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.
| 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
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.
Frequently Asked Questions
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.
Explore
Partnering with leading clinics, Virtual Consultant combines clinical expertise with advanced digital technology — making orthodontic care more efficient, accessible, and rewarding for both teams and patients.