Early orthodontic treatment for reverse bite: an orthopaedic facemask treatment for children < 10 years old reduces the need for jaw surgery in the late teens
ISRCTN | ISRCTN10014340 |
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DOI | https://doi.org/10.1186/ISRCTN10014340 |
Secondary identifying numbers | N/A |
- Submission date
- 22/04/2016
- Registration date
- 12/05/2016
- Last edited
- 20/01/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Oral Health
Plain English summary of protocol
Background and study aims
Class III malocclusion is where the lower jaw is larger and lies ahead of the top jaw, resulting in a reverse bite. Around 3-8% of European children have this sort of bite. It may result in difficulty biting food and children are often teased about their facial appearance. The management of severe class III cases often involves surgery. Around 2,500 teenagers have jaw surgery per year, of which 60% will be for class III problems. This costs around £13.5 million. Additionally, there are the risks of general anaesthesia and surgery, and injury to the nerve supplying feeling/sensation to the lower lip and chin. There is a treatment involving a facemask brace which is used to pull the top jaw and teeth forwards with elastics. This only works in children under 10 years old. They wear the facemask brace at night for about 8 months. As clinicians we need to decide whether to treat children at a young age with the facemask brace or simply to observe their jaw growth and treat them with facial surgery when they are 16 years old. There is not enough evidence about the long-term effects of the facemask brace and whether it would reduce the need for jaw surgery in the teenage years. Therefore the main focus of our study is to see whether early brace treatment means that a child does not need jaw surgery later.
Who can participate?
Patients aged 7-9 with class III malocclusion
What does the study involve?
Participants are randomly allocated to receive either facemask brace treatment or no treatment. All participants are followed up for 6 years to assess whether their reverse bite is corrected or whether they need jaw surgery.
What are the possible benefits and risks of participating?
Correction of the reverse bite at an early age might reduce the amount of orthodontic treatment or jaw surgery treatment that may be required later. There are no addition risks of participating – there is the routine risk of decalcification of the enamel around the brace if the teeth are not kept clean or if the patient has a high sugar diet.
Where is the study run from?
Tameside Hospital NHS Foundation Trust (lead site) (UK)
When is the study starting and how long is it expected to run for?
January 2004 to April 2014
Who is funding the study?
1. British Orthodontic Society (UK)
2. TP Orthodontics Europe
Who is the main contact?
Dr Nicky Mandall
Nicky.mandall@tgh.nhs.uk
Contact information
Scientific
Tameside Hospital NHS Foundation Trust
Fountain Street
Ashton under Lyne
OL6 9RW
United Kingdom
Phone | +44 (0)161 922 6461 |
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Nicky.mandall@tgh.nhs.uk |
Study information
Study design | Interventional multi-centre randomised controlled trial |
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Primary study design | Interventional |
Secondary study design | Randomised controlled trial |
Study setting(s) | Hospital |
Study type | Treatment |
Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
Scientific title | Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multicentre, two-arm, parallel randomised controlled trial |
Study acronym | Early class III trial |
Study objectives | The null hypotheses stated that early class III protraction facemask did not reduce the need for orthognathic surgery and that there were no differences between treated patients (Protraction Facemask Group, PFG) and the untreated/control group (CG) in terms of skeletal and occlusal changes, self-esteem and oral aesthetic impact of malocclusion. |
Ethics approval(s) | North West MREC, 18/02/2003, MREC 03/8/2 |
Health condition(s) or problem(s) studied | Class III reverse bite with a class III skeletal face profile (small upper jaw and large lower jaw) |
Intervention | Random allocation to protraction facemask treatment or no treatment/control groups. The intervention was a protraction facemask treatment which is a head brace attached to an upper plastic brace. The upper plastic brace is cemented to the upper teeth. Elastics are attached from the plastic brace in the mouth to the head brace. The elastics and head brace are worn at night for about 8 months and this gradually corrects the reverse bite. |
Intervention type | Device |
Pharmaceutical study type(s) | |
Phase | |
Drug / device / biological / vaccine name(s) | |
Primary outcome measure | 1. Need for orthognathic surgery: measured at 6 year follow-up using expert panel consensus 2. Skeletal change: measured from lateral cephalogram facial radiographs at 15 months, 3 years and 6 years follow-up 3. Dental change, correction of reverse bite: measured from dental models at 15 months, 3 years and 6 years follow-up |
Secondary outcome measures | 1. Self esteem: using Piers Harris questionnaire at 15 months, 3 years and 6 years follow-up 2. Oral aesthetic impact: using OASIS questionnaire at 15 months, 3 years and 6 years follow-up 3. Temporomandibular joint signs or symptoms: clinical examination at 15 months and 3 years |
Overall study start date | 01/01/2004 |
Completion date | 01/04/2014 |
Eligibility
Participant type(s) | Patient |
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Age group | Child |
Lower age limit | 7 Years |
Upper age limit | 9 Years |
Sex | Both |
Target number of participants | Target = 46. Over recruitment n=73 to allow for dropouts. Final sample size = 65 |
Key inclusion criteria | 1. 7-9 years old 2. Class III skeletal pattern 3. 3 or 4 incisors in crossbite |
Key exclusion criteria | 1. Non-white Caucasian origin 2. Cleft lip and or palate or craniofacial syndrome 3. Maxillomandibular plane angle of more than 35 degrees 4. Lower face height greater than 70 mm 5. Previous temporomandibular pain dysfunction syndrome |
Date of first enrolment | 01/01/2004 |
Date of final enrolment | 01/12/2006 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
United Kingdom
BD5 ONA
United Kingdom
United Kingdom
United Kingdom
United Kingdom
United Kingdom
United Kingdom
Sponsor information
Hospital/treatment centre
Fountain Street
Ashton under Lyne
OL6 9RW
England
United Kingdom
https://ror.org/01knk7v72 |
Funders
Funder type
Industry
No information available
No information available
Results and Publications
Intention to publish date | 01/05/2016 |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not expected to be made available |
Publication and dissemination plan | |
IPD sharing plan |
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
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Results article | results (15 months follow-up) | 01/09/2010 | Yes | No | |
Results article | results (3 years follow-up) | 01/09/2012 | Yes | No | |
Results article | results (6 years follow-up) | 01/09/2016 | Yes | No |
Editorial Notes
20/01/2020: Internal review.
30/08/2016: Publication reference added.