| 1. |
- Bondemark, Lars, et al.
(författare)
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An updated systematic review regarding early Class II malocclusion correction
- 2019
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Ingår i: Journal of the World Federation of Orthodontists. - : Elsevier. - 2212-4438. ; 8:3, s. 89-94
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Forskningsöversikt (refereegranskat)abstract
- Background and aim: Class II malocclusion is one of the most common malocclusions in young children and a great deal of research on this topic has been undertaken. Despite this, there are still knowledge gaps on whether it is effective to treat these malocclusions early or what type of treatment should be performed. The aim of this article was to systematically review and update the quality of evidence for various treatment modalities considering Class II malocclusion correction before 10 years of age and with a focus on improvement of dental and skeletal relationships, soft tissue profile, relation to temporomandibular disorder (TMD), incidence on dental trauma, cost-effectiveness, and quality of life. Material and methods: Four databases were searched, from January 1960 to April 2019. Inclusion criteria were randomized or controlled trials reporting short- or long-term effects on dental or basal relationships, soft tissue profile, associations to TMD, quality of life, incidence of trauma, or costs. The quality of evidence was scored according to Grading of Recommendations Assessment Development and Evaluation. Results: A total of 300 publications were identified and 23 satisfied the inclusion criteria for full evaluation. The quality of evidence was high in 5 trials, moderate in 3, and low in 15. Conclusions: From the short- term perspective, there is a high level of evidence that early treatment reduces overjet and improves the anterior-posterior skeletal relationship. There is insufficient evidence about whether early treatment can reduce the incidence of trauma, is cost-effective, provides improved soft tissue profile, improves oral healtherelated quality of life, or possesses a risk of developing TMD. (C) 2019 World Federation of Orthodontists.
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| 2. |
- Kallunki, Jenny, et al.
(författare)
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Comparisons of costs and treatment effects—an RCT on headgear activator treatment of excessive overjet in the mixed and late mixed dentition
- 2022
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Ingår i: European Journal of Orthodontics. - Oxford, United Kingdom : Oxford University Press. - 0141-5387 .- 1460-2210. ; 44:1, s. 86-94
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare the costs and treatment effects of headgear activator treatment of Class II malocclusion with excessive overjet between treatments started in the mixed (MD) and late mixed dentition (LMD).Trial design: Two-arm parallel-group single-centre randomized controlled trial (RCT).Material and methods: A total of 56 children presenting Class II malocclusion with excessive overjet were assessed and invited to an RCT designed as intention-to-treat. The children were randomized, by an independent person not involved in the trial into two groups, treatment with headgear activator in the MD starting at the age of 9 or to treatment with a headgear activator in LMD, starting at the age of 11. The primary outcome measure was to compare the treatment costs between the two groups. Societal costs (the sum of direct and indirect costs) were calculated for successful treatments only and when unsuccessful treatments were included. Secondary outcomes were comparisons of oral health-related quality of life (OHRQoL), dental and skeletal treatment effects, lip closure, and trauma incidence. Data collections were performed before and after treatment, corresponding to a treatment period of 2 years. Blinding was accomplished when assessing outcomes.Results: No group differences in costs were found of successful treatments or when unsuccessful treatments were included. The most pronounced treatment effects in both groups were the reduction of overjet and improved molar relation. Treatment started in MD or in LMD were equal and without significant differences regarding effects on OHRQoL, skeletal effects, lip closure, and incidence of trauma.Harms: No harm was observed, but 8 of 30 children (27%) in the MD and 6 of 21 children (29%) in the LMD group showed unsuccessful results.Limitations: Costs depend on local factors and can thereby not be directly transferred to other settings. It was a single-centre trial and can thus be less generalizable.Conclusions: Regarding costs and treatment effects, there is no difference if headgear activator treatment of excessive overjet starts in the MD or LMD.Clinical trial registration: NCT04508322.
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| 3. |
- Kallunki, Jenny, et al.
(författare)
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Early headgear activator treatment of Class II malocclusion with excessive overjet : a randomized controlled trial.
- 2021
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 43:6, s. 639-647
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare early headgear activator treatment of Class II malocclusion with excessive overjet with untreated control subjects in terms of the primary outcomes overjet and overbite as well as the effect regarding oral-health-related quality of life (OHRQoL), lip closure, incidence of trauma, and skeletal changes.TRIAL DESIGN: Two-arm parallel group single-centre randomized controlled trial.MATERIAL AND METHODS: A total of 60 children (mean age 9.5 years) presenting a Class II malocclusion with excessive overjet were recruited. The trial was designed as intention-to-treat and the participants randomized by an independent person not involved in the trial to either early treatment with headgear activator or to an untreated control group (UG). Dental and skeletal variables as well as registrations of OHRQoL, lip closure, and incidence of trauma were recorded. For the treatment group, data were registered at baseline before treatment and when treatment was finished, corresponding to approximately 2 years. For the UG, registrations were made at baseline and at 11 years of age. Observers were blinded to treatment allocation when assessing outcomes.RESULTS: Early treatment with headgear activator significantly decreased overjet and improved molar relationship when compared with untreated controls. The effects were primarily due to dentoalveolar changes. Early treatment had no evident effect regarding OHRQoL, lip closure, or incidence of trauma. Lack of cooperation resulted in unsuccessful treatments for 27% of the patients.LIMITATIONS: The trial was a single-centre trial and can thus be less generalizable.CONCLUSIONS: The main treatment effect of early headgear activator treatment of Class II malocclusion with excessive overjet is reduction of overjet.TRIAL REGISTRATION: NCT04508322.
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| 4. |
- Kallunki, Jenny, 1978-
(författare)
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Early Treatment of Class II Malocclusion With Excessive Overjet : evaluating oral health-related quality of life, randomised controlled trials on headgear activator treatment and costs
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Class II malocclusion with excessive overjet is one of the most common malocclusions among children and adolescents. In addition to increasing the risk for dental trauma, the malocclusion can also be related to bullying due to the prominent maxillary incisors. The treatment for a Class II malocclusion can be initiated at different ages and with different treatment strategies, but the treatment timing has often been, and still is, discussed within the orthodontic profession and literature. Research reports that an early treatment approach, initiated in mixed dentition and often including an additional phase of treatment in permanent dentition, reduces the incidence of dental trauma. Otherwise, no differences in treatment effects have yet been seen between treatment that is started early in mixed dentition or treatment initiated later in permanent dentition. During the last decades, there has been an increased focus on patient-reported outcomes within orthodontic research. The patient perspective and economic evaluations of performed treatment are areas where knowledge gaps can be found in the available research. This thesis is based on four studies. The studies were designed with high level of methodology and validity as a priority and with the objective to identify and address knowledge gaps related to the impact of Class II malocclusion with excessive overjet and a subsequent early treatment with headgear activator. Firstly, a systematic review addressing treatment effects was performed. This was followed by the implementation of two randomised controlled trials (RCTs) with the aims to evaluate treatment effects and self-perceived oral health-related quality of life (OHRQoL) as well as the cost associated with treatment. In addition, a clinical controlled trial was performed to assess the self-perceived OHRQoL for children with Class II malocclusion with excessive overjet, and compare to children with unilateral posterior crossbite or normal occlusion with no or mild orthodontic treatment need. The papers referred to in this thesis: Paper I. A systematic literature review performed to evaluate the evidence supporting early treatment (before the age of 10) of Class II malocclusion. The search included four data bases and spanned from January 1960 to October 2017. Paper II. A clinical controlled multicenter trial with the objective to investigate the OHRQoL among 9-year-old children in mixed dentition and to compare the self-perceived OHRQoL by the use of the Child Perceptions Questionnaire (CPQ). Evaluation and comparisons were made for children with Class II malocclusion with excessive overjet (EO), children with unilateral posterior crossbite (UPC), and children with normal occlusion (NO) presenting with no or mild orthodontic treatment need. The sample consisted of 229 children, sourced from 19 Public Dental Service Clinics in Sweden and covering a range of demographic areas.A single centre RCT designed to evaluate the effects of headgear activator treatment and the associated costs forms the basis of the final two papers: Paper III. The effects of early headgear activator treatment was compared to an untreated control group. The sample consisted of 60 children presenting with a Class II malocclusion with excessive overjet. Primary outcome was the reduction of overjet and overbite as well as effects regarding oral health-related quality of life, lip closure, incidence of trauma, and skeletal changes.Paper IV. The costs and treatment effects of headgear activator treatment started in the mixed or late mixed dentition was registered and compared. The sample consisted of 51 children starting treatment at 9 or 11 years of age. The primary outcome measure was comparison of the treatment costs between the two groups. Secondary outcomes were comparisons of oral health-related quality of life, dental and skeletal treatment effects, lip closure, and trauma incidence. The following conclusions were drawn: There is medium to high level of evidence, depending on treatment appliance, that early treatment reduces overjet and improves antero-posterior skeletal relationship, but currently, insufficient evidence is available regarding the effects of early treatment on OHRQoL, incidence of trauma, soft tissue profile, or treatment-related costs. There is a knowledge gap with respect to long-term outcome and the stability of early treatment.Children with Class II malocclusion with excessive overjet report significantly lower self-perceived OHRQoL compared to children with unilateral posterior crossbite or normal occlusion, with the domains of social and emotional well-being being most affected. The children in all three groups reported generally low CPQ scores, which implies an overall fairly good self-perceived OHRQoL.Early treatment with headgear activator was successful in reducing overjet and correcting molar relationship. Early treatment did not result in any significant difference regarding self-reported OHRQoL, lip closure, or incidence of trauma when compared to the untreated control group.The costs associated with headgear activator treatment, as well as the treatment effects, were equivalent regardless of whether treatment was started at 9 or 11 years of age. The most pronounced treatment effects were reduction of overjet and correction of molar relationship, whereas the treatment effects regarding OHRQoL, lip closure, and trauma incidences were found to be modest.With costs and treatment effects being equivalent, an early treatment approach can be advocated to enhance trauma prevention.
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| 5. |
- Kallunki, Jenny, et al.
(författare)
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Oral health-related quality of life among children with excessive overjet or unilateral posterior crossbite with functional shift compared to children with no or mild orthodontic treatment need.
- 2019
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Ingår i: European Journal of Orthodontics. - : Oxford Academic. - 0141-5387 .- 1460-2210. ; 41:2, s. 111-116
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare Oral health-related quality of life (OHRQoL) among 9-year-old children with excessive overjet (EO) to children with unilateral posterior crossbite (UPC) and children with normal occlusion (NO). Materials and methods: The study sample sourced from 19 Public Dental Service Clinics in Sweden. Reported are baseline data originating from two controlled trials, one regarding UPC and the other focusing on EO. The NO children derive from the same trials. The UPC group comprised 93 children (45 boys and 48 girls), the EO group 71 children (36 boys and 35 girls), and the NO group 65 children (32 boys and 33 girls). In conjunction to a clinical examination, all children completed the Child Perceptions Questionnaire (CPQ8-10) for evaluation of OHRQoL. The CPQ8-10 comprises 25 questions grouped into four domains: oral symptoms, functional limitations, emotional, and social well-being. Validated questions about pain in the jaws and face were also included. Results: The total mean CPQ score was 5.1 for the UPC, 7.4 for the EO, and 4.4 for the NO group, showing a significant difference between the UPC and EO (P = 0.048) and between EO and NO group (P = 0.012). These differences remained when adjusted for the confounders' caries, trauma, enamel defects, and headache. No difference between UPC and NO was found. The EO children also reported significantly higher scores in the domains emotional and social well-being (P = 0.039 and P = 0.012). Limitations: The study would be strengthened if a longitudinal design had been performed. Conclusion: Children with EO reported significantly lower OHRQoL compared to children with UPC or NO. The children generally reported low CPQ scores that imply an overall fairly good OHRQoL.
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| 6. |
- Kallunki, Jenny, et al.
(författare)
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Outcomes of Early Class II Malocclusion Treatment : A Systematic Review
- 2018
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Ingår i: Journal of Dentistry: Oral Health Care & Cosmesis. - : Herald. - 2473-6783. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To undertake a systematic review of the evidence supporting early treatment (before the age of 10) of Class II malocclusion, with special reference to short and long-term outcomes: correction of overjet, dental relationships, improvement in intermaxillary relationships, soft tissue profile, associations to Temporomandibular Disorders (TMD), quality of life, incidence of trauma and cost-effectiveness. Material and methods: Four databases were searched, from January 1960 to October 2017. Inclusion criteria were randomized controlled or controlled trials reporting short or long-term effects on dental or basal relationships, soft tissue profile, associations to TMD, quality of life, incidence of trauma, or costs. The quality of evidence was scored according to GRADE. Results: 297 studies were identified and 23 satisfied the inclusion criteria for full evaluation. The quality of evidence was high in 5 studies, moderate in 3, and low in 15. There is lack of data on long-term outcomes and stability, thus all evidence is based on short-term results. There is high level of evidence that early treatment of Class II malocclusion with functional appliances reduces overjet and improves skeletal relationships, moderate evidence that headgear reduces overjet and restrains forward growth of the maxilla, but insufficient evidence to determine how early treatment influences soft tissue profile, TMD, quality of life, incidence of trauma or treatment-related costs. Conclusion: There is moderate to high evidence that in the short term, early treatment of Class II malocclusion division 1 reduces overjet and improves skeletal relationships.
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| 7. |
- Paulsson-Björnsson, Liselotte, et al.
(författare)
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Craniofacial morphology in prematurely born children
- 2009
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Ingår i: Angle orthodontist. - : The Angle Orthodontist (EH Angle Education & Research Foundation). - 0003-3219 .- 1945-7103. ; 79:2, s. 276-283
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To test the null hypothesis that there is no difference between the craniofacial morphology of prematurely born children and that of matched full-term born controls. MATERIALS AND METHODS: White children 8 to 10 years of age, born at the University Hospitals of Lund and Malmö and living in the same part of Sweden, were included. One group consisted of 36 very preterm children, born during gestational weeks 29 to 32; the other group included 36 extremely preterm children, who were born before the 29th gestational week. Subjects were compared with a control group of 31 full-term children, who were matched for gender, age, nationality, and living area. One lateral head radiograph was taken for each child, and the cephalometric analysis included 15 angular and 11 linear variables. Also, the height, weight, and head circumference of each child were registered. RESULTS: A significantly shorter anterior cranial base and a less convex skeletal profile were found among extremely preterm children, and significantly shorter maxillary length was noted in both extremely preterm and very preterm groups as compared with full-term children. The lower incisors were significantly more retroclined and retruded in the extremely preterm group compared with the very preterm group and the full-term control group. Extremely preterm children were significantly shorter, and both extremely preterm and very preterm children had significantly lower weight and smaller head circumference compared with full-term children. CONCLUSION: The null hypothesis was rejected because several craniofacial parameters differed significantly between preterm and full-term born control children.
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| 8. |
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| 9. |
- Paulsson-Björnsson, Liselotte, et al.
(författare)
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Permanent tooth-crown dimensions in Prematurely born children (Portoroz)
- 2010
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Ingår i: Abstract book. 86th Congress of the European Orthodontic Society.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- AIM: According to the literature, the scientific evidence is insufficient to answer the question as to whether premature birth causes altered tooth-crown dimensions. The aim of this study was to evaluate permanent tooth-crown dimensions in prematurely born children and to compare the findings with full-term born controls. SUBJECTS AND METHOD: White pre-term children, 8 to 10 years of age, were selected from the Swedish Medical Birth Register. One group consisted of 36 extremely pre-term children (born before the 29th gestational week), and the other 37 very pre-term children (born during gestational weeks 29 to 32). The pre-term children were compared with a control group of 41 full-term children, who were matched for gender, age, nationality and living area. Clinical examinations were undertaken and study casts and panoramic radiographs were obtained for each child. The permanent maxillary and mandibular first molars, central incisors and laterals were measured with a digital sliding calliper on the study casts. The tooth-crowns were measured both mesiodistally and buccolingually. The examiner conducting the measurement analysis was unaware of the subject grouping. RESULTS: The maxillary and mandibular first molars were smaller mesiodistally and buccolingually (P ≤ 0.01) whereas the central incisors and lower laterals were smaller mesiodistally (P ≤ 0.02) in the extremely pre-term group compared with the full-term group. A reduction in tooth size of 5-8 per cent was found between the extremely pre-term group and the full-term group. Furthermore, the maxillary first molars and mandibular left first molar were also smaller mesiodistally (P ≤ 0.035) in the extremely pre-term group compared with the very pre-term group. CONCLUSION: Premature birth is associated with reduced toothcrown dimensions of the permanent teeth, and the more preterm the birth the smaller the tooth-crown dimensions.
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| 10. |
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