What are the effects of orthodontic treatment for distalising upper first molars in children and adolescents?

This summary is based on the review published in the Chochrane database of systematic reviews: Orthodontic treatment for distalising upper first molars in children and adolescents (October 2013)

Safa Jambi, Badri Thiruvenkatachari, Kevin D O’Brien, Tanya Walsh

Context

• When orthodontic treatment is provided with fixed appliances, it is sometimes necessary to move the upper molar teeth backwards (distalise) to create space or help to overcome anchorage requirements.
• This can be achieved with the use of extraoral or intraoral appliances.
• The most common appliance is extraoral headgear, which requires considerable patient co-operation.
• Further, reports of serious injuries have been published.
• Intraoral appliances have been developed to overcome such shortcomings.
• The comparative effects of extraoral and intraoral appliances have not been fully evaluated.

Purpose of the Review

To assess the effects of orthodontic treatment for distalising upper first molars in children and adolescents.

Key Findings

• There was a statistically significant difference in mean distal molar movement favouring intraoral appliances compared to headgear. However, a statistically significant difference in mean mesial upper incisor movement and overjet favoured headgear, i.e. there was less loss of anterior anchorage with headgear.
• It is suggested that intraoral appliances are more effective than headgear in distalising upper first molars. However, this effect is counteracted by loss of anterior anchorage, which was not found to occur with headgear when compared with intraoral distalising appliance in a small number of studies.
• The number of trials assessing the effects of orthodontic treatment for distilisation is low, and the current evidence is of low or very low quality.

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