Introduction: The curricula for UK dental specialty training have recently been under review and until 2024, completion of a research component during training in Dental Public Health, Oral Microbiology and Orthodontics has been mandatory (with an alternative route for Orthodontics involving the submission of two scientific papers for those trainees not wishing to undertake a higher degree). Anecdotally, some trainees in other dental specialties choose to undertake higher degrees alongside specialty training. Aims: The aims were to investigate how many dental specialty registrars study for higher degrees alongside specialty training, and whether undertaking a higher degree alongside specialty training has an impact on completion of training, research skills, research experience, patient care and career opportunities. Materials and Methods: This was a cross-sectional study design, involving the distribution of an online, anonymous questionnaire-based survey to UK dental specialty registrars in November and December 2022. Results: In total, 38 questionnaires were completed, representing a 7.7% response rate of the entire dental specialty registrar cohort in the UK and 42% of those who received it. Most respondents (76.3%) were either studying or had completed a clinically relevant higher degree prior to specialty training. Most respondents (76.3%) reported that the higher degree increased career opportunities and gave them additional skills. Conclusions: Dental specialty trainees who responded to this survey perceived the higher degree to be beneficial in terms of preparing for exams, gaining skills in critical appraisal and for increasing future career opportunities.

Objectives To assess the changes in compliance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines for randomized controlled trials (RCTs) in four orthodontic journals. To assess whether reporting of randomization, concealment, and blinding has improved. Methods Electronic hand searching was undertaken to identify orthodontic RCTs published in four orthodontic journals from January 2016 to June 2017 (T1) and from January 2019 to June 2020 (T2). The journals were the American Journal of Orthodontics and Dentofacial Orthopaedics (AJO-DO), Angle Orthodontist (AO), European Journal of Orthodontics (EJO), and Journal of Orthodontics (JO). Each item on the CONSORT checklist was scored as either reported, not reported, or not applicable for each paper reporting an RCT. Results The study included 69 papers reporting an RCT published in T1 and 64 RCTs published in T2. The median CONSORT score in T1 was 48.7% (interquartile range [IQR] 27.6%, 68.6%) and 67% in T2 (IQR 43.9%, 79.5%). This increase was statistically significant (P = 0.001) and largely attributable to improved reporting in AO (P = 0.016) and EJO (P = 0.023). Reporting did not change significantly in AJO-DO (P = 0.13) or in JO (P = 1.0). Reporting of random allocation sequence generation (OR 2.09; 95% CI 1.01, 4.29) and concealment of allocation (OR 2.27%, 95% CI 1.12, 4.57) were significantly higher in T2 compared with T1. Reporting of blinding did not change significantly. Conclusion Overall reporting of CONSORT items in reports of orthodontic RCTs published in the AJO-DO, AO, EJO, and JO, improved significantly from 2016-17 to 2019-20. This could be improved further by authors, journal referees, and editors adhering to the guidelines.

AIMS:To explore any changes in the perceived gender and affiliation of first authors of papers published in the British Journal of Orthodontics (BJO) and Journal of Orthodontics (JO), over the last 50 years.METHODS:Electronic hand searches of the BJO and JO from 1973 to 2021, were undertaken to identify research and clinical papers published the first volume of the BJO (1973-74) and then the first two volumes of each subsequent decade i.e. 1980-81; 1990-91 to 2020-21. Articles such as Editorials, Product Updates and Abstract summaries, were excluded.The perceived gender of the first author was identified from their forename, internet sources and/or personal knowledge, where possible. The country of the first author's affiliation was identified from the author details stated in the papers. The countries were then grouped into geographical areas.RESULTS:A total of 385 papers were identified with a steady increase from 1973 to 2021. There was a statistically significant increase in papers published by authors who were perceived to be female (odds ratio 8.33; 95% CI 4.75, 14.64). The increase in papers published by non-UK affiliated first authors was significant (odds ratio 5.01; 95% CI 2.78, 9.02).CONCLUSIONS:The Journal has seen a significant change, over the last 50 years, in its authorship profile from nearly exclusively male, UK based authors to more than 60% of published papers having a first author who was perceived as being female and 37% originating from outside the UK.

case and of split-mouth and parallel-arm designs investigating the impact of orthodontic treatment following periodontal treatment with either no comparison or comparison with no orthodontic treatment. Studies were participants being treated with or removable appliances, had been diagnosed with periodontitis and received periodontal treatment for tilted molars, intra-bony or furcation defects. Included studies needed to have a minimum mean follow-up time of 6 months with at least 10 participants for split-mouth studies or at least 10 participants in each treatment arm at follow-up; clinical examination also needed to occur at follow-up. The studies with participants who disorders that affect periodontal and orthodontic treatment, pre-clinical as where was for Background: Gingival recession, involving the lower inci-sors, is relatively common and can result in hypersensitivity, an aesthetic problem and may compromise the longevity of the tooth. There appears to be variation in the decision of when and if a gingival graft should be undertaken for patients with gingival recession for whom orthodontic treatment is being considered. Aim: This study was undertaken to compare the periodontal parameters outcomes after fixed orthodontic treatment in patients receiving subepithelial connective tissue grafts (SCTG) and compared with those not receiving root coverage procedures for an isolated tooth in the lower labial seg-ment with gingival recession, prior to orthodontic treatment. Method: This was a parallel randomised controlled clinical trial with a 1:1 allocation ratio. The trial involved 36 participants who were 36 systemically healthy patients with isolated labial gingival recession and anterior crowding of less than 4mm. The experimental group received SCTG three months prior to starting non-extraction fixed orthodontic treatment. The control group had non-extraction fixed orthodontic treatment only. Primary outcomes included change in recession depth, or gingival margin level, keratinised tissue width, root coverage, root aesthetic score and gingival phenotype. Patients were followed up for one year post-surgery. Secondary outcomes included gingival index, pocket depth, clinical attachment level, bleeding on probing, and patient reported outcomes for pain and hypersensitivity. Outcomes were measured before the CTG was placed, at the start of orthodontic treatment, mid-orthodontic treatment and at the end of levelling and aligning.Patients were allocated on a 1:1 ratio. Block randomisation was used and allocation was concealed using sealed

Introduction In the UK, orthodontic speciality training takes place over three years full-time. In addition to the clinical training, there is an expectation that trainees undertake a higher degree. Currently, there is little evidence regarding the impact of undertaking a higher degree on specialist orthodontists. Aims Investigate UK orthodontists' perceptions of undertaking a higher degree alongside speciality training. Materials and methods A cross-sectional research study involving the distribution of an anonymous, descriptive, online, questionnaire-based survey between May and June 2021 via the British Orthodontic Society. Data were obtained in relation to the impact of undertaking a higher degree on the completion of speciality training, research skills, delivery of patient care and career opportunities. Results In total, 166 questionnaires were completed (approximately 13.3% response rate). Most respondents 'agreed' or 'strongly agreed' that undertaking a higher degree had improved their scientific (77.1%) and critical appraisal skills (80.7%), job prospects (60.2%) and career opportunities (63.9%). Most respondents felt the benefits of the higher degree outweighed the associated costs (65.1%) and was a worthwhile component of training (69.3%). Conclusions Specialist orthodontists place a high value on undertaking a higher degree. The results of this questionnaire should be of importance to stakeholders involved in the development of the orthodontic curriculum.

BACKGROUND Crowded teeth develop when there is not enough space in the jaws into which the teeth can erupt. Crowding can affect baby teeth (deciduous dentititon), adult teeth (permanent dentition), or both, and is a common reason for referral to an orthodontist. Crowded teeth can affect a child's self-esteem and quality of life. Early loss of baby teeth as a result of tooth decay or trauma, can lead to crowded permanent teeth. Crowding tends to increase with age, especially in the lower jaw. OBJECTIVES To assess the effects of orthodontic intervention for preventing or correcting crowded teeth in children. To test the null hypothesis that there are no differences in outcomes between different orthodontic interventions for preventing or correcting crowded teeth in children. SEARCH METHODS Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 11 January 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated any active interventions to prevent or correct dental crowding in children and adolescents, such as orthodontic braces or extractions, compared to no or delayed treatment, placebo treatment or another active intervention. The studies had to include at least 80% of participants aged 16 years and under. DATA COLLECTION AND ANALYSIS Two review authors, independently and in duplicate, extracted information regarding methods, participants, interventions, outcomes, harms and results. We resolved any disagreements by liaising with a third review author. We used the Cochrane risk of bias tool to assess the risk of bias in the studies. We calculated mean differences (MDs) with 95% confidence intervals (CI) for continuous data and odds ratios (ORs) with 95% CIs for dichotomous data. We undertook meta-analysis when studies of similar comparisons reported comparable outcome measures, using the random-effects model. We used the I2 statistic as a measure of statistical heterogeneity. MAIN RESULTS Our search identified 24 RCTs that included 1512 participants, 1314 of whom were included in analyses. We assessed 23 studies as being at high risk of bias and one as unclear.  The studies investigated 17 comparisons. Twenty studies evaluated fixed appliances and auxiliaries (lower lingual arch, lower lip bumper, brackets, archwires, lacebacks, headgear and adjunctive vibrational appliances); two studies evaluated removable appliances and auxiliaries (Schwarz appliance, eruption guidance appliance); and two studies evaluated dental extractions (lower deciduous canines or third molars). The evidence should be interpreted cautiously as it is of very low certainty. Most interventions were evaluated by a single study. Fixed appliances and auxiliaries One study found that use of a lip bumper may reduce crowding in the early permanent dentition (MD -4.39 mm, 95% CI -5.07 to -3.71; 34 participants). One study evaluated lower lingual arch but did not measure amount of crowding. One study concluded that coaxial nickel-titanium (NiTi) archwires may cause more tooth movement in the lower arch than single-stranded NiTi archwires (MD 6.77 mm, 95% CI 5.55 to 7.99; 24 participants). Another study, comparing copper NiTi versus NiTi archwires, found NiTi to be more effective for reducing crowding (MD 0.49 mm, 95% CI 0.35 to 0.63, 66 participants). Single studies did not show evidence of one type of archwire being better than another for Titinol versus Nitinol; nickel-titanium versus stainless steel or multistrand stainless steel; and multistranded stainless steel versus stainless steel.  Nor did single studies find evidence of a difference in amount of crowding between self-ligating and conventional brackets, active and passive self-ligating brackets, lacebacks added to fixed appliances versus fixed appliances alone, or cervical pull headgear versus minor interceptive procedures. Meta-analysis of two studies showed no evidence that adding vibrational appliances to fixed appliances reduces crowding at 8 to 10 weeks (MD 0.24 mm, 95% CI -0.81 to 1.30; 119 participants). Removable appliances and auxiliaries One study found use of the Schwarz appliance may be effective at treating dental crowding in the lower arch (MD -2.14 mm, 95% CI -2.79 to -1.49; 28 participants). Another study found an eruption guidance appliance may reduce the number of children with crowded teeth after one year of treatment (OR 0.19, 95% CI 0.05 to 0.68; 46 participants); however, this may have been due to an increase in lower incisor proclination in the treated group. Whether these gains were maintained in the longer term was not assessed. Dental extractions One study found that extracting children's lower deciduous canines had more effect on crowding after one year than no treatment (MD -4.76 mm, 95 CI -6.24 to -3.28; 83 participants), but this was alongside a reduction in arch length. One study found that extracting wisdom teeth did not seem to reduce crowding any more than leaving them in the mouth (MD -0.30 mm, 95% CI -1.30 to 0.70; 77 participants). AUTHORS' CONCLUSIONS Most interventions were assessed by single, small studies. We found very low-certainty evidence that lip bumper, used in the mixed dentition, may be effective for preventing crowding in the early permanent dentition, and a Schwarz appliance may reduce crowding in the lower arch. We also found very low-certainty evidence that coaxial NiTi may be better at reducing crowding than single-stranded NiTi, and that NiTi may be better than copper NiTi. As the current evidence is of very low certainty, our findings may change with future research.

Background: Scientific meetings provide a platform for disseminating new research. Abstracts presented at these meetings are frequently published as full-length papers in peer-reviewed journals. The primary aims of this study were to determine the publication rate and time to publication of abstracts presented at the European Orthodontic Society (EOS) and World Federation of Orthodontists (WFO) congresses in 2015. The secondary aim was to identify factors predicting the publication of abstracts. Methods: The congress abstracts were identified from the congress report or organizers. Systematic searches of the PubMed, Google Scholar, Scopus, and Web of Science databases were performed to identify papers based on the abstracts identified. Abstract titles, first and last authors' last name, and keywords were used to identify whether an abstract resulted in a publication. Abstracts published as full-length articles were then analyzed. Results: In total, 208 abstracts were identified, of which 46.6% were published as full-length articles. The median time to publication was 17 months after the EOS congress, and 8.5 months after the WFO congress. Abstracts presented orally were more likely to be published than those presented as posters. Abstracts from Europe were more likely to result in publication. The subject and setting of the study were poor predictors of publication. Conclusions: Less than half of the abstracts presented at the EOS and WFO congresses in 2015 led to full publication in a peer-reviewed journal. The mode of presentation and the region of origin of the research were good predictors of publication. Crown Copyright (C) 2021 Published by Elsevier Inc. on behalf of World Federation of Orthodontists. All rights reserved.

BACKGROUND:A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth, the lower jaw may have to move to one side to allow the back teeth to meet together. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth while others are directed at treating the cause of the posterior crossbite (e.g. breathing problems or sucking habits). Most treatments have been used at each stage of dental development. This is an update of a Cochrane review first published in 2001.OBJECTIVES:To assess the effects of orthodontic treatment for posterior crossbites.SEARCH METHODS:We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 21 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 21 January 2014), and EMBASE via OVID (1980 to 21 January 2014). We searched the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.SELECTION CRITERIA:Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults.DATA COLLECTION AND ANALYSIS:Two review authors, independently and in duplicate, screened the results of the electronic searches, and extracted data and assessed the risk of bias of the included studies. We attempted to contact the first named authors of the included studies for missing data and for clarification. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous (event) data, and mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models (we would have used random-effects models if we had included four or more studies in a meta-analysis) when comparisons and outcomes were sufficiently similar.MAIN RESULTS:We included 15 studies, of which two were at low risk of bias, seven were at high risk of bias and six were unclear. Fixed appliances with mid-palatal expansionNine studies tested fixed appliances with mid-palatal expansion against each other. No study reported a difference between any type of appliance. Fixed versus removable appliancesFixed quad-helix appliances may be 20% more likely to correct crossbites than removable expansion plates (RR 1.20; 95% CI 1.04 to 1.37; two studies; 96 participants; low-quality evidence).Quad-helix appliances may achieve 1.15 mm more molar expansion than expansion plates (MD 1.15 mm; 95% CI 0.40 to 1.90; two studies; 96 participants; moderate-quality evidence).There was insufficient evidence of a difference in canine expansion or the stability of crossbite correction.Very limited evidence showed that both fixed quad-helix appliances and removable expansion plates were superior to composite onlays in terms of crossbite correction, molar and canine expansion. Other comparisonsVery limited evidence showed that treatments were superior to no treatment, but there was insufficient evidence of a difference between any active treatments.AUTHORS' CONCLUSIONS:There is a very small body of low- to moderate-quality evidence to suggest that the quad-helix appliance may be more successful than removable expansion plates at correcting posterior crossbites and expanding the inter-molar width for children in the early mixed dentition (aged eight to 10 years). The remaining evidence we found was of very low quality and was insufficient to allow the conclusion that any one intervention is better than another for any of the outcomes in this review.

Aims: To assess the performance of the referral management system (RMS) compared to a previous paper-based referral system and to determine whether referrals reflected the patients’ malocclusion and met current guidelines. Design: Three-cycle audit. Setting: Orthodontic Department, Liverpool University Dental Hospital, UK. Participants: Consecutive new orthodontic patient referrals. Methods: Data were collected prospectively from orthodontic referral letters and new patient clinic proformas (2016–2017). Cycle 1 assessed the original paper-based referral form, Cycle 2 assessed the first RMS online form and Cycle 3 assessed a modified RMS form. Results: Cycles 1, 2 and 3 audited 83, 84 and 81 referrals, respectively. Agreement between the reason for referral and the new patient clinic findings was moderate for Cycles 1 and 3 (Kappa = 0.47 and 0.60, respectively) and fair for Cycle 2 (Kappa = 0.40). In Cycles 1, 2 and 3, the proportion of new patients appropriate for hospital orthodontic care reduced from 52% to 51% and 40%, respectively. None of the three cycles reached the 90% target for compliance with current referral guidelines. Conclusions: Cycle 3’s RMS form gave a truer reflection of the patients’ malocclusion but reduced the proportion of appropriate referrals. Further audit is required in this area to investigate the cost-effectiveness and clinical benefits of the RMS.

This case report describes the multidisciplinary clinical management of a male patient, diagnosed at the age of 7, with Regional Odontodysplasia of the right maxilla. Following fixed orthodontic treatment to align his teeth, extraction of malformed teeth and subsequent bone grafting, the patient was successfully rehabilitated with implant-supported bridgework of a hybrid design to replace the teeth in the right maxillary quadrant. Clinical steps, as well as the complexities of this particular case, will be described. CPD/Clinical Relevance: This case highlights the need for a multidisciplinary team approach to provide comprehensive care for patients with complex dental anomalies.

This review will consider changes in clinical practice associated with the management of patients with missing teeth and briefly review the evidence base that underpins what we do for them.

This review will consider changes in clinical practice associated with the management of patients with missing teeth and briefly review the evidence base that underpins what we do for them.

s 371 similar satisfaction outcomes across all dimensions, except for eating and chewing, where the Invisalign group reported greater satisfaction.

Introduction: Knowledge of a patient's stage of growth and development plays a vital role in diagnosis, treatment planning, results, and stability of the outcome. Cervical vertebral maturation (CVM) predicts the stage of growth and development, but its validity has only been investigated restrospectively, using historic samples. Our objective was to assess prospectively whether a correlation exists between CVM stage and statural height growth velocity. Methods: Participants were aged between 8 and 18 years and of both sexes. Standing height was measured every 6 weeks with participants barefoot and in natural head position. CVM stage was assessed from lateral cephalograms taken at the start of treatment. Intraobserver and interobserver reliability of CVM staging and statural height measurements were assessed using the Cohen weighted kappa, percentage of agreement, intraclass correlation coefficient, and Bland-Altman plots, respectively. Analysis of variance was used to test for statistically significant differences between growth velocities at the CVM stages. Results: We analyzed 108 participants. The peak in statural height growth velocity occurred at CVM stage 3 (P = 0.001). There was a statistically significant difference in the mean annualized growth velocity between all CVM stages except stages 2 and 4. Girls had their peak pubertal growth spurt an average of 1.2 years earlier than did boys. Conclusions: This study suggests that there is a significant relationship between CVM stage and statural height velocity.

BACKGROUND:Prominent upper front teeth are a common problem affecting about a quarter of 12-year old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. These teeth are more likely to be injured and their appearance can cause significant distress.If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. OBJECTIVES:To assess the effects of orthodontic treatment for prominent upper front teeth when this treatment is initiated when the child is seven to 11 years old compared to when they are in early adolescence, or when treatment uses different types of orthodontic braces. SEARCH METHODS:We searched the following databases: Cochrane Oral Health Group's Trials Register (to 17 April 2013), CENTRAL (The Cochrane Library 2013, Issue 3), MEDLINE (OVID) (1946 to 17 April 2013) and EMBASE (OVID) (1980 to 17 April 2013). There were no restrictions regarding language or publication date. SELECTION CRITERIA:Randomised controlled trials of children and/or adolescents (age < 16 years) on early treatment (either one or two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces compared with late treatment with any type of orthodontic braces or head-braces; or, on any type of orthodontic braces or head-braces compared with no treatment or another type of orthodontic brace or appliance (with treatment starting in children of similar ages in both groups) to correct prominent upper front teeth. DATA COLLECTION AND ANALYSIS:Review authors screened the search results, extracted data and assessed risk of bias independently, used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, mean differences (MDs) and 95% CIs for continuous outcomes and a fixed-effect model for meta-analyses as there were fewer than four studies. MAIN RESULTS:We included 17 studies based on data from 721 participants.Three trials (n = 343) compared early (two-phase) treatment (7-11 years of age) with a functional appliance, with adolescent (one-phase) treatment. Statistically significant differences in overjet, ANB and PAR scores were found in favour of functional appliance when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18) (low quality evidence), final ANB (MD -0.02, 95% CI -0.47 to 0.43, P = 0.92), PAR score (MD 0.62, 95% CI -0.66 to 1.91, P = 0.34) or self concept score (MD 0.83, CI -2.31 to 3.97, P = 0.60). However, two-phase treatment with functional appliance showed a statistically significant reduction in the incidence of incisal trauma (OR 0.59, 95% CI 0.35 to 0.99, P = 0.04) (moderate quality evidence). The incidence of incisal trauma was clinically significant with 29% (54/185) of patients reporting new trauma incidence in the adolescent (one-phase) treatment group compared to only 20% (34/172) of patients receiving early (two-phase) treatment.Two trials (n = 285), compared early (two-phase) treatment using headgear, with adolescent (one-phase) treatment. Statistically significant differences in overjet and ANB were found in favour of headgear when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.22, 95% CI -0.56 to 0.12, P = 0.20) (low quality evidence), final ANB (MD -0.27, 95% CI -0.80 to 0.26, P = 0.32) or PAR score (MD -1.55, 95% CI -3.70 to 0.60, P = 0.16). The incidence of incisal trauma was, however, statistically significantly reduced in the two-phase treatment group (OR 0.47, 95% CI 0.27 to 0.83, P = 0.009) (low quality evidence). The adolescent treatment group showed twice the incidence of incisal trauma (47/120) compared to the young children group (27/117).Two trials (n = 282) compared different types of appliances (headgear and functional appliance) for early (two-phase) treatment. At the end of the first phase of treatment statistically significant differences, in favour of functional appliances, were shown with respect to final overjet only. At the end of phase two, there was no evidence of a difference between appliances with regard to overjet (MD -0.21, 95% CI -0.57 to 0.15, P = 0.26), final ANB (MD -0.17, 95% CI -0.67 to 0.34, P= 0.52), PAR score (MD -0.81, 95% CI -2.21 to 0.58, P = 0.25) or the incidence of incisal trauma (OR 0.79, 95% CI 0.43 to 1.44, P = 0.44).Late orthodontic treatment for adolescents with functional appliances showed a statistically significant reduction in overjet of -5.22 mm (95% CI -6.51 to -3.93, P < 0.00001) and ANB of -2.37° (95% CI -3.01 to -1.74, P < 0.00001) when compared to no treatment (very low quality evidence).There was no evidence of a difference in overjet when Twin Block was compared to other appliances (MD 0.01, 95% CI -0.45 to 0.48, P = 0.95). However, a statistically significant reduction in ANB (-0.63°, 95% CI -1.17 to -0.08, P = 0.02) was shown in favour of Twin Block. There was no evidence of a difference in any reported outcome when Twin Block was compared with modifications of Twin Block.There was insufficient evidence to determine the effects of Activator, FORSUS FRD EZ appliances, R-appliance or AIBP. AUTHORS' CONCLUSIONS:The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective in reducing the incidence of incisal trauma than providing one course of orthodontic treatment when the child is in early adolescence. There appears to be no other advantages for providing treatment early when compared to treatment in adolescence.