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Meta-Analysis
. 2016 Apr;38(2):113-26.
doi: 10.1093/ejo/cjv034. Epub 2015 May 19.

Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis

Vasileios F Zymperdikas  1 , Vasiliki Koretsi  2 , Spyridon N Papageorgiou  3 , Moschos A Papadopoulos  4
Affiliations
Meta-Analysis

Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis

Vasileios F Zymperdikas et al. Eur J Orthod. 2016 Apr.

Abstract

Objective: To assess the treatment effects of fixed functional appliances (FFAs) in treated versus untreated Class II patients by means of lateral cephalometric radiographs.

Search methods: Unrestricted electronic search of 18 databases and additional manual searches up to October 2014.

Selection criteria: Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with FFAs and their matched untreated controls.

Data collection and analysis: Skeletal, dental, and soft tissue cephalometric data were annualized and stratified according to the time of evaluation in effects. Following risk of bias evaluation, the mean differences (MDs) and 95 % confidence intervals (CIs) were calculated with random-effects models. Patient- and appliance-related subgroup analyses and sensitivity analyses were performed with mixed-effects models.

Results: Nine studies were included (244 patients; mean age: 13.5 years and 174 untreated controls; mean age: 12.8 years) reporting on cephalometric effects directly after the removal of FFAs. FFAs were found to induce a small reduction of SNA angle (MD = -0.83 degree/year, 95 % CI: -1.17 to -0.48), a small increase of SNB angle (MD = 0.87 degree/year, 95 % CI: 0.30-1.43), and moderate decrease of ANB angle (MD = -1.74 degree/year, 95 % CI: -2.50 to -0.98) compared to untreated Class II patients. FFA treatment resulted in significant dentoalveolar and soft tissue changes. Several patient- or appliance-related factors seem to affect the treatment outcome. Long-term effectiveness of FFAs could not be assessed due to limited evidence.

Conclusions: According to existing evidence, FFAs seem to be effective in improving Class II malocclusion in the short term, although their effects seem to be mainly dentoalveolar rather than skeletal.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram for the selection of studies.
Figure 2.
Figure 2.
Forest plot of the mean difference of the SNA, SNB, and ANB angles (Post-Pre increments in °/year) between FFAs and control groups based on the random-effects model together with the 95% confidence interval (CI) and the 95% prediction interval (PI).
See this image and copyright information in PMC

Comment in

  • Ideal parameter to assess efficacy of fixed functional appliance: angular or linear?
    Devi A, Srinivasan B, Padmanabhan S. Devi A, et al. Eur J Orthod. 2016 Jun;38(3):337. doi: 10.1093/ejo/cjw025. Epub 2016 Apr 6. Eur J Orthod. 2016. PMID: 27053726 Free PMC article. No abstract available.
  • Reply.
    Zymperdikas VF, Koretsi V, Papageorgiou SN, Papadopoulos MA. Zymperdikas VF, et al. Eur J Orthod. 2016 Jun;38(3):338. doi: 10.1093/ejo/cjw028. Epub 2016 Apr 6. Eur J Orthod. 2016. PMID: 27053727 Free PMC article. No abstract available.

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