Evidence-Based Evaluation of Malocclusion Management in the Mixed Dentition: From Prevention to Clinical Controversy

The management of malocclusion during the mixed dentition is a crucial time for preventive and interceptive orthodontic intervention, given the complex interactions among craniofacial growth, tooth eruption, and orofacial function. Despite widespread use of early orthodontic treatment, uncertainty still remains about the optimal timing, choice of appliance, and long-term stability. This review collates recent evidence and proposes a functional-preventive approach to managing malocclusion in the mixed dentition, emphasizing risk assessment, etiologic control, and individualized treatment planning rather than traditional appliance therapy. A structured literature search was performed across PubMed/MEDLINE, Scopus, and Web of Science, including clinical trials, cohort studies, and systematic reviews on epidemiology, diagnosis, prevention, and interceptive treatment. The existing evidence supports early treatment for certain conditions, such as functional crossbites, developing Class III malocclusion, transverse maxillary deficiency, and space loss due to premature tooth loss. On the other hand, early treatment of Class II malocclusion and vertical discrepancies remains debatable due to limited long-term benefit. Preventive measures like caries prevention, space maintenance, and myofunctional treatment play a critical role in treatment stability. Emerging technologies, such as digital diagnostics, artificial intelligence-assisted analysis, and airway assessment, may enhance patient selection and treatment precision, but their clinical use should be interpreted with caution. In summary, this review shows a shift towards interdisciplinary, evidence- and biology-based decision-making to achieve stable occlusal and balanced craniofacial development.