Cochrane · intervention · CD008375
Orthodontic treatment for distalising upper first molars in children and adolescents
Jambi, S, Thiruvenkatachari, B, O'Brien, KD, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
9
No studies
10
Included studies
10
as reported
No studies 10 · 47.6%Ungraded 2 · 9.5%Very low 4 · 19%Low 5 · 23.8%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 or less at the start of treatment who receive orthodontic treatment intended to move the upper molars distally; patients with cleft lip and palate or other craniofacial problems excluded | Ten trials with 354 analysed participants; children/adolescents aged 9 to 15 years (mean 9.2 to 9.7 years in one trial, 11.45 to 14.75 years across the rest); even gender distribution in most trials; conducted in Turkey, Italy, Sweden, Brazil, Greece and the UK, mostly in university dental hospital settings; published 2005-2011 |
| Intervention | Removable or fixed orthodontic appliances intended to distalise upper first molars | Intraoral appliance with superelastic coils (n=1); Jasper Jumper (n=2); pendulum appliance with K-loops (n=1); pendulum appliance with midline screw (n=1); First Class appliance (n=1); Forsus Nitinol Flat Spring (n=2); three-dimensional bimetric maxillary distalisation arches (n=1); modified Begg intraoral distalisation system (n=1); upper removable appliance with finger springs (n=1); Jones Jig appliance (n=1); cervical headgear (n=2, as intervention versus untreated control) |
| Comparison | No treatment, or another active intervention (removable or fixed orthodontic appliance intended to distalise upper first molars) | Untreated control (n=4); headgear/cervical headgear (n=4); another intraoral distalising appliance (n=3) |
| Outcomes | Primary: (1) Movement of upper first molars (mm; mesial positive, distal negative); (2) Loss of anterior anchorage (mm), reported as mesial movement of upper incisor teeth or change in overjet. Secondary: duration of treatment; non-compliance; number of attendances. Adverse effects: headgear injuries; gum health; tooth damage (e.g. decay); root resorption. SoF outcomes: movement of upper first molars; mesial movement of upper incisor teeth; change in overjet | Movement of upper first molars (n=10); mesial/anterior movement of upper incisor teeth (n=7); change in overjet (n=5); duration of treatment (n=6); number of attendances (n=0); adverse effects (n=0) |
| Study designs | Parallel-group randomised controlled trials evaluating orthodontic appliances intended to move upper first molars distally; split-mouth trials excluded; no restriction on publication language | Parallel-group randomised controlled trials (n=10); seven two-arm and three three-arm trials |
| Timing | Clinical evaluation at any point during orthodontic treatment; the most clinically relevant time point(s) extracted | End of molar distalisation (most trials); end of active orthodontic treatment (n=1, De Oliveira 2007); study durations 12 weeks to 18 months |
Search date: 2012-12. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID
Questions and results
Current version onlyOrthodontic distalising appliance (intraoral or extraoral) vs Untreated control (no treatment)
Population: Children and adolescents (aged 16 years or less at the start of treatment) undergoing orthodontic treatment to distalise upper first molars; patients with cleft lip and palate or other craniofacial problems excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of treatment | Duration of treatment was not reported in the studies of the appliance-versus-untreated-control comparison ("Duration of treatment, non-compliance, number of attendances required to complete treatment and adverse… | 0 studies | No studies |
Number of attendances required to complete treatment | Number of attendances required to complete treatment was not reported in the studies of this comparison (not reported by any included study across the review). | 0 studies | No studies |
Non-compliance rate of the intervention | Non-compliance rate was not reported in the studies of this comparison. | 0 studies | No studies |
Movement of upper incisor teeth (mm) | SoF table 1. Assumed risk "Not estimated"; Corresponding risk "Not estimated"; Relative effect "Meta-analysis not appropriate". Comment: "No pooled estimate due to different types of appliances (First Class and… | 2 studies · 74 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects (headgear injuries, gum health, tooth damage/decay, root resorption) | Adverse effects were not reported in the studies of this comparison; no included study across the review reported adverse effects, harm or injury. | 0 studies | No studies |
Movement of upper first molars (mm) | SoF table 1 (orthodontic appliance vs untreated control). Illustrative comparative risks: Assumed risk (untreated control) "Not estimated"; Corresponding risk (orthodontic appliance) "Not estimated"; Relative effect… | 2 studies · 74 participants | Low Downgraded: risk of bias, imprecision |
Change in overjet (mm) | SoF table 1. Assumed risk "Not estimated"; Corresponding risk "Not estimated"; Relative effect "Meta-analysis not appropriate". Comment: "No pooled estimate due to different types of appliances (First Class and… | 2 studies · 74 participants | Low Downgraded: risk of bias, imprecision |
Intraoral distalising appliance vs Headgear (extraoral appliance)
Population: Children and adolescents (aged 16 years or less at the start of treatment) undergoing orthodontic treatment to distalise upper first molars; patients with cleft lip and palate or other craniofacial problems excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Non-compliance rate of the intervention | Non-compliance rate not reported ("The remaining secondary outcomes and adverse effects were not reported by these studies"). | 0 studies | No studies |
Adverse effects (headgear injuries, gum health, tooth damage/decay, root resorption) | Adverse effects were not reported by these studies. | 0 studies | No studies |
Movement of upper first molars (mm) | MD -1.45 [-2.74, -0.15] -1.45 [-2.74, -0.15] mm (distal movement; intraoral vs headgear) | 4 studies · 150 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Duration of treatment | Duration of treatment (to end of molar distalisation) reported by 3 studies (120 participants); not GRADE-rated and not in a SoF table. Bondemark 2005: intraoral appliance with superelastic coils 5.2 months (SD 1) vs… | 3 studies · 120 participants | Ungraded |
Movement of upper incisor teeth (mm) | MD 1.82 [1.39, 2.24] 1.82 [1.39, 2.24] mm (mesial movement; intraoral vs headgear) | 4 studies · 150 participants | Low Downgraded: risk of bias, imprecision |
Change in overjet (mm) | MD 1.64 [1.26, 2.02] 1.64 [1.26, 2.02] mm (increase in overjet; intraoral vs headgear) | 2 studies · 70 participants | Low Downgraded: risk of bias, imprecision |
Number of attendances required to complete treatment | Number of attendances required to complete treatment was not reported by these studies. | 0 studies | No studies |
Intraoral distalising appliance vs Another (different) intraoral distalising appliance
Population: Children and adolescents (aged 16 years or less at the start of treatment) undergoing orthodontic treatment to distalise upper first molars; patients with cleft lip and palate or other craniofacial problems excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of treatment | Duration of treatment reported by 2 studies (Altug-Atac 2008, Karacay 2006); not GRADE-rated and not in a SoF table. 3D bimetric distalising arch 3.4 months vs modified Begg intraoral distalising system 6.5 months (MD… | 2 studies | Ungraded |
Number of attendances required to complete treatment | Number of attendances required to complete treatment was not reported by these studies. | 0 studies | No studies |
Adverse effects (headgear injuries, gum health, tooth damage/decay, root resorption) | Adverse effects were not reported by these studies. | 0 studies | No studies |
Non-compliance rate of the intervention | Non-compliance rate not reported ("The remaining secondary outcomes and adverse effects were not reported by these studies"). | 0 studies | No studies |
Movement of upper first molars (mm) | SoF table 3 (intraoral vs other intraoral appliance). Assumed risk "Not estimated"; Corresponding risk "Not estimated"; Relative effect "Meta-analysis not appropriate". Quality: very low. Comment: "No pooled estimate… | 3 studies · 93 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Movement of upper incisor teeth (mm) | SoF table 3. Assumed risk "Not estimated"; Corresponding risk "Not estimated"; Relative effect "Meta-analysis not appropriate". Quality: very low. Comment: "No pooled estimate due to different types of appliances used… | 2 studies · 70 participants | Very low Downgraded: risk of bias, imprecision |
Change in overjet (mm) | SoF table 3. Assumed risk "Not estimated"; Corresponding risk "Not estimated"; Relative effect "Meta-analysis not appropriate". Quality: very low. Comment: "No pooled estimate due to different types of appliances used… | 2 studies · 70 participants | Very low Downgraded: risk of bias, imprecision |
Orthodontic distalising appliance (intraoral or extraoral) vs Untreated control (no treatment)
Population: Children and/or adolescents (aged 16 years or less at the start of treatment) receiving orthodontic treatment intended to distalise upper first molars in addition to a fixed appliance; excludes cleft lip/palate or other craniofacial deformity/syndrome, prior surgical treatment, and trials with <80% children/adolescents
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Intraoral distalising appliance vs Headgear (extraoral appliance)
Population: Children and/or adolescents (aged 16 years or less at the start of treatment) receiving orthodontic treatment intended to distalise upper first molars in addition to a fixed appliance; excludes cleft lip/palate or other craniofacial deformity/syndrome, prior surgical treatment, and trials with <80% children/adolescents
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |
Intraoral distalising appliance vs Another (different) intraoral distalising appliance
Population: Children and/or adolescents (aged 16 years or less at the start of treatment) receiving orthodontic treatment intended to distalise upper first molars in addition to a fixed appliance; excludes cleft lip/palate or other craniofacial deformity/syndrome, prior surgical treatment, and trials with <80% children/adolescents
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | no estimate extracted | 0 studies | No studies |