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Functional orthopedic treatment for anterior open bite in children. A systematic review of randomized clinical trials

Funktionelle kieferorthopädische Behandlung bei Kindern mit frontal offenem Biss. Eine systematische Übersicht zu den randomisierten klinischen Studien

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Abstract

Purpose

This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children.

Methods

A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence.

Results

We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63–4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85–6.55) with Frankel’s functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, a beneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported.

Conclusion

There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects.

PROSPERO register

CRD42020175634, prospectively registered (05 July 2020).

Zusammenfassung

Zielsetzung

Ziel dieser systematischen Übersichtsarbeit war es, die Auswirkungen von funktionellen kieferorthopädischen Apparaturen zur Behandlung des frontal offenen Bisses (AOB) bei Kindern im Milchgebiss oder im Wechselgebiss zu untersuchen.

Methoden

Die Suche nach randomisierten kontrollierten Studien (RCTs) wurde im November 2020 in elektronischen Datenbanken ohne Daten- und Sprachbeschränkung durchgeführt. Primäre Outcomes waren skelettale kephalometrische Variablen und unerwünschte Ereignisse. Zur Bewertung der methodischen Qualität wurde das Cochrane „risk-of-bias tool“ verwendet, zur Bewertung der Verlässlichkeit der Evidenz der GRADE-Ansatz.

Ergebnisse

Wir identifizierten 5 RCTs (220 Teilnehmende). Die Evidenz mit sehr geringer Verlässlichkeit zeigte eine Verbesserung des Überbisses (mittlere Differenz [MD] 3,60; 95%-Konfidenzintervall [KI] 2,63‑4,57) und der Winkelung der oberen Schneidezähne zur Gaumenebene (MD 3,70; 95 % KI 0,85–6,55) mit dem Funktionsregler nach Fränkel im Vergleich zu keiner Behandlung. Es gab keinen Unterschied in den gemessenen kephalometrischen Variablen beim Vergleich der herausnehmbaren Gaumensegel mit den festsitzenden Gaumensegeln, den eingeklebten Spornen und der Kinnkappe. Beim Vergleich zwischen herausnehmbaren und magnetischen Aufbissstücken wurde in der magnetischen Gruppe ein positiver Effekt in Bezug auf Überbiss, Overjet, anteroposteriore skelettale Winkelmessungen und vertikale skelettale lineare Messungen beobachtet. Es wurden keine unerwünschten Ereignisse berichtet.

Schlussfolgerung

Es gab keine hinreichende Evidenz, um auf die Auswirkungen dieser Behandlungen auf die AOB zu schließen, und es sind hochwertige RCTs erforderlich, um die geschätzten Auswirkungen zu erhöhen.

PROSPERO-Register

CRD42020175634, prospektiv registriert (05. Juli 2020).

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Funding

The authors declare that there are funding sources that support this work.

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Authors and Affiliations

  1. Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Avenida Conselheiro Nébias, 536—Encruzilhada, 11045-002, Santos, SP, Brazil

    Elaine Marcílio Santos PhD, Carla Pecoraro &  Ana Luiza Cabrera Martimbianco PhD

  2. Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil

    Sandra Kalil Bussadori PhD,  Anna Carolina Ratto Tempestini Horliana PhD &  Lara Jansiski Motta PhD

  3. Pediatric Dentistry, Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil

    Caroline Moraes Moriyama PhD

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  1. Elaine Marcílio Santos PhD
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Elaine Marcílio Santos, Ana Luiza C Martimbianco and Carla Pecoraro, Anna Carolina RT Horliana. The first draft of the manuscript was written by Ana Luiza C Martimbianco, Caroline Moraes Moriyama and Sandra Kalil Bussadori, and all authors commented on previous versions of the manuscript. All authors read and approved the final paper.

Corresponding author

Correspondence to Ana Luiza Cabrera Martimbianco PhD.

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Conflict of interest

E. Marcílio Santos, S. Kalil Bussadori, A.C. Ratto Tempestini Horliana, C. Moraes Moriyama, L. Jansiski Motta, C. Pecoraro and A.L. Cabrera Martimbianco declare that they have no competing interests.

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Supplementary Information

Supplemental table 1. Search strategies for each electronic database

Supplemental table 2. Risk of bias judgements for each domain.

Supplemental table 3. Summary of findings tables (GRADE approach) for the main comparison.

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Marcílio Santos, E., Kalil Bussadori, S., Ratto Tempestini Horliana, A.C. et al. Functional orthopedic treatment for anterior open bite in children. A systematic review of randomized clinical trials. J Orofac Orthop 84, 405–414 (2023). https://doi.org/10.1007/s00056-022-00388-5

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