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What are the effects of orthodontic treatment for class II malocclusion in children?

cheerful boy 5 years shut by the hands mouthThis summary is based on the Cochrane Oral Health Group review: Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children (November 2013)

Badri Thiruvenkatachari, Jayne E Harrison, Helen V Worthington, Kevin D O’Brien


Prominent upper front teeth are a common problem affecting about a quarter of 12-year old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists. This condition develops when the child’s permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. These teeth are more likely to be injured and their appearance can cause significant distress.

If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence.

Purpose of the Review

To assess the effects of orthodontic treatment for prominent upper front teeth when this treatment is initiated when the child is seven to 11 years old compared to when they are in early adolescence, or when treatment uses different types of orthodontic braces.

Key Findings

  • The evidence suggests that providing orthodontic treatment, for children with prominent upper front teeth, in two phases appears to significantly reduce the incidence of damage to incisor teeth (middle four teeth at the top) as compared to treatment that is provided in one phase when the child is in early adolescence. There are no other advantages for providing a two-phase treatment i.e. early from age seven to 11 years and again in adolescence compared to one phase in adolescence.
  • When functional appliance treatment is provided in early adolescence it appears that there are minor beneficial changes in skeletal pattern, however, these are probably not clinically significant. Similarly, the choice of functional appliance when compared to the Twin Block does not result in any advantageous effects.


List of references included in the review (PDF)




  1. I really feel that the report here is misleading and not comprehensive.

    I have seen many cases through reports, studies and case reviews from dentists/orthodontists that have treated in 2 phases that show great improvement physically (better breathing, better aesthetics, more patient confidence) than with 1 phase of braces only. Treating earlier prevents speech problems and other habits from developing. Twin Blocks are not the only appliances out there!

    The old days of ‘wait until your 13’ are over!

    • VR you’ve hit the nail right on the head. Overly simplistic and, as with many Cochrane reviews that involve orthodontics, misleading. “No advantage to 2 Phase treatment compared to adolescence”? A blanket, misleading statement if there ever was one. They’ve completely ignored the issues of paediatric sleep disordered breathing, speech, habits, predictability of response to orthopaedic correction in teens, ability to correct severe Class IIs in teens, even practical issues of patient motivation and cooperation in protracted treatment plans… the list is long and varied. To paraphrase, “There are lies, damned lies, and Cochrane reviews.” A bit harsh, maybe, but a warning for the value one should place on retrospective literature reviews. They are only as good as their foundation, and the sad truth is a great deal of orthodontic literature does not serve as a good basis for these reviews. One paper a couple of years back in the AJODO concluded that the only literature that was viable for this purpose were Class III correction studies. But some people didn’t want to hear that.

    • You are so correct. I am an orthodontist and I can tell you that early interceptive treatment reduces the need for extraction which in turn allows for improved facial support in later years. We are realizing that orthodontics is a treatment that affects far more than just teeth. Dentistry is so preventative in nature. It is only common sense that Orthodontics follow the same course.

  2. Thank you for the blog post! We often overlook preventative dental care as everyday people, but this article helps give us motivation :)i have a Dental İlan in Turkey. Have a nice day…

  3. Compared to Twin Block? The twin block appliance is a FUNCTIONAL appliance. It is essentially a Bionator divided into an upper and lower appliance. When the patient closes, the appliances acts as a single unit. The effectiveness of any functional appliance is basically dependant on patient cooperation.

  4. Teeth prominence, misaligned teeth, teeth gapes, crooked teeth are all common in children. There are many orthodontic treatments like dental braces that are perfectly accurate in treating these. Child age at which they are to seek such treatment is the subject of doctor consultation; and should be performed at the right time!!

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