No evidence to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children

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One of important differences about Cochrane reviews is their commitment of their authors to regularly review and update the content of their reviews.  This is an update of a Cochrane review published in 2006.  The aim of the review being to establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth.

Class II division 2 malocclusion is a type of orthodontic problem characterised by the upper front teeth being tilted toward the roof of the mouth (retroclined) front teeth and an increased overbite (deep overbite). In the UK reports suggest that about 10% of the population are affected with higher rates being reported in other populations.

For this update the detailed systematic search was repeated and the contents have been updated  but as no randomised controlled (RCTs), or controlled trials (CCTs) were identified that assessed the treatment of Class II division 2 malocclusion in children the authors conclusions remain unaltered.

The conclusions were

It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

The authors note that one ongoing RCT comparing extractions of upper premolars (with/without anchorage reinforcement) followed by fixed appliance therapy versus a two-phase treatment with a functional appliance (Twin Block) followed by a phase of fixed appliance therapy has unfortunately being discontinued.  It is not surprising then that in the implications for research section, the authors call for RCTs of the management of Class II division 2 malocclusion in children, designed, conducted and reported according to the criteria of the Consolidated Standards of Reporting Trials (CONSORT) guidelines.


Millett DT, Cunningham S, O’Brien KD, Benson PE, Williams A, de Oliveira CM. Orthodontic treatment for deep bite and retroclined upper front teeth in children. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005972. DOI:10.1002/14651858.CD005972.pub2.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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