Orthodontic treatment for crowded teeth in children

Area of Science:

• Orthodontics
• Pediatric Dentistry
• Evidence-Based Dentistry

Background:

• Crowded teeth, a common orthodontic concern, arise from insufficient jaw space and can impact children's self-esteem and quality of life.
• Early loss of primary teeth due to decay or trauma can contribute to the development of crowded permanent teeth.
• Dental crowding tends to worsen with age, particularly in the lower jaw.

Purpose of the Study:

• To evaluate the effectiveness of orthodontic interventions in preventing or correcting dental crowding in children.
• To compare outcomes between different orthodontic treatment approaches for crowded teeth.

Main Methods:

• Systematic review and meta-analysis of 24 randomized controlled trials (RCTs) involving 1512 children and adolescents (≤16 years).
• Included studies assessed active interventions (braces, extractions) versus control or alternative treatments.
• Data extraction and risk of bias assessment were performed independently by two reviewers.

Main Results:

• Very low-certainty evidence suggests lip bumpers may reduce crowding in the early permanent dentition.
• A Schwarz appliance showed potential for reducing lower arch crowding.
• Nickel-titanium (NiTi) archwires, particularly coaxial NiTi, demonstrated some effectiveness in reducing crowding compared to other types.

Conclusions:

• The current evidence supporting orthodontic interventions for crowded teeth is of very low certainty, primarily due to small study sizes and high risk of bias.
• Findings suggest potential benefits of certain appliances, but results may change with future research.
• Further high-quality RCTs are needed to confirm the efficacy of various orthodontic treatments for dental crowding.