Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.0004
Revista de Odontologia da UNESP
Original Article

Do orthodontists recommend Class II treatment according to evidence-based knowledge?

Os ortodontistas recomendam o tratamento das más oclusões de Classe II de acordo com os conceitos científicos atuais?

Almeida, Soraia Azevedo; Cheib, Paula Loureiro; Souki, Gustavo Quiroga; Franchi, Lorenzo; Souki, Bernardo Quiroga

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Abstract

Introduction: The adequate indications for the timing of treatment for Class II malocclusion are mandatory for the ethical and efficient practice of orthodontics, but clinicians are reluctant to accept new information that contradicts their preferred method of treatment. Objective: The aim of this investigation was to assess the agreement regarding the indications for Class II malocclusion interceptive therapy between a group of international opinion-makers on early treatment and a group of orthodontists and to compare their treatment indications with the current evidence-based knowledge. Material and method: An electronic survey containing photographs of mild, moderate and severe Class II malocclusions in children was sent to two panels of experts. Panel 1 (n=28) was composed of international orthodontists who had authored world-class publications on early orthodontic treatment, and Panel 2 (n=261) was composed of clinical orthodontists. Based on a 5-point Likert-type scale, the orthodontists selected their therapy option for each of the 9 Class II malocclusion cases. Result: The Class II malocclusion treatment recommendations of Panel 2 were significantly different from those offered by Panel 1 with a skew of at least 1 scale point toward earlier treatment. The Class II malocclusion treatment recommendations of the members of Panel 1 members were in accordance with contemporary evidence-based knowledge. Conclusion: Class II malocclusion overtreatment appears to be the tendency among clinical orthodontists but not among orthodontists who are academically involved with early treatment. There is a gap between the scientific knowledge and the practices of orthodontists.

Keywords

Malocclusion, Angle Class II, therapeutics, questionnaires.

Resumo

Introdução: A indicação correta da época de tratamento de uma má oclusão de Classe II é essencial para o exercício ético e eficiente da Ortodontia, mas os clínicos são resistentes em aceitar novos conceitos que contradizem seus métodos preferidos de tratamento. Objetivo: Avaliar a concordância na indicação de tratamento interceptor das más oclusões de Classe II entre um grupo de formadores de opinião em nível internacional e um grupo de ortodontistas clínicos, e comparar a indicação de tratamento com os conceitos científicos contemporâneos. Material e método: Um questionário eletrônico composto por fotografias representativas de diversos graus de gravidade no acometimento da má oclusão de Classe II em crianças foi enviado a dois painéis de especialistas. Painel 1 (n=28) foi composto por ortodontistas internacionais autores de artigos científicos em revistas de elevado impacto, e o Painel 2 (n=261) foi composto por ortodontistas clínicos. Baseando-se em uma escala de Likert de 5 pontos, os ortodontistas indicaram suas opções de tratamento para cada um dos 9 casos apresentados. Resultado: As indicações de tratamento do Painel 2 foram estatisticamente diferentes daquelas ofertadas pelo Painel 1, com pelo menos 1 ponto de divergência no sentido de tratamento mais precoce. A indicação de tratamento ortodôntico interceptor do Painel 1 está de acordo com os conceitos científicos atuais. Conclusão: Tratamento muito precoce parece ser a tendência de conduta entre os ortodontistas clínicos, mas não entre os ortodontistas que estão academicamente envolvidos com a interceptação ortodôntica. Existe uma lacuna entre o conhecimento científico e a prática da Ortodontia.

Palavras-chave

Má oclusão de Angle Classe II, terapêutica, questionários.

References

1. Ackerman JL, Proffit WR. Preventive and interceptive orthodontics: a strong theory proves weak in practice. Angle Orthod. 1980 Apr;50(2):75-87. PMid:6929171.

2. Freeman JD. Preventive and interceptive orthodontics: a critical review and the results of a clinical study. J Prev Dent. 1977 Sept-Oct;4(5):7-14, 20-3. PMid:351175.

3. King GJ, Brudvik P. Effectiveness of interceptive orthodontic treatment in reducing malocclusions. Am J Orthod Dentofacial Orthop. 2010 Jan;137(1):18-25. http://dx.doi.org/10.1016/j.ajodo.2008.02.023. PMid:20122426.

4. King GJ, Keeling SD, Hocevar RA, Wheeler TT. The timing of treatment for Class II malocclusions in children: a literature review. Angle Orthod. 1990;60(2):87-97. PMid:2111647.

5. Proffit WR. The timing of early treatment: an overview. Am J Orthod Dentofacial Orthop. 2006 Apr;129(4 Suppl):S47-9. http://dx.doi.org/10.1016/j.ajodo.2005.09.014. PMid:16644417.

6. Franchi L, Baccetti T, De Toffol L, Polimeni A, Cozza P. Phases of the dentition for the assessment of skeletal maturity: a diagnostic performance study. Am J Orthod Dentofacial Orthop. 2008 Mar;133(3):395-400. PMid: 18331939.

7. Tausche E, Luck O, Harzer W. Prevalence of malocclusions in the early mixed dentition and orthodontic treatment need. Eur J Orthod. 2004 June;26(3):237-44. http://dx.doi.org/10.1093/ejo/26.3.237. PMid:15222706.

8. Gianelly AA. One-phase versus two-phase treatment. Am J Orthod Dentofacial Orthop. 1995 Nov;108(5):556-9. http://dx.doi.org/10.1016/S0889-5406(95)70057-9. PMid:7484976.

9. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006 May;129(5):599.e1-12. PMid: 1667919.

10. Flores-Mir C, Major MP, Major PW. Soft tissue changes with fixed functional appliances in Class II division 1. Angle Orthod. 2006 July;76(4):712-20. PMid:16808582.

11. Ghafari J, King GJ, Tulloch JF. Early treatment of Class II, division 1 malocclusion--comparison of alternative treatment modalities. Clin Orthod Res. 1998 Nov;1(2):107-17. PMid:10321139.

12. O’Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Am J Orthod Dentofacial Orthop. 2003 Sept;124(3):234-43. http://dx.doi.org/10.1016/S0889-5406(03)00352-4. PMid:12970656.

13. Thiruvenkatachari B, Harrison JE, Worthington HV, O’Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database Syst Rev. 2013;11:CD003452. http://dx.doi.org/10.1002/14651858.CD003452.pub3. PMid:24226169.

14. Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop. 2004 June;125(6):657-67. http://dx.doi.org/10.1016/j.ajodo.2004.02.008. PMid:15179390.

15. Dolce C, Schader RE, McGorray SP, Wheeler TT. Centrographic analysis of 1-phase versus 2-phase treatment for Class II malocclusion. Am J Orthod Dentofacial Orthop. 2005 Aug;128(2):195-200. http://dx.doi.org/10.1016/j.ajodo.2004.04.028. PMid:16102404.

16. Bowman SJ. One-stage versus two-stage treatment: are two really necessary? Am J Orthod Dentofacial Orthop. 1998 Jan;113(1):111-6. http://dx.doi.org/10.1016/S0889-5406(98)70283-5. PMid:9457026.

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