Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial.

Factors influencing treatment time in orthodontic patients.

Background
A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth, the lower jaw may have to move to one side to allow the back teeth to meet together. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth while others are directed at treating the cause of the posterior crossbite (e.g. breathing problems or sucking habits). Most treatments have been used at each stage of dental development. This is an update of a Cochrane review first published in 2001.

Objectives
To assess the effects of orthodontic treatment for posterior crossbites.

Search methods
We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 21 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 21 January 2014), and EMBASE via OVID (1980 to 21 January 2014). We searched the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.

Selection criteria
Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults.

Data collection and analysis
Two review authors, independently and in duplicate, screened the results of the electronic searches, and extracted data and assessed the risk of bias of the included studies. We attempted to contact the first named authors of the included studies for missing data and for clarification. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous (event) data, and mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models (we would have used random-effects models if we had included four or more studies in a meta-analysis) when comparisons and outcomes were sufficiently similar.

Main results
We included 15 studies, of which two were at low risk of bias, seven were at high risk of bias and six were unclear.

Fixed appliances with mid-palatal expansion

Nine studies tested fixed appliances with mid-palatal expansion against each other. No study reported a difference between any type of appliance.

Fixed versus removable appliances

Fixed quad-helix appliances may be 20% more likely to correct crossbites than removable expansion plates (RR 1.20; 95% CI 1.04 to 1.37; two studies; 96 participants; low-quality evidence).

Quad-helix appliances may achieve 1.15 mm more molar expansion than expansion plates (MD 1.15 mm; 95% CI 0.40 to 1.90; two studies; 96 participants; moderate-quality evidence).

There was insufficient evidence of a difference in canine expansion or the stability of crossbite correction.

Very limited evidence showed that both fixed quad-helix appliances and removable expansion plates were superior to composite onlays in terms of crossbite correction, molar and canine expansion.

Other comparisons

Very limited evidence showed that treatments were superior to no treatment, but there was insufficient evidence of a difference between any active treatments.

Authors' conclusions
There is a very small body of low- to moderate-quality evidence to suggest that the quad-helix appliance may be more successful than removable expansion plates at correcting posterior crossbites and expanding the inter-molar width for children in the early mixed dentition (aged eight to 10 years). The remaining evidence we found was of very low quality and was insufficient to allow the conclusion that any one intervention is better than another for any of the outcomes in this review.

Orthodontic treatment for posterior crossbites

Retention and stability: a review of the literature

The influence of occlusal conditions on stomatognathic function can be assessed by electromyography. Electromyographic activity of left and right temporal and masseter muscles was recorded in 30 young healthy adults with a normal occlusion during: (1) a 3-s maximum voluntary clench on cotton rolls positioned on the posterior teeth (standardization recording); (2) a 3-s maximum voluntary clench in intercuspal position; and (3) a 3-s alternate 'maximum' voluntary contraction and relaxation with a 1 Hz frequency. All potentials were standardized as a percentage of the maximum potential of test 1. Waveforms of paired muscles were compared by computing a percentage overlapping coefficient (ratio between each 50-ms overlapped areas and the total areas, up to 100% for symmetric muscles). Waveforms were also analysed for a laterodeviating effect on the mandible given by unbalanced muscular couples, and a torque coefficient (up to 100% for a significant laterodeviating couple on the mandible) was computed. In all subjects, both tests were performed with symmetric muscular patterns (more than 88%) and with negligible laterodeviating couples on the mandible (lower than 10%). The two coefficients allow an assessment of muscular asymmetry during static and dynamic clenching tests, and, together with the standardization of the potentials, could be a useful tool to detect functionally altered occlusal conditions, i.e. conditions where an apparent good morphological situation is not related to a correct neuromuscular status.

An electromyographic investigation of masticatory muscles symmetry in normo-occlusion subjects.

Long-term stability after orthodontic treatment: nonextraction with prolonged retention

An evaluation of mandibular asymmetry in adults with unilateral posterior crossbite.

Facial and dental arch asymmetries in Class II subdivision malocclusion.

Effectiveness and duration of orthodontic treatment in adults and adolescents

The effectiveness and long-term stability of overbite correction with incisor intrusion mechanics.

Bernard J. Schneider

Papers

Long-term stability after orthodontic treatment: nonextraction with prolonged retention

An evaluation of mandibular asymmetry in adults with unilateral posterior crossbite.

Facial and dental arch asymmetries in Class II subdivision malocclusion.

Effectiveness and duration of orthodontic treatment in adults and adolescents

The effectiveness and long-term stability of overbite correction with incisor intrusion mechanics.