Functional orthopedic treatment for anterior open bite in children. A systematic review of randomized clinical trials.

Purpose: This systematic review aimed to assess the effects of orthopedic functional appliances for anterior open bite (AOB) in primary or mixed dentition children.

Methods: A search for randomized controlled trials (RCT) was conducted in November 2020 in electronic databases with no data or language restrictions. Primary outcomes were skeletal cephalometric variables and adverse events. We used the Cochrane risk-of-bias tool to assess methodological quality and the GRADE approach to assess the certainty of the evidence.

Results: We identified five RCTs (220 participants). Very low certainty evidence showed an improvement in overbite (mean difference [MD] 3.60; 95% confidence interval [CI] 2.63-4.57) and in the angulation of the upper incisors to the palatal plane (MD 3.70; 95% CI 0.85-6.55) with Frankel's functional regulator, compared to no treatment. There was no difference in the measured cephalometric variables when comparing removable palatal crib to fixed palatal crib, bonded spurs, and chin cup. When comparing removable versus magnetic bite blocks, a beneficial effect was observed in overbite, overjet, skeletal anteroposterior angular measurements, and skeletal vertical linear measures in the magnetic group. No adverse events were reported.

Conclusion: There was insufficient evidence to infer the effects of these treatments for AOB, and high-quality RCTs are needed to increase the estimated effects.

Prospero register: CRD42020175634, prospectively registered (05 July 2020).