Comparative Efficacy of Fixed Versus Removable Habit-Breaking Appliances for the Management of Non-nutritive Sucking Habits: A Systematic Review

Non-nutritive sucking habits, including thumb, finger, and pacifier sucking, are common self-soothing behaviors in early childhood, and persistence beyond the preschool years is associated with anterior open bite, increased overjet, and altered orofacial function. Interceptive management often involves habit-breaking appliances that may be fixed or removable, yet their relative effectiveness remains debated. This systematic review compared the clinical efficacy of fixed versus removable habit-breaking appliances in achieving habit cessation and correcting associated dentoalveolar discrepancies in children. Electronic searches covering January 2005 to October 2025 identified randomized and prospective clinical studies evaluating these appliances. Outcomes of interest included overbite and overjet changes, skeletal and dentoalveolar effects, habit-cessation rates, and adverse events. A total of 15 studies met the inclusion criteria. Fixed appliances, particularly palatal cribs, bonded spurs, and Bluegrass designs, consistently produced faster overbite correction, with mean gains of about 3.0-3.6 mm, and better vertical control than removable devices, while removable appliances achieved comparable improvements mainly when compliance was high. Functional assessments also showed improved tongue posture and pressure patterns following treatment. Reported adverse effects were generally mild and transient, most commonly temporary speech alteration and local irritation. Overall, fixed appliances provide more predictable and efficient correction of malocclusions related to non-nutritive sucking habits, whereas removable appliances can be similarly effective when patient cooperation is strong, supporting early and individualized appliance selection to optimize stability and reduce relapse.