Can we intercept AOB development from thumb sucking?

Can we intercept AOB development from thumb sucking?

We are all familiar with the young patient who has an anterior open bite caused by thumb sucking.  This new systematic review provides us with some evidence on the treatment for this common problem.

I have just got back from a four day trip to New Zealand to lecture to the New Zealand Association of Orthodontists, which was great but a turn round in four days does not do your brain much good. So I am sorry if this post is a little shorter than others.

vervolg: Can we intercept AOB development from thumb sucking?

It is important to intercept the development of an AOB that is caused by digit sucking.  We commonly use several methods and I am sure that we all have our favourite method of addressing the long term “digit sucker”.  However, there is little strong evidence on the most effective method of addressing this problem.  This post is about a recently published systematic review that appeared in the EJO.

Effectiveness of open bite correction when managing deleterious oral habits in growing children and adolescents: a systematic review and meta-analysis

Murilo Fernando Neuppmann Feres et al

European Journal of Orthodontics, 2017, 31–42

doi:10.1093/ejo/cjw005

They did this systematic review to provide information on the best method of correcting habit induced AOB using habit-interception appliances.

What did they do?

They did a review using standard systematic review methodology. The PICO was

Participants: Children under 18 years with AOB

Intervention: Any interceptive treatment tested in a randomised or non randomised trials

Comparison: Untreated control

Outcome: Overbite.

I could not find the PICO in the text of the paper and I had to generate this version. I found this was difficult to find because they did not clearly describe the usual criteria.   But, I hope that my interpretation is clear.

They evaluated risk of bias in RCTs using the Cochrane Risk of bias tool and the MINORS tool for non-randomised trials.

What did they find?

They initially identified 3491 studies and after filtering for methodology etc, they reduced this to 11 studies. Unfortunately,  they could only combine data from 4 studies into a meta-analysis.  These were all concerned with the use of crib therapy.

All the studies looked at treatment in the mixed dentition with a time span from 3 months to more than 6 years.  The papers reported on two types of habit interception appliances, these were fixed or removable cribs and spurs.

They found that 2 of the studies were RCTs with a high risk of bias. The remaining non-randomised trials were also of high risk of bias.

They presented the data in four pages of detailed information reporting on multiple detailed cephalometric variables.  I did not really look at all this information and I am not sure who ploughs through these ceph festivals?

However, in the text they reported that the crib therapy significantly increased the overbite when compared to untreated controls, regardless of appliance design.  This increase was approximately 3mm. I think that this is clinically important. They did not find any evidence suggesting that other interventions were effective.

What did I think?

Firstly, I found that this paper was very difficult to read. This was partly because of the complex nature of a review that tried to evaluate the effects of several interventions. Nevertheless, the data presentation was rather complex with one massive table of data that was pretty much impenetrable.  Nevertheless, I hope that I have extrapolated the main parts of the review.

I found it interesting that crib therapy was the only method that they found was effective.  However, I also cannot help thinking that this was because it was the only method that had been adequately researched. We must remember that the overall conclusion was that there was not strong evidence that the other interventions were effective. In this respect, these methods could be effective, but we do not have the evidence.

My favoured method of habit interception for patients with AOB is to fit a quad helix, as this can also correct any posterior crossbites.  I wonder if this is gong to have the same action as any crib because it may act in the same way? But they did not find any strong evidence to support my preferred option.

I have said before when we read a paper, it is a good idea to ask “so what”.  In other words “does this change my clinical practice”.  When I  thought about this paper, I am not sure because I cannot see any difference in the action of a crib or a quad. I think that I will stick with the quad….for the time being.

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