
Jaw joint problems (temporomandibular) | no estimate extracted | NR | No studies |
Damage to the teeth (e.g. tooth decay) | no estimate extracted | NR | No studies |
Lower molars to mandible (relationship of lower back teeth to the mandible) | no estimate extracted | NR | No studies |
Amount of crowding (mm or index of malocclusion) | no estimate extracted | NR | No studies |
Lower incisors to mandible (relationship of lower front teeth to the mandible) | no estimate extracted | NR | No studies |
Patient satisfaction | no estimate extracted | NR | No studies |
Health of the gums (gingivae) | no estimate extracted | NR | No studies |