Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review

Am J Orthod Dentofacial Orthop. 2015 Jul;148(1):47-59. doi: 10.1016/j.ajodo.2015.01.030.


In this article, we summarize the most clinically relevant findings of our recently updated Cochrane systematic review into the treatment of Class II Division 1 malocclusion.

Methods: A systematic review of the databases was performed to identify all randomized controlled trials evaluating early treatment with functional appliances to correct Class II Division 1 malocclusion.

Results: Three early treatment studies with data from 353 participants were included in this review. The results showed no significant difference for any outcomes, except new incidence of incisor trauma, which was significantly less for the early treatment group. The risk ratio analysis for new incisor trauma showed that providing early treatment reduced the risk of trauma by 33% and 41% in the functional and headgear groups, respectively. However, when the numbers needed to treat were calculated, early treatment with functional appliances prevents 1 incidence of incisal trauma for every 10 patients (95% CI, 5-174), and headgear treatment prevents 1 incidence of incisal trauma for every 6 patients (95% CI, 3-23).

Conclusions: Orthodontic treatment for young children, followed by a later phase of treatment when the child is in early adolescence, appears to reduce the incidence of new incisal trauma significantly compared with treatment that is provided in 1 phase when the child is in early adolescence. However, these data should be interpreted with caution because of the high degree of uncertainty. There are no other advantages in providing 2-phase treatment compared with 1 phase in early adolescence.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Extraoral Traction Appliances
  • Humans
  • Incisor / injuries*
  • Malocclusion, Angle Class II / complications
  • Malocclusion, Angle Class II / therapy*
  • Orthodontics*