Cochrane · intervention · CD005515
Orthodontic and orthopaedic treatment for anterior open bite in children
Lentini‐Oliveira, DA, Carvalho, FR, Rodrigues, CG, et al. · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
19
current version
GRADE rated
0
No studies
8
Included studies
3
as reported
No studies 8 · 42.1%Ungraded 11 · 57.9%Very low 0 · 0%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 and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of contact or vertical overlap between upper and lower front teeth); who have stopped any sucking habits 1 year or more before treatment; do not have a class III skeletal relationship, cleft lip or palate, or other syndrome associated with craniofacial anomalies | Three included studies (120 participants): Kiliaridis 1990 (Sweden, n=20); Erbay 1995 (Turkey, n=40); Almeida 2005 (Brazil, n=60). Ages ranged from 7 years 5 months to 16 years 1 month. Two studies required skeletal anterior open bite; anterior open bite of at least 1 mm was an inclusion criterion in two studies |
| Intervention | Orthodontic or orthopaedic (non-surgical) treatment used to correct anterior open bite: Orthopaedic functional appliances (e.g. Simoes Network 2 (SN2), Simoes Network 3 (SN3), Frankel's function regulator-4 (FR-4)); Fixed orthodontic appliances (e.g. multiloop edgewise archwire (MEAW), Mcloughlin, Bennett, Trevisi); Removable orthodontic appliances (e.g. tongue crib appliances, fixed intraoral habit appliances, removable habit-breaker) | Frankel's function regulator-4 with lip-seal training (n=20); Repelling-magnet splints (n=10); Removable appliance with palatal crib associated with high-pull chincup (n=30) |
| Comparison | No intervention; Another technique | No treatment (n=50); Bite-blocks (n=10) |
| Outcomes | Primary: Correction of the anterior open bite (contacts/overlap between upper and lower central incisors; plaster models, cephalometric data, clinical assessment); Secondary: Stability of correction (1 year); Expansion of the upper and lower jaws; Incisor position and inclination; Alteration of hyperdivergent growth pattern; Mandibular ramus growth; Reduction of snoring; Signs and symptoms of respiratory disease (mouth breathing, nasal airway resistance); Signs and symptoms of atypical swallowing and speech disturbances; Reduction or treatment of OSAS or UARS; Economic evaluation (costs); Drop-outs; Side effects/tolerability; Patient satisfaction | Anterior open bite correction (n=3); Incisor position and inclination (n=2); Alteration of hyperdivergent growth pattern (n=2); Mandibular ramus growth (n=2); Expansion of the upper and lower jaw (n=1); Side effects/adverse effects (unilateral crossbite) (n=1) |
| Study designs | Randomised controlled trials (RCTs); quasi-randomised trials eligible (subjected to sensitivity analysis) | Randomised controlled trials (n=3) |
| Timing | Not specified (stability of correction assessed 1 year after treatment) | Treatment duration: FR-4 with lip-seal training 2 years; repelling-magnet splints vs bite-blocks 6 months (interrupted at about 4 months); palatal crib with high-pull chincup 12 months |
Search date: 2014-02. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; LILACS via BIREME Virtual Health Library; Brazilian Bibliography of Odontology (BBO) via BIREME Virtual Health Library; SciELO; ClinicalTrials.gov
Questions and results
Current version onlyFrankel's function regulator-4 (FR-4) with lip-seal training vs No treatment
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure to correct the anterior open bite (open bite not closed) End of treatment (about 2 years) | RR 0.02 [0.00, 0.38] | 1 study · 40 participants | Ungraded |
Signs and symptoms of respiratory disease (mouth breathing, nasal airway resistance) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Economic evaluation (costs) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Reduction or treatment of obstructive sleep apnoea syndrome (OSAS) or upper airway resistance syndrome (UARS) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Mandibular ramus growth End of treatment (about 2 years) | The author reported no difference between groups in mandibular ramus growth (linear measure Ar-Go). No pooled estimate. | 1 study | Ungraded |
Patient satisfaction | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Stability of anterior open bite correction (1 year after treatment) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Position of the incisors (upper incisor inclination) End of treatment (about 2 years) | The angulation of the upper incisors with the palatal plane (1/ANSPNS) decreased on average 0.3 (SD 4.6) degrees in the control group, whereas in the treated group the mean retrusion was 4 (SD 4.6) degrees, P < 0.01.… | 1 study | Ungraded |
Alteration of hyperdivergent growth pattern End of treatment (about 2 years) | Multiple cephalometric measures reported (Erbay 1995). Treated group: total anterior facial height (N-Me) +3.9 (SD 1.8) mm, upper anterior facial height (N-ANS) +3.3 (SD 1.2) mm; controls showed significantly greater… | 1 study | Ungraded |
Signs and symptoms of atypical swallowing and speech production disturbances | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Reduction of snoring | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Side effects / tolerability | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Repelling-magnet splints vs Bite-blocks
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Side effects / adverse effects (unilateral crossbite; transverse problems) About 4 months (treatment interrupted early) | "After 4 months the open bite was observed to close in the magnet group, but in four out of these ten patients, transverse problems were observed (unilateral crossbite) which led to the interruption of the treatment… | 1 study · 10 participants | Ungraded |
Anterior open bite correction About 4 months (treatment interrupted early) | Could not be analysed statistically. After 4 months the open bite was observed to close in the magnet group, but in four out of these ten patients transverse problems (unilateral crossbite) were observed, which led to… | 1 study | Ungraded |
Removable appliance with palatal crib associated with high-pull chincup vs No treatment
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mandibular ramus growth End of treatment (12 months) | Cephalometric data (SNA, Co-A, SNB, Ar-Go, Ar.GoMe, Co-Gn, ANB) were reported to be not significantly different between groups; effects were dento-alveolar rather than skeletal. No pooled estimate (Almeida 2005). | 1 study | Ungraded |
Expansion of the upper and lower jaw End of treatment (12 months) | Listed among the outcome measures evaluated by Almeida 2005. No separate width/expansion estimate is reported in the text; the review concluded the interventions produced no significant change in the skeletal maxillary… | 1 study | Ungraded |
Alteration of hyperdivergent growth pattern End of treatment (12 months) | The angles (SN.GoGN, SN.PP, NS.Gn) and linear measures (AFA, AFP, AFAI) did not demonstrate significant alterations between groups; interventions did not produce significant changes in the skeletal maxillary or… | 1 study | Ungraded |
Position of the incisors (upper incisor inclination) End of treatment (12 months) | The author reported that data (1.NA, 1-NA, 1-PP, 1.NB, 1-NB, 1-GoMe) showed a statistically significant difference. There was palatal inclination of the upper incisors in the intervention group that contributed to… | 1 study | Ungraded |
Failure to correct the anterior open bite (open bite not closed) End of treatment (12 months) | RR 0.23 [0.11, 0.48] | 1 study · 60 participants | Ungraded |
Frankel's function regulator-4 (FR-4) with lip-seal training vs No treatment
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Position of the incisors (upper incisor inclination) End of treatment (about 2 years) | The angulation of the upper incisors with the palatal plane (1/ANSPNS) decreased on average 0.3 (SD 4.6) degrees in the control group, whereas in the treated group the mean retrusion was 4 (SD 4.6) degrees, P < 0.01.… | 1 study | Ungraded |
Economic evaluation (costs) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Stability of anterior open bite correction (1 year after treatment) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Failure to correct the anterior open bite (open bite not closed) End of treatment (about 2 years) | RR 0.02 [0.00, 0.38] | 1 study · 40 participants | Ungraded |
Side effects / tolerability | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Mandibular ramus growth End of treatment (about 2 years) | The author reported no difference between groups in mandibular ramus growth (linear measure Ar-Go). No pooled estimate. | 1 study | Ungraded |
Reduction or treatment of obstructive sleep apnoea syndrome (OSAS) or upper airway resistance syndrome (UARS) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Reduction of snoring | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Signs and symptoms of atypical swallowing and speech production disturbances | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Alteration of hyperdivergent growth pattern End of treatment (about 2 years) | Multiple cephalometric measures reported (Erbay 1995). Treated group: total anterior facial height (N-Me) +3.9 (SD 1.8) mm, upper anterior facial height (N-ANS) +3.3 (SD 1.2) mm; controls showed significantly greater… | 1 study | Ungraded |
Signs and symptoms of respiratory disease (mouth breathing, nasal airway resistance) | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Patient satisfaction | Outcome proposed in the review but not found in any included study. The review states: 'The other outcomes proposed in this review were not found: stability of anterior open bite correction; reduction of snoring; signs… | 0 studies | No studies |
Repelling-magnet splints vs Bite-blocks
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Side effects / adverse effects (unilateral crossbite; transverse problems) About 4 months (treatment interrupted early) | "After 4 months the open bite was observed to close in the magnet group, but in four out of these ten patients, transverse problems were observed (unilateral crossbite) which led to the interruption of the treatment… | 1 study · 10 participants | Ungraded |
Anterior open bite correction About 4 months (treatment interrupted early) | Could not be analysed statistically. After 4 months the open bite was observed to close in the magnet group, but in four out of these ten patients transverse problems (unilateral crossbite) were observed, which led to… | 1 study | Ungraded |
Removable appliance with palatal crib associated with high-pull chincup vs No treatment
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Position of the incisors (upper incisor inclination) End of treatment (12 months) | The author reported that data (1.NA, 1-NA, 1-PP, 1.NB, 1-NB, 1-GoMe) showed a statistically significant difference. There was palatal inclination of the upper incisors in the intervention group that contributed to… | 1 study | Ungraded |
Failure to correct the anterior open bite (open bite not closed) End of treatment (12 months) | RR 0.23 [0.11, 0.48] | 1 study · 60 participants | Ungraded |
Mandibular ramus growth End of treatment (12 months) | Cephalometric data (SNA, Co-A, SNB, Ar-Go, Ar.GoMe, Co-Gn, ANB) were reported to be not significantly different between groups; effects were dento-alveolar rather than skeletal. No pooled estimate (Almeida 2005). | 1 study | Ungraded |
Expansion of the upper and lower jaw End of treatment (12 months) | Listed among the outcome measures evaluated by Almeida 2005. No separate width/expansion estimate is reported in the text; the review concluded the interventions produced no significant change in the skeletal maxillary… | 1 study | Ungraded |
Alteration of hyperdivergent growth pattern End of treatment (12 months) | The angles (SN.GoGN, SN.PP, NS.Gn) and linear measures (AFA, AFP, AFAI) did not demonstrate significant alterations between groups; interventions did not produce significant changes in the skeletal maxillary or… | 1 study | Ungraded |
Orthodontic or orthopaedic (non-surgical) treatment to correct anterior open bite (orthopaedic functional appliances e.g. Simoes Network 2/3, Frankel's function regulator-4; fixed appliances e.g. multiloop edgewise archwire; removable appliances e.g. tongue crib) vs No intervention, or another technique
Population: Children and adolescents (over 80% aged 16 years or younger at treatment start) with anterior open bite (lack of vertical overlap or contact of the upper and lower incisors); sucking habits stopped 1 year or more before treatment; excluding class III skeletal relationship, cleft lip or palate, or other craniofacial syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol only (2005); no studies included at protocol stage. Planned primary outcome: correction of the anterior open bite. Planned secondary outcomes: stability of correction (1 year); expansion of the upper and lower… | NR | No studies |