The effectiveness of early intervention on malocclusion and its impact on craniofacial growth: A systematic review


Contemp Pediatr Dent 2021:2(2):72-89

The effectiveness of early intervention on malocclusion and its impact on craniofacial growth: A systematic review

OrcidPatrícia Valério1 ✉, OrcidTina Poklepović Peričić2, OrcidAndrea Rossi3, OrcidCristina Grippaud4,OrcidJúlia dos Santos Tavares Campos5, OrcidIsrael Júnior Borges do Nascimento6


1. Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte,
Minas Gerais, Brazil
Patricia Valerio Institute, Belo Horizonte, Minas Gerais, Brazil ( Correspondence:

2. Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croati

3. School of Dentistry, Università Cattolica del Sacro Cuore, and Fondazione Policlinico
Universitario “A. Gemelli” IRCCS, Roma, Italy

4. School of Dentistry, Università Cattolica del Sacro Cuore, and Fondazione Policlinico
Universitario “A. Gemelli” IRCCS, Roma, Italy

5. Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte,
Minas Gerais, Brazil

6. School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America


The early delivery of orthodontic treatment plays a critical role in craniofacial development and the establishment/re-establishment of appropriate stomatognathic function.

Early interventions effectively affect the masticatory system, increasing average bite force and general thickness of facial muscles.

This review emphasizes the need for well designed clinical trials that would consider patient-important outcomes.


This review aims to assess the available evidence related to the effectiveness of early interventions on malocclusion and its impact on the craniofacial structure among children under six years of age. Furthermore, we aimed to evaluate the correlation between nutritive sucking behavior mechanisms on the oral facial components. We searched Medline, Embase, Cochrane Library, Scopus, and the LILACS from inception to December 10, 2020, to identify published randomized and non-randomized controlled trials that investigated the broad spectrum of early interventions for the treatment of malocclusions among pediatric patients under six years old. We have also included studies that evaluated the impact or the relationship between feeding alternatives, malocclusion, and craniofacial growth. Reviewers working in pairs investigators independently performed title and abstract screening, full-text screening, data extraction, risk of bias assessment using ROBINS-I tool, and rated the certainty of evidence using GRADE. Seven studies were included (783 patients), with an overall risk of bias classified as critical. Early treatment was shown to improve facial asymmetry, particularly in the lower part of the face, along with an increase of palatal volume and palatal surface. Early treatment showed important reduction of mandibular protrusion and length, leading to favorable sagittal growth of the maxilla. Furthermore, the early intervention significantly enhanced the average bite force magnitude (from 318.20 N to 382.79 N) and increased the general thickness of facial muscles. Our findings suggest that the benefits generated by early orthodontic interventions are related to the improvement of craniofacial symmetry/bone structure, and refinement of masticatory ability and performance. Notwithstanding, there is still a need for further studies appraising patient-important outcomes, such as quality of life and nutritional features.

Keywords: Bone Growth; Early Intervention; Malocclusion; Maxillofacial Development; Systematic Review

Copyright © 2021 Contemporary Pediatric Dentistry


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31 May 2021


14 July 2021

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29 July 2021