Treatment and stability of Class II division 2 malocclusion in children and adolescents: a systematic review

Objectives: To evaluate the evidence with regard to the effectiveness and stability of orthodontic treatment interventions for Class II division 2 malocclusion (II/2M) in children and adolescents. Design: Systematic review conducted according to the PRISMA statement. Methods: The Cochrane Oral Health Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched to November 2011. Relevant conference abstracts were also screened. No language restrictions were applied. Inclusion criteria were: clinical studies with > 20 II/2M subjects where comparisons were made with an untreated II/2 M group or another treated II/2 M group or neither. For included studies ranked best on the hierarchy of evidence, assessments of methodological quality and risk of bias were undertaken. Abstracts and, when appropriate, full papers were examined independently by two investigators. Disagreements were resolved through discussion. Outcomes: Treatment changes and/or stability with or without retainers using the following measures: skeletal, soft tissue, dental, occlusal changes, gingival health, TMJ status and/or related muscular activity or quality of life. Results: Of the 322 studies identified in the search, 20 met the final inclusion criteria. All were at high risk of bias. Conclusions: Highly biased evidence exists with regard to management and stability of II/2 M. Guidelines are proposed based on current evidence.