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. 2021 Dec 24;12(12):CD000979.
doi: 10.1002/14651858.CD000979.pub3.

Orthodontic treatment for posterior crossbites

Alessandro Ugolini  1 , Paola Agostino  1 , Armando Silvestrini-Biavati  1 , Jayne E Harrison  2 , Klaus Bsl Batista  3
Affiliations

Orthodontic treatment for posterior crossbites

Alessandro Ugolini et al. Cochrane Database Syst Rev. .

Abstract

Background: A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively. Several treatments have been recommended to correct this problem, which is related to such dental issues as tooth attrition, abnormal development of the jaws, joint problems, and imbalanced facial appearance. Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate). This is the third update of a Cochrane review first published in 2001.

Objectives: To assess the effects of different orthodontic treatments for posterior crossbites.

Search methods: Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 8 April 2021 and used additional search methods to identify published, unpublished and ongoing studies.

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, extracted data, and assessed the risk of bias of the included studies. A third review author participated to resolve disagreements. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous data (event), unless there were zero values in trial arms, in which case we used odds ratios (ORs). We used mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models. We used the GRADE approach to assess the certainty of the evidence for the main outcomes.

Main results: We included 31 studies that randomised approximately 1410 participants. Eight studies were at low risk of bias, 15 were at high risk of bias, and eight were unclear. Intervention versus observation For children (age 7 to 11 years), quad-helix was beneficial for posterior crossbite correction compared to observation (OR 50.59, 95% CI 26.77 to 95.60; 3 studies, 149 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 4.71 mm, 95% CI 4.31 to 5.10; 3 studies, 146 participants; moderate-certainty evidence). For children, expansion plates were also beneficial for posterior crossbite correction compared to observation (OR 25.26, 95% CI 13.08 to 48.77; 3 studies, 148 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 3.30 mm, 95% CI 2.88 to 3.73; 3 studies, 145 participants, 3 studies; moderate-certainty evidence). In addition, expansion plates resulted in higher inter-canine distances (MD 2.59 mm, 95% CI 2.18 to 3.01; 3 studies, 145 participants; moderate-certainty evidence). The use of Hyrax is probably effective for correcting posterior crossbite compared to observation (OR 48.02, 95% CI 21.58 to 106.87; 93 participants, 3 studies; moderate-certainty evidence). Two of the studies focused on adolescents (age 12 to 16 years) and found that Hyrax increased the inter-molar distance compared with observation (MD 5.80, 95% CI 5.15 to 6.45; 2 studies, 72 participants; moderate-certainty evidence). Intervention A versus intervention B When comparing quad-helix with expansion plates in children, quad-helix was more effective for posterior crossbite correction (RR 1.29, 95% CI 1.13 to 1.46; 3 studies, 151 participants; moderate-certainty evidence), final inter-molar distance (MD 1.48 mm, 95% CI 0.91 mm to 2.04 mm; 3 studies, 151 participants; high-certainty evidence), inter-canine distance (0.59 mm higher (95% CI 0.09 mm to 1.08 mm; 3 studies, 151 participants; low-certainty evidence) and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and Haas for posterior crossbite correction (RR 1.05, 95% CI 0.94 to 1.18; 3 studies, 83 participants; moderate-certainty evidence) or inter-molar distance (MD -0.15 mm, 95% CI -0.86 mm to 0.56 mm; 2 studies of adolescents, 46 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and tooth-bone-borne expansion for crossbite correction (RR 1.02, 95% CI 0.92 to 1.12; I² = 0%; 3 studies, 120 participants; low-certainty evidence) or inter-molar distance (MD -0.66 mm, 95% CI -1.36 mm to 0.04 mm; I² = 0%; 2 studies, 65 participants; low-certainty evidence). There was no evidence of a difference between Hyrax with bone-borne expansion for posterior crossbite correction (RR 1.00, 95% CI 0.94 to 1.07; I² = 0%; 2 studies of adolescents, 81 participants; low-certainty evidence) or inter-molar distance (MD -0.14 mm, 95% CI -0.85 mm to 0.57 mm; I² = 0%; 2 studies, 81 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: For children in the early mixed dentition stage (age 7 to 11 years old), quad-helix and expansion plates are more beneficial than no treatment for correcting posterior crossbites. Expansion plates also increase the inter-canine distance. Quad-helix is more effective than expansion plates for correcting posterior crossbite and increasing inter-molar distance. Treatment duration is shorter with quad-helix than expansion plates. For adolescents in permanent dentition (age 12 to 16 years old), Hyrax and Haas are similar for posterior crossbite correction and increasing the inter-molar distance. The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.

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Conflict of interest statement

Alessandro Ugolini: involved in running and reporting of Ugolini 2015; however, he was not involved in the quality assessment of this study. Armando Silvestrini‐Biavati: involved in running and reporting of Ugolini 2015; however, he was not involved in the quality assessment of this study. Klaus Batista: no interest to declare Paola Agostino: no interest to declare Jayne Harrison: no interest to declare

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Removable tooth‐borne expansion (expansion plate) versus observation, Outcome 1: Outcomes at appliance removal: expansion plate versus observation
1.2
1.2. Analysis
Comparison 1: Removable tooth‐borne expansion (expansion plate) versus observation, Outcome 2: Outcomes at appliance removal: expansion plate versus observation
2.1
2.1. Analysis
Comparison 2: Fixed tooth‐borne expansion (quad‐helix) versus observation, Outcome 1: Outcomes at appliance removal: quad‐helix versus observation
2.2
2.2. Analysis
Comparison 2: Fixed tooth‐borne expansion (quad‐helix) versus observation, Outcome 2: Outcomes at appliance removal: quad‐helix versus observation
3.1
3.1. Analysis
Comparison 3: Fixed tooth‐borne expansion (Hyrax) versus observation, Outcome 1: Outcomes at appliance removal: Hyrax versus observation
3.2
3.2. Analysis
Comparison 3: Fixed tooth‐borne expansion (Hyrax) versus observation, Outcome 2: Outcomes at appliance removal: Hyrax versus observation
4.1
4.1. Analysis
Comparison 4: Fixed tooth‐borne expansion (quad‐helix) versus removable tooth‐borne expansion (expansion plate), Outcome 1: Outcomes at appliance removal: quad‐helix versus expansion plate
4.2
4.2. Analysis
Comparison 4: Fixed tooth‐borne expansion (quad‐helix) versus removable tooth‐borne expansion (expansion plate), Outcome 2: Outcomes at appliance removal: quad‐helix versus expansion plate
4.3
4.3. Analysis
Comparison 4: Fixed tooth‐borne expansion (quad‐helix) versus removable tooth‐borne expansion (expansion plate), Outcome 3: Outcomes at appliance removal: quad‐helix versus expansion plate (months)
5.1
5.1. Analysis
Comparison 5: Fixed tooth‐borne expansion (Hyrax) versus fixed tooth‐tissue‐borne expansion (Haas), Outcome 1: Outcomes at appliance removal: Hyrax versus Haas
5.2
5.2. Analysis
Comparison 5: Fixed tooth‐borne expansion (Hyrax) versus fixed tooth‐tissue‐borne expansion (Haas), Outcome 2: Outcomes at appliance removal: Haas versus Hyrax
6.1
6.1. Analysis
Comparison 6: Fixed tooth‐borne expansion (Hyrax) versus fixed tooth‐bone‐borne expansion, Outcome 1: Outcomes at appliance removal: Hyrax versus tooth‐bone‐borne expansion
6.2
6.2. Analysis
Comparison 6: Fixed tooth‐borne expansion (Hyrax) versus fixed tooth‐bone‐borne expansion, Outcome 2: Outcomes at appliance removal: Hyrax versus tooth‐bone‐borne expansion
7.1
7.1. Analysis
Comparison 7: Fixed tooth‐borne expansion (Hyrax) versus fixed bone‐borne expansion, Outcome 1: Outcomes at appliance removal: Hyrax versus bone‐borne expansion
7.2
7.2. Analysis
Comparison 7: Fixed tooth‐borne expansion (Hyrax) versus fixed bone‐borne expansion, Outcome 2: Outcomes at appliance removal: Hyrax versus bone‐borne expansion
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

Akim 2021 {published data only}
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Ferreira 2016 {published data only}
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Garcia 2016 {published data only}
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Garib 2021 {published data only}
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Gianoni‐Capenakas 2021 {published data only}
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References to other published versions of this review

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