Clinical effectiveness of chin cup treatment for the management of Class III malocclusion in pre-pubertal patients: a systematic review and meta-analysis

Maria I Chatzoudi, Ioulia Ioannidou-Marathiotou, Moschos A Papadopoulos, Maria I Chatzoudi, Ioulia Ioannidou-Marathiotou, Moschos A Papadopoulos

Abstract

Background: Chin cup is regarded as the oldest orthodontic appliance for the management of Class III malocclusion. To assess its clinical effectiveness in pre-pubertal patients, a meta-analysis on specific cephalometric values is attempted.

Methods: Detailed electronic and hand searches with no restrictions were performed up to July 2014. Only randomized controlled trials (RCTs) and cohort studies, i.e. prospective controlled trials (pCCTs) and (retrospective) observational studies (OS), were included. Analyses were performed by calculating the standard difference in means and the corresponding 95% confidence intervals, using the random effects model. Data heterogeneity and risk of bias assessment of the included studies were also performed. Study selection, data extraction and risk of bias assessment were performed twice. The level of significance was set at P ≤ 0.05 for all tests, except for heterogeneity (P ≤ 0.1).

Results: Seven treated groups from five studies (no RCTs, four pCCTs, one OS) were eligible for inclusion, assessing only the short-term occipital pull chin cup effects. In total, 120 treated patients (mean age: 8.5 to 11 years) compared with 64 untreated individuals (mean age: 7.3 to 9.89 years) were assessed by means of 13 cephalometric variables. The overall quality of these studies was low to medium. In comparison to untreated individuals, the SNB and gonial angles decreased significantly following chin cup use, whereas ANB, Wits appraisal, SN-ML, N-Me and overjet increased. For the rest of the variables, no statistically significant differences were detected.

Conclusions: Although the occipital chin cup affects significantly a number of skeletal and dentoalveolar cephalometric variables, indicating an overall positive effect for the treatment of Class III malocclusion, data heterogeneity and between-studies variance impose precaution in the interpretation of the results.

Figures

Figure 1
Figure 1
Flow diagram of the retrieved studies through the selection process.
Figure 2
Figure 2
Cephalometric variables examined in current investigation.
Figure 3
Figure 3
Forest plot of the cephalometric variable SNA.
Figure 4
Figure 4
Forest plot of the cephalometric variable SNB.
Figure 5
Figure 5
Forest plot of the cephalometric variable ANB.
Figure 6
Figure 6
Forest plot of the cephalometric variable Wits appraisal.
Figure 7
Figure 7
Forest plot of the cephalometric variable Co-Gn.
Figure 8
Figure 8
Forest plot of the cephalometric variable Co-Go.
Figure 9
Figure 9
Forest plot of the cephalometric variable Gonial angle.
Figure 10
Figure 10
Forest plot of the cephalometric variable N-Me.
Figure 11
Figure 11
Forest plot of the cephalometric variable UFH.
Figure 12
Figure 12
Forest plot of the cephalometric variable LAFH.
Figure 13
Figure 13
Forest plot of the cephalometric variable SN-ML.
Figure 14
Figure 14
Forest plot of the cephalometric variable overjet.
Figure 15
Figure 15
Forest plot of the cephalometric variable overbite.

References

    1. Alexander KN. Genetic and phenotypic evaluation of the class III dentofacial deformity: comparisons of three populations [Dissertation]. Chapel Hill (USA): University of North Carolina at Chapel Hill; 2007.
    1. Chang HP, Lin HC, Liu PH, Chang CH. Geometric morphometric assessment of treatment effects of maxillary protraction combined with chin cup appliance on the maxillofacial complex. J Oral Rehabil. 2005;32:720–28. doi: 10.1111/j.1365-2842.2005.01504.x.
    1. McNamara JA. Treatment of patients in the mixed dentition. In: Graber TM, Vanarsdall RL, Vig KWL, editors. Orthodontics: Current Principles and Techniques. China: CV Mosby; 2005. pp. 543–77.
    1. Ngan P. Treatment of Class III malocclusion in the primary and mixed dentitions. In: Bishara ES, editor. Textbook of Orthodontics. US: Saunders; 2001. pp. 375–414.
    1. Proffit WR, Fields HW. Contemporary Orthodontics. 3. US: CV Mosby; 2000.
    1. Rakosi T. Treatment of Class III malocclusions. In: Graber T, Rakosi T, Petrovic A, editors. Dentofacial Orthopedics with Functional Appliances. US: CV Mosby; 1997. pp. 461–80.
    1. Ritucci R, Nanda R. The effect of chin cup therapy on the growth and development of the cranial base and midface. Am J Orthod Dentofacial Orthop. 1986;90:475–83. doi: 10.1016/0889-5406(86)90107-1.
    1. Sugawara J. Clinical practice guidelines for developing Class III malocclusion. In: Nanda R, editor. Biomechanics and Esthetic Strategies in Clinical Orthodontics. US: Saunders; 2005. pp. 211–63.
    1. Barrett AA, Baccetti T, McNamara JA. Treatment effects of the light-force chincup. Am J Orthod Dentofacial Orthop. 2010;138:468–76. doi: 10.1016/j.ajodo.2008.12.024.
    1. Abdelnaby YL, Nassar EA. Chin cup effects using two different force magnitudes in the management of Class III malocclusions. Angle Orthod. 2010;80:957–62. doi: 10.2319/022210-110.1.
    1. Gökalp H, Kurt G. Magnetic resonance imaging of the condylar growth pattern and disk position after chin cup therapy: a preliminary study. Angle Orthod. 2005;75:568–75.
    1. Deguchi T, McNamara JA. Craniofacial adaptations induced by chincup therapy in Class III patients. Am J Orthod Dentofacial Orthop. 1999;115:175–82. doi: 10.1016/S0889-5406(99)70346-X.
    1. Tuncer BB, Kaygisiz E, Tuncer C, Yüksel S. Pharyngeal airway dimensions after chin cup treatment in Class III malocclusion subjects. J Oral Rehabil. 2009;36:110–17. doi: 10.1111/j.1365-2842.2008.01910.x.
    1. Oppenheim A. A possibility for physiologic orthodontic movement. Am J Orthod Oral Surg. 1944;30:345–6. doi: 10.1016/S0096-6347(44)90075-X.
    1. Thilander B. Chin-cap treatment for angle Class III malocclusion. Report of the congress. European Orthodontic Society. 1965;41:311–27.
    1. Altuğ Z, Erdem D, Rübendüz M. Investigation of the functional treatment effects of the skeletal and dental Class III anomalies on the skeletal region. Ankara Üniversitesi Diş Hekimliği Fakültesi dergisi. 1989;16:447–52.
    1. Wahabuddin S. Determinants of successful chincup therapy in skeletal Class III malocclusions. Am J Orthod Dentofacial Orthop. 2005;127:2–3. doi: 10.1016/j.ajodo.2004.11.021.
    1. Greenhalgh T, Taylor R. Papers that go beyond numbers (qualitative research) BMJ. 1997;315:740–43. doi: 10.1136/bmj.315.7110.740.
    1. Oxford Centre of Evidence Based Medicine Table of Evidence Glossary [Internet]. Available from: .
    1. Victor N. The challenge of meta-analysis: discussion. Indications and contra-indications for meta-analysis. J Clin Epidemiol. 1995;48:5–8. doi: 10.1016/0895-4356(94)00107-2.
    1. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration [Internet]. Available from: . Accessed March 2011.
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis J, Clarke M, Devereaux P, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:1–34. doi: 10.1016/j.jclinepi.2009.06.006.
    1. Auger CP. Information Sources in Grey Literature. 2. London: Bowker-Saur; 1989.
    1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46. doi: 10.1177/001316446002000104.
    1. Moher D, Cook DJ, Jadad AR, Tugwell P, Moher M, Jones A, Pham B, Klassen TP. Assessing the quality of reports of randomized trials: implication for the conduct of meta-analyses. Health Technol Assess. 1999;3:1–98.
    1. Downs HS, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epid Community Health. 1998;52:377–84. doi: 10.1136/jech.52.6.377.
    1. Borenstein M, Hedges LV, Rothstein H. Fixed-effect versus random-effects models. In: Borenstein M, Hedges LV, Higgins JPT, Rothstein H, editors. Introduction to Meta-analysis. Hoboken: Wiley; 2009. pp. 57–85.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. doi: 10.1016/0197-2456(86)90046-2.
    1. Janket SJ, Wightman A, Baird AE, Van Dyke TE, Jones JA. Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies. J Dent Res. 2005;84:1154–9. doi: 10.1177/154405910508401212.
    1. Kolokitha OE, Kaklamanos EG, Papadopoulos MA. Prevalence of nickel hypersensitivity in orthodontic patients: a meta-analysis. Am J Orthod Dentofacial Orthop. 2008;134:722.e1–722.e2.
    1. Papageorgiou SN, Zogakis IP, Papadopoulos MA. Failure rates and associated risk factors of orthodontic miniscrew implants: a meta-analysis. Am J Orthod Dentofacial Orthop. 2012;142:577–95. doi: 10.1016/j.ajodo.2012.05.016.
    1. Anello C, Fleiss JL. Exploratory or analytic meta-analysis: should we distinguish between them? J Clin Epidemiol. 1995;48:109–18. doi: 10.1016/0895-4356(94)00084-4.
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60. doi: 10.1136/bmj.327.7414.557.
    1. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11:193–206. doi: 10.1037/1082-989X.11.2.193.
    1. Pigott TD. Advances in Meta-analysis. 1. Chicago: Springer; 2012. pp. 49–51.
    1. Graber W. Chin cup therapy for mandibular prognathism. Am J Orthod. 1977;72:23–41. doi: 10.1016/0002-9416(77)90122-1.
    1. Abu Alhaija ES, Richardson A. Long-term effect of the chincap on hard and soft tissues. Eur J Orthod. 1999;21:291–8. doi: 10.1093/ejo/21.3.291.
    1. Arman A, Toygar TU, Abuhijleh E. Profile changes associated with different orthopedic treatment approaches in Class III malocclusions. Angle Orthod. 2004;74:733–40.
    1. Lu YC, Tanne K, Hirano Y, Sakuda M. Craniofacialmorphology of adolescent mandibular prognathism. Angle Orthod. 1993;63:277–82.
    1. Sugawara J, Mitani H. Facial growth of skeletal Class III malocclusion and the effects, limitations, and long-term dentofacial adaptations to chincap therapy. Semin Orthod. 1997;3:244–54. doi: 10.1016/S1073-8746(97)80057-6.
    1. Deguchi T, Kuroda T, Minoshima Y, Graber TM. Craniofacial features of patients with Class III abnormalities: growth-related changes and effects of short-term and long-term chincup therapy. Am J Orthod Dentofacial Orthop. 2002;121:84–92. doi: 10.1067/mod.2002.120359.
    1. Alarcón JA, Bastir M, Rosas A, Molero J. Chincup treatment modifies the mandibular shape in children with prognathism. Am J Orthod Dentofacial Orthop. 2011;140:38–43. doi: 10.1016/j.ajodo.2009.10.046.
    1. Sakamoto T, Iwase I, Uka A, Nakamura S. A roentgenocephalometric study of skeletal changes during and after chin cup treatment. Am J Orthod. 1984;85:341–50. doi: 10.1016/0002-9416(84)90191-X.
    1. Deguchi T. Force distribution of the temporomandibular joint and temporal bone surface subjected to the head-chincup force. Am J Orthod Dentofacial Orthop. 1998;114:277–82. doi: 10.1016/S0889-5406(98)70209-4.
    1. Lin HC, Chang HP, Chang HF. Treatment effects of occipitomental anchorage appliance of maxillary protraction combined with chincup traction in children with Class III malocclusion. J Formos Med Assoc. 2007;106:380–91. doi: 10.1016/S0929-6646(09)60323-5.
    1. Liu ZP, Li CJ, Hu HK, Chen JW, Li F, Zou SJ. Efficacy of short-term chincup therapy for mandibular growth retardation in Class III malocclusion. Angle Orthod. 2011;81:162–8. doi: 10.2319/050510-244.1.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa