Background

Orthodontics is concerned with growth of the jaws and face, development of the teeth, and the way teeth and jaws bite together. Ideally, the lower front teeth bite in the middle of the back surface of the upper front teeth. When the lower front teeth bite further behind the upper front teeth than ideal, this is known as a Class II malocclusion. A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (vertical overlap of the front teeth), which can cause oral problems and may affect appearance.

This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. These braces can be removed from the mouth and this approach does not usually require removal of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.

An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth.

If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed arch placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).

Aim

We carried out this Cochrane Review to find out if orthodontic treatment without the removal of permanent teeth had different effects than no orthodontic treatment or orthodontic treatment involving the removal of permanent teeth, in children with a Class II division 2 malocclusion.

Method

We searched the scientific literature up to 13 November 2017 and found no relevant studies to include in this review.

Results

There are no clinical trials that evaluate whether orthodontic treatment, carried out without the removal of permanent teeth, is better or worse than no orthodontic treatment or orthodontic treatment that involves taking out permanent teeth, in children with Class II division 2 malocclusion.

Author conclusions

There is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment to correct the teeth of children whose bite is deep and whose upper front teeth are tilted towards the roof of the mouth. It seems unlikely that trials will be carried out to evaluate this treatment as they are challenging to design and conduct.