Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review

Background/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was...

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Main Authors: Gianna Dipalma, Grazia Marinelli, Lucia Casamassima, Paola Nardelli, Danilo Ciccarese, Paolo De Sena, Francesco Inchingolo, Vito Crincoli, Andrea Palermo, Ioana Roxana Bordea, Andrea Carbonara, Angelo Michele Inchingolo, Alessio Danilo Inchingolo
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:Children
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Online Access:https://www.mdpi.com/2227-9067/12/7/897
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author Gianna Dipalma
Grazia Marinelli
Lucia Casamassima
Paola Nardelli
Danilo Ciccarese
Paolo De Sena
Francesco Inchingolo
Vito Crincoli
Andrea Palermo
Ioana Roxana Bordea
Andrea Carbonara
Angelo Michele Inchingolo
Alessio Danilo Inchingolo
author_facet Gianna Dipalma
Grazia Marinelli
Lucia Casamassima
Paola Nardelli
Danilo Ciccarese
Paolo De Sena
Francesco Inchingolo
Vito Crincoli
Andrea Palermo
Ioana Roxana Bordea
Andrea Carbonara
Angelo Michele Inchingolo
Alessio Danilo Inchingolo
author_sort Gianna Dipalma
collection DOAJ
description Background/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was conducted across PubMed, Web of Science, and Scopus (May 2000–May 2025). The inclusion criteria focused on open-access, in vivo/human studies, case–control studies, cohort studies, and RCTs in English. Risk of bias was assessed using Rob 2.0. Results: Out of 362 initial records, 7 studies were included. Most of the included studies showed a low risk of bias, with some moderate risk in terms of confounding variables and participant selection, but no high risk was identified. Conclusions: The 2 × 4 fixed orthodontic appliance is an effective interceptive therapy for mixed dentition. Clinicians can optimize outcomes by understanding its biomechanics and clinical applications. Further research is needed to understand long-term impacts and improve efficiency.
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spelling doaj-art-2c26ae98b2e2450ca08cd2eb0cee35662025-08-20T02:45:38ZengMDPI AGChildren2227-90672025-07-0112789710.3390/children12070897Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic ReviewGianna Dipalma0Grazia Marinelli1Lucia Casamassima2Paola Nardelli3Danilo Ciccarese4Paolo De Sena5Francesco Inchingolo6Vito Crincoli7Andrea Palermo8Ioana Roxana Bordea9Andrea Carbonara10Angelo Michele Inchingolo11Alessio Danilo Inchingolo12Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Experimental Medicine, University of Salento, 73100 Lecce, ItalyDepartment of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy, 400012 Cluj-Napoca, RomaniaDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, ItalyBackground/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was conducted across PubMed, Web of Science, and Scopus (May 2000–May 2025). The inclusion criteria focused on open-access, in vivo/human studies, case–control studies, cohort studies, and RCTs in English. Risk of bias was assessed using Rob 2.0. Results: Out of 362 initial records, 7 studies were included. Most of the included studies showed a low risk of bias, with some moderate risk in terms of confounding variables and participant selection, but no high risk was identified. Conclusions: The 2 × 4 fixed orthodontic appliance is an effective interceptive therapy for mixed dentition. Clinicians can optimize outcomes by understanding its biomechanics and clinical applications. Further research is needed to understand long-term impacts and improve efficiency.https://www.mdpi.com/2227-9067/12/7/897mixed dentitionearly mixed dentition2 × 4 appliancefixed applianceorthodontic bracketsinterceptive orthodontic treatment
spellingShingle Gianna Dipalma
Grazia Marinelli
Lucia Casamassima
Paola Nardelli
Danilo Ciccarese
Paolo De Sena
Francesco Inchingolo
Vito Crincoli
Andrea Palermo
Ioana Roxana Bordea
Andrea Carbonara
Angelo Michele Inchingolo
Alessio Danilo Inchingolo
Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
Children
mixed dentition
early mixed dentition
2 × 4 appliance
fixed appliance
orthodontic brackets
interceptive orthodontic treatment
title Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
title_full Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
title_fullStr Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
title_full_unstemmed Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
title_short Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
title_sort effectiveness and clinical indications of 2 4 fixed orthodontic therapy in regard to mixed dentition a systematic review
topic mixed dentition
early mixed dentition
2 × 4 appliance
fixed appliance
orthodontic brackets
interceptive orthodontic treatment
url https://www.mdpi.com/2227-9067/12/7/897
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