--- title: "Early vs Later Orthodontic Treatment for Prominent Upper Front" url: https://staging.virtualconsultant.online/research/early-orthodontic-treatment-evidence description: "A 2018 Cochrane review of 27 randomised trials (1,251 participants) found low to moderate quality evidence that early treatment for children with..." updated: 2026-10-17T00:00:00Z publisher: Virtual Consultant Online --- Evidence summary Cochrane review Early treatment # Early vs Later Orthodontic Treatment for Prominent Upper Front Teeth: What the Evidence Says A 2018 Cochrane review of 27 randomised trials (1,251 participants) found low to moderate quality evidence that early treatment for children with prominent upper front teeth was more effective at reducing the incidence of incisor trauma than one course of treatment in adolescence. It found no other advantages of early treatment: final overjet and jaw relationship were similar once both groups had finished treatment. [Start Photo Assessment](https://staging.virtualconsultant.online/evaluations/quote) [Compare Costs](https://staging.virtualconsultant.online/costs) | Outcome | Early treatment (age 7 to 11) | Late treatment (age 12 to 16) | | --- | --- | --- | | Incisor trauma (functional appliance trials) | 19% of children (31 of 161) | 30% of children (51 of 171) | | Final overjet after both groups finished | No difference | No difference | | Final jaw relationship (ANB) | No difference | No difference | ## What the evidence found 1. The review included 27 randomised controlled trials with 1,251 participants. It compared early (two-phase) treatment started at 7 to 11 years with late (one-phase) treatment at about 12 to 16 years, late treatment with no treatment, and different types of braces. 2. Prominent upper front teeth affect about a quarter of 12-year-old children in the UK. These teeth are more likely to be injured, and their appearance can cause significant distress. 3. With functional appliances, early treatment reduced overjet and the ANB angle after phase one, but once both groups had completed treatment there was no difference in final overjet (low-quality evidence) or ANB (moderate-quality evidence). 4. Early treatment with functional appliances reduced the incidence of incisor trauma compared with late treatment (odds ratio 0.56): 30% (51 of 171) of the late-treatment group had new trauma, compared with 19% (31 of 161) of the early-treatment group (moderate-quality evidence). 5. Early treatment with headgear also reduced incisor trauma (24 of 117 children, against 44 of 120 with late treatment), but the evidence was low quality, and final overjet and ANB did not differ between groups. 6. Compared with no treatment, late treatment in adolescence with functional appliances reduced final overjet, by about 5.5 mm with fixed functional appliances and 4.6 mm with removable ones (low-quality evidence). ## How good is the evidence? The review rated the evidence low to moderate quality. Several comparisons rested on two or three trials, and many of the findings, including the effect of late treatment compared with no treatment, were low-quality evidence. Trials that included children with cleft lip or palate or other craniofacial conditions were excluded, so the findings do not apply to those groups. The authors conclude that early treatment is more effective at reducing incisor trauma than one course of treatment in adolescence, and that there appear to be no other advantages of early treatment. This page restates that review only; its searches ran to September 2017. ## Sources Batista KB, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database of Systematic Reviews. 2018;(3):CD003452. doi:10.1002/14651858.CD003452.pub4 (https://doi.org/10.1002/14651858.CD003452.pub4) ## Useful related pages [All research and evidence reviews](https://staging.virtualconsultant.online/research) [Early orthodontic treatment guide](https://staging.virtualconsultant.online/early-orthodontic-treatment) [Children's orthodontics](https://staging.virtualconsultant.online/childrens-orthodontics) This page summarises published research for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist. ### Compare next steps [Orthodontist Near Me](https://staging.virtualconsultant.online/locations/orthodontic-treatment-near-me) [Clear Aligners Near Me](https://staging.virtualconsultant.online/treatments/clear-aligners-near-me) [Invisalign Near Me](https://staging.virtualconsultant.online/locations/invisalign-provider-near-me) [Browse Locations](https://staging.virtualconsultant.online/locations) ### Ready for a clearer starting point? Upload guided photos and receive an indication of likely treatment options and pricing before booking appointments. [Get an Online Quote](https://staging.virtualconsultant.online/evaluations/quote) ### Frequently Asked Questions Is early orthodontic treatment better than waiting? For prominent upper front teeth, the 2018 Cochrane review found low to moderate quality evidence that early treatment reduced the incidence of incisor trauma compared with one course of treatment in adolescence, with no other advantages: final overjet and jaw relationship were similar once both groups had finished. Does early treatment reduce the risk of broken front teeth? In the review, early treatment with functional appliances cut new incisor trauma from 30% of children (51 of 171) in the late-treatment group to 19% (31 of 161) in the early-treatment group, from moderate-quality evidence. Headgear showed a similar direction, from low-quality evidence. Does early treatment give a better final result? The review found no difference in final overjet or jaw relationship (ANB) between early and late treatment once both groups had completed treatment, so early treatment did not produce a better end result on those measures. Does this apply to my child? Not necessarily. The review covers prominent upper front teeth in children and excluded cleft lip or palate and other craniofacial conditions. Whether and when to treat is a decision for a registered dentist or orthodontist after an in-person assessment of your child. Explore your options Quick links Not sure where to start? Use these quick links to explore orthodontic treatments, typical costs, and helpful guides that explain what different options involve. Whether you're researching braces or clear aligners, comparing pricing, or just getting a feel for what comes next, you can browse at your own pace and come back when you're ready to request a quote. 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Upload guided photos and get a tailored recommendation for your teeth and bite. [Start Photo Assessment](https://staging.virtualconsultant.online/evaluations/quote) [Find an Orthodontist](https://staging.virtualconsultant.online/locations) Citation details Title Early vs Later Orthodontic Treatment for Prominent Upper Front Teeth: What the Evidence Says Publisher Virtual Consultant Online Published 2026-10-17 Updated 2026-10-17 URL [https://staging.virtualconsultant.online/research/early-orthodontic-treatment-evidence](https://staging.virtualconsultant.online/research/early-orthodontic-treatment-evidence)