The report is available in English with a Dutch summary - KCE

More documents

Recommendations

Info

36 Orthodontics KCE Reports 77 DISTURBANCES IN NUMBER(2): SUPERNUMERARY TEETH No references on this topic were retrieved within the preset inclusion criteria. DISTURBANCES IN ERUPTION(1): ECTOPIC TEETH ERUPTION Although every tooth can be placed ectopically, due to its eruption path and/ or a lack of space in the dental arch, only one relevant study was found on ectopic maxillary first molars 30 Impacted canines (incorrectly positioned in the jaw before their eruption) are known to increase the risk of root resorption of neighbouring teeth as they erupt ectopically (see section 2.3.1.1). In this observational study of good quality, it was shown that forced eruption with orthodontics largely decreases this risk (90/92 cases). For 46 children, treatment of the ectopically erupted tooth with a cervical headgear (46 cases) was studied prospectively. After an average treatment of 9 months, the first permanent molars were uprighted to good occlusion and in about 70% of the children sufficient space for the second premolars could be obtained. In the long-term follow-up, 10 years after treatment, the effects of the eruption disturbance had been corrected and all negative side effects of the treatment were eliminated 30 (low quality of scientific evidence). These results remain to be confirmed by other studies. DISTURBANCES IN ERUPTION(2): IMPACTED CANINES Impacted permanent canines can be treated by extraction of the primary canine and creation of excess of space, or by surgical exposure followed by orthodontic treatment. Most studies concerning the outcome of these procedures, are of low quality (retrospective cohort or case-control studies). The age at the time of recognition and referral seems to be the most important factor for the final outcome, and the position of the canine can be a compromising factor as well 31 . Nevertheless, the esthetic outcome of both these treatments are satisfying to the majority of patients 32 , 33 . The results also seem to be clinically acceptable: there is no long-term difference between impacted teeth and control teeth regarding shape, colour or position, and the periodontal conditions and the occlusal function are similar 34 , 32 , 35 . Only for lateral movements of the mandible, significant differences in contact pattern were found between sides with normally erupted canines and sides with impacted canines 32 . Duration of treatment is dependent on the distance of the impacted crown to the occlusal plane, and bilateral impaction requires on average 6 months more to treat than unilateral impaction 36 . Relapse by vertical displacement (intrusion) was more frequent after surgical exposure and orthodontic treatment than after extraction of the deciduous canine and creation of excess of space 33 . Further investigation is necessary 34 . Impacted canines can be treated by extraction of the residual deciduous tooth and space retaining, or by orthodontic treatment after surgical exposure. Both treatment modalities are probably satisfying, but more evidence is needed. Time of referral is an important factor in outcome. Impacted canines can be treated by extraction of the residual deciduous tooth and space retaining, or by orthodontic treatment after surgical exposure. Both treatment modalities are probably satisfying, but more evidence is needed. Time of referral is an important factor in outcome. ORTHODONTIC ANCHORAGE An attempt was made in one systematic review 37 to examine, in an evidence-based way, what kind of orthodontic anchorage is the most effective. Because of contradictory results and the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate anchorage efficiently during space closure. Further RCT’s are needed to determine which anchorage system is the most effective.
KCE Reports 77 Orthodontics 37 Also a Cochrane review on this item 38 found only one study on the reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods. A limited level of evidence was found that mid-palatal implants are an acceptable alternative to headgear reinforced anchorage in orthodontic patients. However, at the present there are insufficient research data on which to base the clinical practice 38 . OROFACIAL CLEFTS AND OTHER MEDICALLY COMPROMISED PATIENTS The benefits of orthodontic treatment in CLP patients and other medically compromised patients (craniofacial syndromes, growth disturbances, oligodontia…) are generally accepted by professionals and lay persons. They should be followed up and treated when necessary, from birth throughout childhood and teenage years, and even after the completion of growth, in adulthood. EVIDENCE FOR ORTHODONTIC TREATMENT OF SEVERAL TYPES OF MALOCCLUSION • The benefits of orthodontic treatment in CLP patients and other medically compromised patients are generally accepted. • The level of evidence for clinically significant effect after treatment of prominent upper front teeth in Class II division 1, can be considered moderate. • Early treatment of this malocclusion is no more effective than providing one course of orthodontic treatment when the child is in early adolescence. The level of evidence for this statement is moderate. • No randomized or controlled clinical trials were found concerning the treatment of Class II,2 treatment and no recommendation can be made. It is clear that, from a dental health point of view, gingival trauma should be avoided. • The level of evidence for the effectiveness (especially before the age of 10 years) of protraction face mask therapy in Class III malocclusions is moderate. • The evidence for treatment of anterior open bite is insufficient and no recommendation can yet be made. • There is evidence for the effectiveness of treatment of posterior crossbite in deciduous teeth by grinding; the quality is low. There is also low quality evidence for the long-term skeletal effectiveness of rapid maxillary expansion. • Forced eruption with orthodontics decreases this risk of root resorption in case of incorrectly positioned impacted canines (low quality of evidence). • Crowding of teeth has been generally accepted as one of the major indications for orthodontic treatment, but evidence on how to deal with this problem is scarce. • The benefits of extracting lower deciduous canines for the "relief" of lower incisor crowding are questionable, but this remains to be confirmed. • More studies are needed on the outcome of (different) orthodontic treatment options for ectopic eruption of teeth as well as for missing teeth. • More evidence is still needed on treatment by means of orthodontic anchorage. 2.3.1.3 Predictors of an orthodontic treatment uptake and equity In several studies an attempt was made to find predictors for which children would start an orthodontic treatment. It could be presumed that there could be a socio-economic factor in whether or not children were uptaken for an orthodontic treatment 39 , 40 .
Page 1 and 2: Orthodontie bij kinderen en adolesc
Page 3 and 4: Orthodontie bij kinderen en adolesc
Page 5: Hoe refereren naar dit document? Ca
Page 8 and 9: ii Orthodontie KCE Reports 77A DOEL
Page 10 and 11: iv Orthodontie KCE Reports 77A Over
Page 12 and 13: vi Orthodontie KCE Reports 77A BELE
Page 15 and 16: KCE Reports 77 Orthodontics 1 Table
Page 17 and 18: KCE Reports 77 Orthodontics 3 3.8.6
Page 19 and 20: KCE Reports 77 Orthodontics 5 7.13
Page 21 and 22: KCE Reports 77 Orthodontics 7 OIIRR
Page 23 and 24: KCE Reports 77 Orthodontics 9 Erupt
Page 25 and 26: KCE Reports 77 Orthodontics 11 1 GE
Page 27 and 28: KCE Reports 77 Orthodontics 13 The
Page 29 and 30: KCE Reports 77 Orthodontics 15 Devi
Page 31 and 32: KCE Reports 77 Orthodontics 17 Thes
Page 33 and 34: KCE Reports 77 Orthodontics 19 Orth
Page 35 and 36: KCE Reports 77 Orthodontics 21 EMBA
Page 37 and 38: KCE Reports 77 Orthodontics 23 Figu
Page 41 and 42: KCE Reports 77 Orthodontics 27 prim
Page 43 and 44: KCE Reports 77 Orthodontics 29 2.3.
Page 45 and 46: KCE Reports 77 Orthodontics 31 this
Page 47 and 48: KCE Reports 77 Orthodontics 33 Howe
Page 49: KCE Reports 77 Orthodontics 35 No s
Page 53 and 54: KCE Reports 77 Orthodontics 39 In t
Page 57 and 58: KCE Reports 77 Orthodontics 43 The
Page 59 and 60: KCE Reports 77 Orthodontics 45 CLAS
Page 61 and 62: Netherlands UK Sweden KCE Reports 7
Page 63 and 64: KCE Reports 77 Orthodontics 49 Pold
Page 65 and 66: KCE Reports 77 Orthodontics 51 Corr
Page 67 and 68: KCE Reports 77 Orthodontics 53 In t
Page 69 and 70: KCE Reports 77 Orthodontics 55 Meas
Page 73 and 74: KCE Reports 77 Orthodontics 59 Conc
Page 75 and 76: KCE Reports 77 Orthodontics 61 •
Page 81 and 82: KCE Reports 77 Orthodontics 67 Orth
Page 83 and 84: KCE Reports 77 Orthodontics 69 Ther
Page 85 and 86: KCE Reports 77 Orthodontics 71 •
Page 87 and 88: KCE Reports 77 Orthodontics 73 Thos
Page 89 and 90: KCE Reports 77 Orthodontics 75 Tabl
Page 93 and 94: KCE Reports 77 Orthodontics 79 Dent
Page 95 and 96: KCE Reports 77 Orthodontics 81 Thes
Page 97 and 98: KCE Reports 77 Orthodontics 83 In S
Page 99 and 100: KCE Reports 77 Orthodontics 85 A pr
Page 101 and 102:
KCE Reports 77 Orthodontics 87 Tabl
Page 103 and 104:
KCE Reports 77 Orthodontics 89 3.10
Page 105 and 106:
KCE Reports 77 Orthodontics 91 RATI
Page 107 and 108:
KCE Reports 77 Orthodontics 93 LICE
Page 109 and 110:
KCE Reports 77 Orthodontics 95 12 1
Page 111 and 112:
KCE Reports 77 Orthodontics 97 1,6
Page 113 and 114:
KCE Reports 77 Orthodontics 99 Tabl
Page 115 and 116:
KCE Reports 77 Orthodontics 101 400
Page 117 and 118:
KCE Reports 77 Orthodontics 103 AVE
Page 119 and 120:
KCE Reports 77 Orthodontics 105 REI
Page 121 and 122:
KCE Reports 77 Orthodontics 107 CON
Page 123 and 124:
KCE Reports vol Orthodontics 109 3.
Page 125 and 126:
KCE Reports 77 Orthodontics 111 4 B
Page 127 and 128:
KCE Reports 77 Orthodontics 113 The
Page 129 and 130:
KCE Reports 77 Orthodontics 115 Loo
Page 131 and 132:
KCE Reports 77 Orthodontics 117 •
Page 133 and 134:
KCE Reports 77 Orthodontics 119 Tab
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
KCE Reports 77 Orthodontics 127 •
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
KCE Reports 77 Orthodontics 143 Ort
Page 159 and 160:
Page 161 and 162:
KCE Reports 77 Orthodontics 147 It
Page 163 and 164:
KCE Reports 77 Orthodontics 149 The
Page 165 and 166:
KCE Reports 77 Orthodontics 151 For
Page 167 and 168:
Page 169 and 170:
KCE Reports 77 Orthodontics 155 A n
Page 171 and 172:
KCE Reports 77 Orthodontics 157 In
Page 173 and 174:
Page 175 and 176:
KCE Reports 77 Orthodontics 161 AAN
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
KCE Reports 77 Orthodontics 169 If
Page 185 and 186:
KCE Reports 77 Orthodontics 171 Wit
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
KCE Reports 77 Orthodontics 177 35.
Page 193 and 194:
KCE Reports 77 Orthodontics 179 71.
Page 195:
Page 198 and 199:
Wettelijk depot : D/2008/10.273/20
Page 200 and 201:
38. Baarmoederhalskankerscreening e
show all

The report is available in English with a Dutch summary - KCE

Create successful ePaper yourself

Delete template?

Save as template?