Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Mar 13;3(3):CD003452.
doi: 10.1002/14651858.CD003452.pub4.

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

Klaus Bsl Batista  1 , Badri Thiruvenkatachari, Jayne E Harrison, Kevin D O'Brien
Affiliations
Meta-Analysis

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

Klaus Bsl Batista et al. Cochrane Database Syst Rev. .

Abstract

Background: Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence.

Objectives: To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.

Data collection and analysis: Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies.

Main results: We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).

Authors' conclusions: Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

PubMed Disclaimer

Conflict of interest statement

Klaus BSL Batista: no interest to declare. Kevin O'Brien was involved in acquiring funding, running and reporting of the UK (11‐14) 2003, UK (Mixed) 2009 and Banks 2004 trials; however, he was not involved in the quality assessment of these trials. Badri Thiruvenkatachari and Helen Worthington (author on previous versions) are among the authors of UK (Mixed) 2009; however, they were not involved in the risk of bias assessment of this trial. Helen V Worthington is a Co‐ordinating Editor with Cochrane Oral Health. Badri Thiruvenkatachari and Kevin O'Brien were involved in running and reporting the Thiruvenkatachari 2010 (Dynamax) study; however, they were not involved in the quality assessment of this trial. Jayne E Harrison: no interest to declare. Dr Harrison is an Editor with Cochrane Oral Health.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 1 Outcomes at the end of phase I: functional versus observation.
1.2
1.2. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 2 Incidence of new incisal trauma during phase I treatment: functional versus observation.
1.3
1.3. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 3 Outcomes at the end of phase I: headgear versus observation.
1.4
1.4. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 4 Incidence of new incisal trauma during phase I treatment: headgear versus observation.
1.5
1.5. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 5 Outcomes at the end of phase II: functional (2‐phase) versus adolescent (1‐phase) treatment.
1.6
1.6. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 6 Incidence of new incisal trauma by the end of phase II treatment: functional (2‐phase) versus adolescent (1‐phase) treatment.
1.7
1.7. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 7 Outcomes at the end of phase II: headgear (2‐phase) versus adolescent (1‐phase) treatment.
1.8
1.8. Analysis
Comparison 1 Early orthodontic treatment: two‐phase versus one‐phase treatment, Outcome 8 Incidence of new incisal trauma by the end of phase II treatment: headgear (2‐phase) versus adolescent (1‐phase) treatment.
2.1
2.1. Analysis
Comparison 2 Early orthodontic treatment: two‐phase appliance 1 (headgear) versus appliance 2 (functional), Outcome 1 Outcomes at the end of phase I: headgear versus functional.
2.2
2.2. Analysis
Comparison 2 Early orthodontic treatment: two‐phase appliance 1 (headgear) versus appliance 2 (functional), Outcome 2 Incidence of new incisal trauma during phase I treatment: headgear versus functional.
2.3
2.3. Analysis
Comparison 2 Early orthodontic treatment: two‐phase appliance 1 (headgear) versus appliance 2 (functional), Outcome 3 Outcomes at the end of phase II: headgear versus functional.
2.4
2.4. Analysis
Comparison 2 Early orthodontic treatment: two‐phase appliance 1 (headgear) versus appliance 2 (functional), Outcome 4 Incidence of new incisal trauma by the end of phase II treatment: headgear versus functional appliance.
3.1
3.1. Analysis
Comparison 3 Late orthodontic treatment: functional versus no treatment, Outcome 1 Final overjet.
3.2
3.2. Analysis
Comparison 3 Late orthodontic treatment: functional versus no treatment, Outcome 2 Final ANB.
4.1
4.1. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 1 Twin Block versus other functional appliances (R‐appliance, Bionator, Bite‐Jumping appliance, Dynamax and Herbst).
4.2
4.2. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 2 Twin Block conventional versus other Twin Block modifications.
4.3
4.3. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 3 Functional (Activator) versus prefabricated functional myobrace appliance (PFA).
4.4
4.4. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 4 Functional (Activator) versus fixed functional (FORSUS FRD EZ).
4.5
4.5. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 5 Fixed functional (FORSUS FRD) versus fixed functional with mini‐implants (FMI).
4.6
4.6. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 6 Fixed functional (FORSUS FRD) versus fixed functional with mini‐implants (FMI) ‐ patient satisfaction with results.
4.7
4.7. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 7 R‐appliance versus AIBP.
4.8
4.8. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 8 Removable functional appliance versus fixed functional appliance.
4.9
4.9. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 9 FORSUS versus intermaxillary elastics.
4.10
4.10. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 10 FMA stepwise (SWG) versus FMA single step (SSG).
4.11
4.11. Analysis
Comparison 4 Late orthodontic treatment: different types of appliances used for late treatment, Outcome 11 Harvold Activator versus Frankel function regulator.
See this image and copyright information in PMC

Update of

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Alali 2014 {published data only}
    1. Alali OH. A prospective controlled evaluation of Class II division 1 malocclusions treated with fixed lingual mandibular growth modificator. Angle Orthodontist 2014;84(3):527‐33. - PMC - PubMed
Aras 2017a {published data only}
    1. Aras I, Pasaoglu A, Olmez S, Unal I, Aras A. Upper airway changes following single‐step or stepwise advancement using the Functional Mandibular Advancer. Journal of Orofacial Orthopedics 2016;77(6):454‐62. - PubMed
    1. Aras I, Pasaoglu A, Olmez S, Unal I, Tuncer AV, Aras A. Comparison of stepwise vs single‐step advancement with the Functional Mandibular Advancer in Class II division 1 treatment. Angle Orthodontist 2017;87(1):82‐7. - PMC - PubMed
Aras 2017b {published data only}
    1. Aras I, Pasaoglu A. Class II subdivision treatment with the Forsus Fatigue Resistant Device vs intermaxillary elastics. Angle Orthodontist 2017;87:371–6. - PMC - PubMed
Banks 2004 {published data only}
    1. Banks P, Wright J, O'Brien K. Incremental versus maximum bite advancement during twin‐block therapy: a randomized controlled clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics 2004;126(5):583‐8. - PubMed
Baysal 2014 {published data only}
    1. Baysal A, Uysal T. Dentoskeletal effects of Twin Block and Herbst appliances in patients with Class II division 1 mandibular retrognathy. European Journal of Orthodontics 2014;36(2):164‐72. - PubMed
    1. Baysal A, Uysal T. Soft tissue effects of Twin Block and Herbst appliances inpatients with Class II division 1 mandibular retrognathy. European Journal of Orthodontics 2013;35:71‐81. - PubMed
Bilgiç 2011 {published data only}
    1. Bilgiç F, Hamamci O, Başaran G. Comparison of the effects of fixed and removable functional appliances on the skeletal and dentoalveolar structures. Australian Orthodontic Journal 2011;27(2):110‐6. - PubMed
Burhan 2015 {published data only}
    1. Burhan AS, Nawaya FR. Dentoskeletal effects of the Bite‐Jumping Appliance and the Twin‐Block Appliance in the treatment of skeletal Class II malocclusion: a randomized controlled trial. European Journal of Orthodontics 2015;37(3):330‐7. - PubMed
Cevidanes 2003 {published data only}
    1. Cevidanes LH, Franco AA, Scanavini MA, Vigorito JW, Enlow DH, Proffit WR. Clinical outcomes of Frankel appliance therapy assessed with a counterpart analysis. American Journal of Orthodontics and Dentofacial Orthopedics 2003;123(4):379‐87. - PubMed
Cirgić 2016 {published data only}
    1. Čirgić E, Kjellberg H, Hansen K. Discomfort, expectations, and experiences during treatment of large overjet with Andresen Activator or Prefabricated Functional Appliance: a questionnaire survey. Acta Orthopaedica Scandinavica 2017;75(3):166‐72. - PubMed
    1. Čirgić E, Kjellberg H, Hansen K. Treatment of large overjet in Angle Class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances — a multicenter, randomized, controlled trial. European Journal of Orthodontics 2016;38(5):516‐24. - PubMed
Cura 1997 {published data only}
    1. Cura N, Sarac M. The effect of treatment with the Bass appliance on skeletal Class II malocclusions: a cephalometric investigation. European Journal of Orthodontics 1997;19(6):691‐702. - PubMed
Eissa 2017 {published and unpublished data}
    1. Eissa O, El‐Shennawy M, Gaballah S, El‐Meehy G, Bialy T. Treatment outcomes of Class II malocclusion cases treated with miniscrew‐anchored Forsus Fatigue Resistant Device: a randomized controlled trial. Angle Orthodontist 2017;87(6):824‐33. - PMC - PubMed
Elkordy 2016 {published data only}
    1. Elkordy SA, Abouelezz AM, Fayed MMS, Attia KH, Ishaq RAR, Mostafa YA. Three‐dimensional effects of the mini‐implant–anchored Forsus Fatigue Resistant Device: A randomized controlled trial. Angle Orthodontist 2016;86(2):292‐305. - PMC - PubMed
    1. Elkordy SA, Fayed MMS, Abouelezz AM, Attia KH. Comparison of patient acceptance of the Forsus Fatigue Resistant Device with and without mini‐implant anchorage: A randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2015;148(5):755‐64. - PubMed
Florida 1998 {published and unpublished data}
    1. Chen DR, McGorray SP, Dolce C, Wheeler TT. Effect of early Class II treatment on the incidence of incisor trauma. American Journal of Orthodontics and Dentofacial Orthopedics 2011;140(4):e155‐60. - PubMed
    1. Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. Timing of Class II treatment: skeletal changes comparing 1‐phase and 2‐phase treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2007; Vol. 132, issue 4:481‐9. - PubMed
    1. Johnson PD, Cohen DA, Aiosa L, McGorray S, Wheeler T. Attitudes and compliance of pre‐adolescent children during early treatment of Class II malocclusion. Clinical Orthodontics and Research 1998;1(1):20‐8. - PubMed
    1. Keeling SD, Garvan CW, King GJ, Wheeler TT, McGorray S. Temporomandibular disorders after early Class II treatment with bionators and headgears: results from a randomized controlled trial. Seminars in Orthodontics 1995;1(3):149‐64. - PubMed
    1. Keeling SD, Wheeler TT, King GJ, Garvan CW, Cohen DA, Cabassa S, et al. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):40‐50. - PubMed
Ghafari 1998 {published data only}
    1. Ghafari J. Class II malocclusion: Comparison of alternative treatments and time of treatment. European Journal of Orthodontics 1999;21(4):439‐40.
    1. Ghafari J, Efstratiadis S, Shofer FS, Markowitz D, Jacobsson‐Hunt U, Baumrind S, et al. Relation between occlusal and cephalometric changes in the treatment of distocclusion. Journal of Dental Research 1999;78(March Spec Issue):443 (Abs No 2699).
    1. Ghafari J, Jacobsson‐Hunt U, Markowitz DL, Shofer FS, Laster LL. Changes of arch width in the early treatment of Class II, division 1 malocclusions. American Journal of Orthodontics and Dentofacial Orthopedics 1994;106(5):496‐502. - PubMed
    1. Ghafari J, King GJ, Tulloch JF. Early treatment of Class II, division 1 malocclusion‐‐comparison of alternative treatment modalities. Clinical Orthodontics and Research 1998;1(2):107‐17. - PubMed
    1. Ghafari J, Shofer FS, Jacobsson‐Hunt U, Markowitz DL, Laster LL. Headgear versus function regulator in the early treatment of Class II, division 1 malocclusion: a randomized clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):51‐61. - PubMed
Jamilian 2011 {published and unpublished data}
    1. Jamilian A, Showkatbakhsh R, Amiri SS. Treatment effects of the R‐appliance and twin block in Class II division 1 malocclusion. European Journal of Orthodontics 2011;33(4):354‐8. - PubMed
Jin 2015 {published data only}
    1. Jin Z, Liu W. Biomechanical difference between Twin‐Block appliance and straight wire appliance in the early treatment of Class II division 1 malocclusion. Chinese Journal of Tissue Engineering Research 2015;19(12):1842‐5.
Lee 2007 {published data only}
    1. Lee RT, Kyi CS, Mack GJ. A controlled clinical trial of the effects of the Twin Block and Dynamax appliances on the hard and soft tissues. European Journal of Orthodontics 2007;29(3):272‐82. - PubMed
London 1998 {published data only}
    1. Illing HM, Morris DO, Lee RT. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I‐‐The hard tissues. European Journal of Orthodontics 1998;20(5):501‐16. - PubMed
    1. McDonagh S, Moss JP, Goodwin P, Lee RT. A prospective optical surface scanning and cephalometric assessment of the effect of functional appliances on the soft tissues. European Journal of Orthodontics 2001;23(2):115‐26. - PubMed
    1. Morris DO, Illing HM, Lee RT. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part II‐‐The soft tissues. European Journal of Orthodontics 1998;20(6):663‐84. - PubMed
Mao 1997 {published data only}
    1. Mao J, Zhao H. The correction of Class II, division 1 malocclusion with bionator headgear combination appliance. Journal of Tongji Medical University 1997;17(4):254‐6. - PubMed
Martina 2013 {published data only}
    1. Martina R, Cioffi I, Galeotti A, Tagliaferri R, Cimino R, Michelotti A, et al. Efficacy of the Sander bite‐jumping appliance in growing patients with mandibular retrusion: a randomized controlled trial. Orthodontics & Craniofacial Research 2013;16(2):116‐26. - PubMed
New Zealand 2000 {published data only}
    1. Courtney M, Harkness M, Herbison P. Maxillary and cranial base changes during treatment with functional appliances. American Journal of Orthodontics and Dentofacial Orthopedics 1996;109(6):616‐24. - PubMed
    1. Nelson C, Harkness M, Herbison P. Mandibular changes during functional appliance treatment. American Journal of Orthodontics and Dentofacial Orthopedics 1993;104(2):153‐61. - PubMed
    1. O'Neill K, Harkness M, Knight R. Ratings of profile attractiveness after functional appliance treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2000;118(4):371‐6. - PubMed
    1. Webster T, Harkness M, Herbison P. Associations between changes in selected facial dimensions and the outcome of orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics 1996;110(1):46‐53. - PubMed
    1. Wijayaratne D, Harkness M, Herbison P. Functional appliance treatment assessed using the PAR index. Australian Orthodontic Journal 2000;16(3):118‐26. - PubMed
North Carolina 2004 {published data only}
    1. Almeida MA, Phillips C, Kula K, Tulloch C. Stability of the palatal rugae as landmarks for analysis of dental casts. Angle Orthodontist 1995;65(1):43‐8. - PubMed
    1. Brin I, Tulloch JF, Koroluk L, Philips C. External apical root resorption in Class II malocclusion: a retrospective review of 1‐ versus 2‐phase treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124(2):151‐6. - PubMed
    1. Dann C 4th, Phillips C, Broder HL, Tulloch JF. Self‐concept, Class II malocclusion, and early treatment. Angle Orthodontist 1995;65(6):411‐6. - PubMed
    1. Ehmer U, Tulloch CJ, Proffit WR, Phillips C. An international comparison of early treatment of angle Class‐II/1 cases. Skeletal effects of the first phase of a prospective clinical trial. Journal of Orofacial Orthopedics 1999;60(6):392‐408. - PubMed
    1. Koroluk LD, Tulloch JF, Phillips C. Incisor trauma and early treatment for Class II Division 1 malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics 2003;123(2):117‐26. - PubMed
Showkatbakhsh 2011 {published and unpublished data}
    1. Showkatbakhsh R, Meybodi SE, Jamilian A, Meybodi SA, Meybodi EM. Treatment effects of R‐appliance and anterior inclined bite plate in class II, division I malocclusion. Journal of Applied Oral Science : Revista FOB 2011;19(6):634‐8. - PMC - PubMed
Thiruvenkatachari 2010 {published data only}
    1. Thiruvenkatachari B, Sandler J, Murray A, Walsh T, O'Brien K. Comparison of Twin‐block and Dynamax appliances for the treatment of Class II malocclusion in adolescents: a randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2010;138(2):144.e1‐9; discussion 144‐5. - PubMed
UK (11‐14) 2003 {published and unpublished data}
    1. O'Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, et al. Effectiveness of treatment for Class II malocclusion with the Herbst or twin‐block appliances: a randomized, controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124(2):128‐37. - PubMed
UK (Mixed) 2009 {published and unpublished data}
    1. O'Brien K, Wright J, Conboy F, Appelbe P, Davies L, Connolly I, et al. Early treatment for Class II Division 1 malocclusion with the Twin‐block appliance: a multi‐center, randomized, controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics 2009;135(5):573‐9. - PubMed
    1. O'Brien K, Wright J, Conboy F, Chadwick S, Connolly I, Cook P, et al. Effectiveness of early orthodontic treatment with the Twin‐block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124(5):488‐94. - PubMed
    1. O'Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, et al. Effectiveness of early orthodontic treatment with the Twin‐block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124(3):234‐43. - PubMed
Yaqoob 2012 {published data only}
    1. Yaqoob O, Dibiase AT, Cobourne MT. Use of the Clark twin block with and without a labial bow in the correction of class II division 1 malocclusion: a randomized clinical trial. Journal of Orthodontics 2010;37(4):310.
    1. Yaqoob O, Dibiase AT, Fleming PS, Cobourne MT. Use of the Clark Twin Block functional appliance with and without an upper labial bow: a randomized controlled trial. Angle Orthodontist 2012;82(2):363‐9. - PMC - PubMed

References to studies excluded from this review

Aknin 2000 {published data only}
    1. Aknin JJ, Morra L. Comparative study of mandibular growth and rotation in two sample groups treated according to the "Distal Active Concept" or the Edgewise technique. Orthodontie Francaise 2000;71(4):343‐61. - PubMed
Aksakalli 2016 {published data only}
    1. Aksakalli S, Calik B, Kara B, Ezirganli S. Accelerated tooth movement with piezocision and its periodontal transversal effects in patients with Class II malocclusion. Angle Orthodontist 2016;86:59–65. - PMC - PubMed
Al‐Sibaie 2014 {published data only}
    1. Al‐Sibaie S, Hajeer MY. Assessment of changes following en‐masse retraction with mini‐implants anchorage compared to two‐step retraction with conventional anchorage in patients with class II division 1 malocclusion: a randomized controlled trial. European Journal of Orthodontics 2014;36(3):275‐83. - PubMed
Antonarakis 2015 {published data only}
    1. Antonarakis GS, Kiliaridis S. Predictive value of masseter muscle thickness and bite force on Class II functional appliance treatment: a prospective controlled study. European Journal of Orthodontics 2015;37(6):570‐7. - PubMed
Antunes 2013 {published data only}
    1. Antunes CF, Bigliazzi R, Bertoz FA, Ortolani CL, Franchi L, Faltin K. Morphometric analysis of treatment effects of the Balters bionator in growing Class II patients. Angle Orthodontist 2013;83(3):455‐9. - PMC - PubMed
Ashmore 2002 {published data only}
    1. Ashmore JL, Kurland BF, King GJ, Wheeler TT, Ghafari J, Ramsay DS. A 3‐dimensional analysis of molar movement during headgear treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(1):18‐30. - PubMed
Aslan 2014 {published data only}
    1. Aslan BI, Kucukkaraca E, Turkoz C, Dincer M. Treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage. Angle Orthodontist 2014;84(1):76‐87. - PMC - PubMed
Baccetti 2009 {published data only}
    1. Baccetti T, Franchi L, Kim LH. Effect of timing on the outcomes of 1‐phase nonextraction therapy of Class II malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics 2009;136(4):501‐9. - PubMed
Bailleau 2012 {published data only}
    1. Bailleau A, Aknin JJ, Gebeile‐Chauty S. One phase or two‐phase orthodontic treatment: comparisons [Traitements orthodontiques en une ou deux phases : comparaisons]. Orthodontie Francaise 2012;83(4):289‐96. - PubMed
Bishara 1995 {published data only}
    1. Bishara SE, Cummins DM, Jakobsen JR, Zaher AR. Dentofacial and soft tissue changes in Class II, division 1 cases treated with and without extractions. American Journal of Orthodontics and Dentofacial Orthopedics 1995;107(1):28‐37. - PubMed
Booij 2013 {published data only}
    1. Booij J W, Goeke J, Bronkhorst E M, Katsaros C, Ruf S. Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison. Journal of Orofacial Orthopedics 2013;74(1):52‐63. - PubMed
Bremen 2015 {published data only}
    1. Bremen J, Ludwig B, Ruf S. Anchorage loss due to Herbst mechanics‐preventable through miniscrews?. European Journal of Orthodontics 2015;37(5):462‐6. - PubMed
Burhan 2013 {published data only}
    1. Burhan A S. Combined treatment with headgear and the Frog appliance for maxillary molar distalization: a randomized controlled trial. Korean Journal of Orthodontics 2013;43(2):101‐9. - PMC - PubMed
Chavan 2014 {published data only}
    1. Chavan SJ, Bhad WA, Doshi UH. Comparison of temporomandibular joint changes in Twin Block and Bionator appliance therapy: a magnetic resonance imaging study. Progress in Orthodontics 2014;15:57. - PMC - PubMed
Chen 2013 {published data only}
    1. Chen XH, Hua YM, Xie XQ, Yu XJ, Wang J, Liu LM. Clinical study of extraction treatment of Class II division I malocclusion with Empower self‐ligating brackets. Shanghai Kou Qiang Yi Xue 2013;22(3):316‐21. - PubMed
Chen 2015 {published data only}
    1. Chen H, Yagi K, Almeida FR, Pliska BT, Lowe AA. A pilot study on the dentoalveolar and skeletal effects of two functional appliances in Class II, Division 1 growing children. International Journal of Orthodontics (Milwaukee, Wis.) 2015;26(2):15‐20. - PubMed
Chintakanon 2000 {published data only}
    1. Chintakanon K, Sampson W, Wilkinson T, Townsend G. A prospective study of Twin‐block appliance therapy assessed by magnetic resonance imaging. American Journal of Orthodontics and Dentofacial Orthopedics 2000;118(5):494‐504. - PubMed
Chiqueto 2013 {published data only}
    1. Chiqueto K, Henriques JF, Barros SE, Janson G. Angle Class II correction with MARA appliance. Dental Press Journal of Orthodontics 2013;18(1):35‐44. - PubMed
Collett 2000 {published data only}
    1. Collett AR. Current concepts on functional appliances and mandibular growth stimulation. Australian Dental Journal 2000;45(3):173‐8. - PubMed
Cura 1996 {published data only}
    1. Cura N, Sarac M, Ozturk Y, Surmeli N. Orthodontic and orthopedic effects of Activator, Activator‐HG combination, and Bass appliances: a comparative study. American Journal of Orthodontics and Dentofacial Orthopedics 1996;110(1):36‐45. - PubMed
Dahan 1989 {published data only}
    1. Dahan J, Serhal JB, Englebert A. Cephalometric changes in Class II, Division 1 cases after orthopedic treatment with the bioactivator. American Journal of Orthodontics and Dentofacial Orthopedics 1989;95(2):127‐37. - PubMed
Davoody 2011 {published data only}
    1. Davoody AR, Upadhyay M, Uribe F, Nanda R. Anchorage control comparison between differential moments and mini‐screws. Proceedings of the 89th General Session of the International Association for Dental Research. IADR, 2011.
De Almeida 2002 {published data only}
    1. Almeida MR, Henriques JF, Ursi W. Comparative study of the Frankel (FR‐2) and bionator appliances in the treatment of Class II malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(5):458‐66. - PubMed
DeVincenzo 1989 {published data only}
    1. DeVincenzo JP, Winn MW. Orthopedic and orthodontic effects resulting from the use of a functional appliance with different amounts of protrusive activation. American Journal of Orthodontics and Dentofacial Orthopedics 1989;96(3):181‐90. - PubMed
dos Santos‐Pinto 2013 {published data only}
    1. dos Santos‐Pinto PR, Martins L P, dos Santos‐Pinto A, Gandini Junior LG, Raveli D B, dos Santos‐Pinto CC. Mandibular growth and dentoalveolar development in the treatment of class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation. Dental Press Journal of Orthodontics 2013;18(4):43‐52. - PubMed
Du 2002 {published data only}
    1. Du X, Hagg U, Rabie AB. Effects of headgear Herbst and mandibular step‐by‐step advancement versus conventional Herbst appliance and maximal jumping of the mandible. European Journal of Orthodontics 2002;24(2):167‐74. - PubMed
El‐Dawlatly 2014 {published data only}
    1. El‐Dawlatly MM, Abou‐El‐Ezz AM, El‐Sharaby FA, Mostafa YA. Zygomatic mini‐implant for Class II correction in growing patients. Journal of Orofacial Orthopedics 2014;75(3):213‐25. - PubMed
Erbas 2014 {published data only}
    1. Erbas B, Kocadereli I. Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography. Angle Orthodontist 2014;84(4):693‐700. - PMC - PubMed
Erverdi 1995 {published data only}
    1. Erverdi N, Ozkan G. A cephalometric investigation of the effects of the Elastic Bite‐block in the treatment of Class II division 1 malocclusions. European Journal of Orthodontics 1995;17(5):375‐84. - PubMed
Falck 1989 {published data only}
    1. Falck F, Frankel R. Clinical relevance of step‐by‐step mandibular advancement in the treatment of mandibular retrusion using the Frankel appliance. American Journal of Orthodontics and Dentofacial Orthopedics 1989;96(4):333‐41. - PubMed
Fang 2006 {published data only}
    1. Fang G, Xu JY, Luo Y. Use of PAR index to evaluate the treatment outcome for Class II division 1 malocclusion with different tooth extraction patterns. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2006;15(1):31‐3. - PubMed
Fernandes 2010 {published data only}
    1. Fernandes ÁF, Brunharo I H, Quintão CC, Costa MG, Oliveira‐Costa M R. Effectiveness of twin blocks and extraoral maxillary splint (Thurow) appliances for the correction of Class II relationships. World Journal of Orthodontics 2010;11(3):230‐5. - PubMed
Firouz 1992 {published data only}
    1. Firouz M, Zernik J, Nanda R. Dental and orthopedic effects of high‐pull headgear in treatment of Class II, division 1 malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics 1992;102(3):197‐205. - PubMed
Franchi 2013 {published data only}
    1. Franchi L, Pavoni C, Faltin K, McNamara JA, Cozza P. Long‐term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion. Angle Orthodontist 2013;83(2):334‐40. - PMC - PubMed
Franco 2002 {published data only}
    1. Franco AA, Yamashita HK, Lederman HM, Cevidanes LH, Proffit WR, Vigorito JW. Frankel appliance therapy and the temporomandibular disc: a prospective magnetic resonance imaging study. American Journal of Orthodontics and Dentofacial Orthopedics 2002;121(5):447‐57. - PubMed
Freeman 2009 {published data only}
    1. Freeman DC, McNamara JA Jr, Baccetti T, Franchi L, Frankel C. Long‐term treatment effects of the FR‐2 appliance of Frankel. American Journal of Orthodontics and Dentofacial Orthopedics 2009;135(5):570.e1‐6; discussion 570‐1. - PubMed
Ghafari 2012 {published data only}
    1. Ghafari JG, Efstratiadis S, Kassab A, Saadeh ME. Dominance of specific facial components in predicting Class II outcome. Proceedings of the General Session of the International Association of Dental Research. IADR, 2012.
Ghiglione 2000 {published data only}
    1. Ghiglione V, Maspero C, Garagiola U. Skeletal Class II therapy ‐ Effects of Bionator and Teuscher appliances. European Journal of Orthodontics 2000;22(4):445.
Gianelly 1983 {published data only}
    1. Gianelly AA, Brosnan P, Martignoni M, Bernstein L. Mandibular growth, condyle position and Frankel appliance therapy. Angle Orthodontist 1983;53(2):131‐42. - PubMed
Gong 2014 {published data only}
    1. Gong Y, Yu Q, Li PL, Wang HH, Wei B, Shen G. Efficacy evaluation of fixed Twin‐block appliance and tooth extraction in skeletal Class II malocclusion. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2014;23(5):597‐600. - PubMed
Gong 2015 {published data only}
    1. Gong Y, Li PL, Wang HH, Yu Q, Wei B, Shen G. Soft tissue linear evaluation of fixed Twin‐block appliance treatment and tooth extraction in skeletal Class II malocclusion. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2015;24(2):232‐5. - PubMed
Guner 2003 {published data only}
    1. Guner DD, Ozturk Y, Sayman HB. Evaluation of the effects of functional orthopaedic treatment on temporomandibular joints with single‐photon emission computerized tomography. European Journal of Orthodontics 2003;25(1):9‐12. - PubMed
Hagg 2002 {published data only}
    1. Hagg U, Tse EL, Rabie AB, Robinson W. A comparison of splinted and banded Herbst appliances: treatment changes and complications. Australian Orthodontic Journal 2002;18(2):76‐81. - PubMed
Haj‐Younis 2016 {published data only}
    1. Haj‐Younis S, Khattab TZ, Hajeer MY, Farah H. A comparison between two lingual orthodontic brackets in terms of speech performance and patients’ acceptance in correcting Class II, Division 1 malocclusion: a randomized controlled trial. Dental Press Journal of Orthodontics 2016;21(4):80‐8. - PMC - PubMed
Harvold 1971 {published data only}
    1. Harvold EP, Vargervik K. Morphogenetic response to activator treatment. American Journal of Orthodontics 1971;60(5):478‐90. - PubMed
Hemmatpour 2017 {published data only}
    1. Hemmatpour S, Mokhtar A, Rakhshan V. Effects of Sabbagh Universal Spring 2 fixed functional appliance on class II/1 patients at their postpubertal‐peak growth period compared with the extraction method : a randomized clinical trial. Journal of Orofacial Orthopedics 2017;1:41‐51. - PubMed
Hiyama 2002 {published data only}
    1. Hiyama S, Kuribayashi G, Ono T, Ishiwata Y, Kuroda T. Nocturnal masseter and suprahyoid muscle activity induced by wearing a bionator. Angle Orthodontist 2002;72(1):48‐54. - PubMed
Ingervall 1991 {published data only}
    1. Ingervall B, Thuer U. Temporal muscle activity during the first year of Class II, division 1 malocclusion treatment with an activator. American Journal of Orthodontics and Dentofacial Orthopedics 1991;99(4):361‐8. - PubMed
Iscan 1997 {published data only}
    1. Iscan HN, Sarisoy L. Comparison of the effects of passive posterior bite‐blocks with different construction bites on the craniofacial and dentoalveolar structures. American Journal of Orthodontics and Dentofacial Orthopedics 1997;112(2):171‐8. - PubMed
Janson 2003 {published data only}
    1. Janson GR, Toruno JL, Martins DR, Henriques JF, Freitas MR. Class II treatment effects of the Frankel appliance. European Journal of Orthodontics 2003;25(3):301‐9. - PubMed
Jarrell 2001 {published data only}
    1. Jarrell KT, Hudson JM, Killiany DM. Activator‐headgear combination appliance treatment of Class II, division I malocclusion. Journal of Dental Research 2001;80 Special Issue:180 (Abs No 1156).
Jena 2013 {published data only}
    1. Jena AK, Singh SP, Utreja AK. Effectiveness of twin‐block and Mandibular Protraction Appliance‐IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible. Angle Orthodontist 2013;83(4):728‐34. - PMC - PubMed
Johansson 2012 {published data only}
    1. Johansson K, Lundström F. Orthodontic treatment efficiency with self‐ligating and conventional edgewise twin brackets: a prospective randomized clinical trial. Angle Orthodontist 2012;82(5):929‐34. - PMC - PubMed
Kalra 1989 {published data only}
    1. Kalra V, Burstone CJ, Nanda R. Effects of a fixed magnetic appliance on the dentofacial complex. American Journal of Orthodontics and Dentofacial Orthopedics: 1989;95(6):467‐78. - PubMed
Kaya 2013 {published data only}
    1. Kaya B, Sar C, Arman‐Özçirpici A, Polat‐Özsoy O. Palatal implant versus zygoma plate anchorage for distalization of maxillary posterior teeth. European Journal of Orthodontics 2013;35(4):507‐14. - PubMed
Keski‐Nisula 2003 {published data only}
    1. Keski‐Nisula K, Lehto R, Lusa V, Keski‐Nisula L, Varrela J. Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2003;124(6):631‐8. - PubMed
Kumar 1996 {published data only}
    1. Kumar S, Sidhu SS, Kharbanda OP. A cephalometric evaluation of the dental and facial‐skeletal effects using the Bionator with stepwise protrusive activations. Journal of Clinical Pediatric Dentistry 1996;20(2):101‐8. - PubMed
Landazuri 2013 {published data only}
    1. Landazuri DR, Raveli DB, dos Santos‐Pinto A, Dib LP, Maia S. Changes on facial profile in the mixed dentition, from natural growth and induced by Balters' bionator appliance. Dental Press Journal of Orthodontics 2013;18(2):108‐15. - PubMed
Lange 1995 {published data only}
    1. Lange DW, Kalra V, Broadbent BH Jr, Powers M, Nelson S. Changes in soft tissue profile following treatment with the bionator. Angle Orthodontist 1995;65(6):423‐30. - PubMed
Lee 2013 {published data only}
    1. Lee J, Miyazawa K, Tabuchi M, Kawaguchi M, Shibata M, Goto S. Midpalatal miniscrews and high‐pull headgear for anteroposterior and vertical anchorage control: cephalometric comparisons of treatment changes. American Journal of Orthodontics and Dentofacial Orthopedics 2013;144(2):238‐50. - PubMed
Li 2010a {published data only}
    1. Li LG, Zuo YP, Yuan D H. Hard and soft tissue changes following the treatment of Class II division 1 malocclusion using twin‐block appliance. Hua Xi Kou Qiang Yi Xue za Zhi [West China Journal of Stomatology] 2010;28(6):637‐40. - PubMed
Li 2010b {published data only}
    1. Li LG, Zuo YP, Yuan DH. Soft tissue changes following the treatment of Class II division 1 malocclusion using Headgear‐activator appliance. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2010;19(6):582‐5. - PubMed
Lima 2013 {published data only}
    1. Lima K J, Henriques J F, Janson G, Pereira S C, Neves L S, Cançado R H. Dentoskeletal changes induced by the Jasper jumper and the activator‐headgear combination appliances followed by fixed orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics 2013;143(5):684‐94. - PubMed
Lombardo 2013 {published data only}
    1. Lombardo L, Bragazzi R, Perissinotto C, Mirabella D, Siciliani G. Cone‐beam computed tomography evaluation of periodontal and bone support loss in extraction cases. Progress in Orthodontics 2013;14:29. - PMC - PubMed
Lund 1998 {published data only}
    1. Lund DI, Sandler PJ. The effects of Twin Blocks: a prospective controlled study. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(1):104‐10. - PubMed
Mai 2014 {published data only}
    1. Mai L, Yao Y, Zhang S, Wang D, Zhang Z. Comparison of temporomandibular joint changes in adolescent Class II division 1 malocclusion patients with mandibular retrusion treated with Twin‐Block and Class II elastics. Zhonghua Kou Qiang Yi Xue Za Zhi [Chinese Journal of Stomatology] 2014;49(7):394‐8. - PubMed
Malmgren 1987 {published data only}
    1. Malmgren O, Omblus J, Hagg U, Pancherz H. Treatment with an orthopedic appliance system in relation to treatment intensity and growth periods. A study of initial effects. American Journal of Orthodontics and Dentofacial Orthopedics 1987;91(2):143‐51. - PubMed
Malta 2010 {published data only}
    1. Malta LA, Baccetti T, Franchi L, Faltin K Jr, McNamara JA Jr. Long‐term dentoskeletal effects and facial profile changes induced by bionator therapy. Angle Orthodontist 2010;80(1):10‐7. - PMC - PubMed
Mariani 2014 {published data only}
    1. Mariani L, Maino G, Caprioglio A. Skeletal versus conventional intraoral anchorage for the treatment of class II malocclusion: dentoalveolar and skeletal effects. Progress in Orthodontics 2014;15:43. - PMC - PubMed
Meral 2004 {published data only}
    1. Meral O, Iscan HN, Okay C, Gursoy Y. Effects of bilateral upper first premolar extraction on the mandible. European Journal of Orthodontics 2004;26(2):223‐31. - PubMed
Miles 2016 {published data only}
    1. Miles, P, E. Fisher. Assessment of the changes in arch perimeter and irregularity in the mandibular arch during initial alignment with the AcceleDent Aura appliance vs no appliance in adolescents: a single‐blind randomized clinical trial. American journal of orthodontics and dentofacial orthopedics 2016;150:928‐936. - PubMed
Muniandy 2000 {published data only}
    1. Muniandy SD, Battagel JM, Moss JP. A prospective study of the twin block and silensor appliances. European Journal of Orthodontics 2000;22(5):604.
Nelson 2000 {published data only}
    1. Nelson B, Hansen K, Hagg U. Class II correction in patients treated with class II elastics and with fixed functional appliances: a comparative study. American Journal of Orthodontics and Dentofacial Orthopedics 2000;118(2):142‐9. - PubMed
Neves 2014 {published data only}
    1. Neves LS, Janson G, Cançado RH, Lima KJ, Fernandes TM, Henriques JF. Treatment effects of the Jasper Jumper and the Bionator associated with fixed appliances. Progress in Orthodontics 2014;15:54. - PMC - PubMed
Op Heij 1989 {published and unpublished data}
    1. Op Heij DG, Callaert H, Opdebeeck HM. The effect of the amount of protrusion built into the bionator on condylar growth and displacement: a clinical study. American Journal of Orthodontics and Dentofacial Orthopedics 1989;95(5):401‐9. - PubMed
Ozturk 1994 {published data only}
    1. Ozturk Y, Tankuter N. Class II: a comparison of activator and activator headgear combination appliances. European Journal of Orthodontics 1994;16(2):149‐57. - PubMed
Pangrazio 1999 {published data only}
    1. Pangrazio‐Kulbersh V, Kaczynski R, Shunock M. Early treatment outcome assessed by the Peer Assessment Rating index. American Journal of Orthodontics and Dentofacial Orthopedics 1999;115(5):544‐50. - PubMed
Pangrazio 2003 {published data only}
    1. Pangrazio‐Kulbersh V, Berger JL, Chermak DS, Kaczynski R, Simon ES, Haerian A. Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics 2003;123(3):286‐95. - PubMed
Parkin 2001 {published data only}
    1. Parkin NA, McKeown HF, Sandler PJ. Comparison of 2 modifications of the twin‐block appliance in matched Class II samples. American Journal of Orthodontics and Dentofacial Orthopedics 2001;119(6):572‐7. - PubMed
Patel 2013 {published data only}
    1. Patel MP, Henriques JF, Almeida RR, Pinzan A, Janson G, Freitas MR. Comparative cephalometric study of Class II malocclusion treatment with Pendulum and Jones jig appliances followed by fixed corrective orthodontics. Dental Press Journal of Orthodontics 2013;18(6):58‐64. - PubMed
Phan 2006 {published data only}
    1. Phan KL, Bendeus M, Hagg U, Hansen K, Rabie AB. Comparison of the headgear activator and Herbst appliance‐‐effects and post‐treatment changes. European Journal of Orthodontics 2006;28(6):594‐604. - PubMed
Phelan 2012 {published data only}
    1. Phelan A, Tarraf N E, Taylor P, Hönscheid R, Drescher D, Baccetti T, et al. Skeletal and dental outcomes of a new magnetic functional appliance, the Sydney Magnoglide, in Class II correction. American Journal of Orthodontics and Dentofacial Orthopedics 2012;141(6):759‐72. - PubMed
Pirttiniemi 2005 {published data only}
    1. Mantysaari R, Kantomaa T, Pirttiniemi P, Pykalainen A. The effects of early headgear treatment on dental arches and craniofacial morphology: a report of a 2 year randomized study. European Journal of Orthodontics 2004;26(1):59‐64. - PubMed
    1. Pirttiniemi P, Kantomaa T, Mantysaari R, Pykalainen A. The effects of early headgear treatment on dental arches and craniofacial morphology: an 8 year report of a randomized study. European Journal of Orthodontics 2005;27(5):429‐36. - PubMed
Reukers 1998 {published data only}
    1. Reukers EA, Sanderink GC, Kuijpers‐Jagtman AM, van't Hof MA. Radiographic evaluation of apical root resorption with 2 different types of edgewise appliances. Results of a randomized clinical trial. Journal of Orofacial Orthopedics 1998;59(2):100‐9. - PubMed
Saikoski 2014 {published data only}
    1. Saikoski L Z, Cançado R H, Valarelli F P, Freitas K M. Dentoskeletal effects of Class II malocclusion treatment with the Twin Block appliance in a Brazilian sample: a prospective study. Dental Press Journal of Orthodontics 2014;19(1):36‐45. - PMC - PubMed
Sari 2003 {published data only}
    1. Sari Z, Goyenc Y, Doruk C, Usumez S. Comparative evaluation of a new removable Jasper Jumper functional appliance vs an activator‐headgear combination. Angle Orthodontist 2003;73(3):286‐93. - PubMed
Schaefer 2004 {published data only}
    1. Schaefer AT, McNamara JA Jr, Franchi L, Baccetti T. A cephalometric comparison of treatment with the Twin‐block and stainless steel crown Herbst appliances followed by fixed appliance therapy. American Journal of Orthodontics and Dentofacial Orthopedics 2004;126(1):7‐15. - PubMed
Shannon 2004 {published data only}
    1. Shannon KR, Nanda RS. Changes in the curve of Spee with treatment and at 2 years posttreatment. American Journal of Orthodontics and Dentofacial Orthopedics 2004;125(5):589‐96. - PubMed
Showkatbakhsh 2013 {published data only}
    1. Showkatbakhsh R, Castaldo M I, Jamilian A, Padricelli G, Fahimi Hanzayi M, Cappabianca S, et al. Treatment effects of R‐appliance and Fränkel‐2 in Class II division 1 malocclusions. European Journal of Paediatric Dentistry 2013;14(1):17‐22. - PubMed
Siara‐Olds 2010 {published data only}
    1. Siara‐Olds NJ, Pangrazio‐Kulbersh V, Berger J, Bayirli B. Long‐term dentoskeletal changes with the Bionator, Herbst, Twin Block, and MARA functional appliances. Angle Orthodontist 2010;80(1):18‐29. - PMC - PubMed
Siqueira 2007 {published data only}
    1. Siqueira DF, Almeira RR, Janson G, Brandao AG, Coelho Filho CM. Dentoskeletal and soft‐tissue changes with cervical headgear and mandibular protraction appliance therapy in the treatment of Class II malocclusions. American Journal of Orthodontics and Dentofacial Orthopedics 2007;131(4):447.e21‐30. - PubMed
Song 2008 {published data only}
    1. Song Y, Yu YL, Shen H, Zhang J. Comparative study of the clinical effects of three different functional appliances on the treatment of skeletal class II malocclusion. Hua Xi Kou Qiang Yi Xue za Zhi [West China Journal of Stomatology] 2008;26(4):406‐8. - PubMed
Taner 2003 {published data only}
    1. Taner TU, Yukay F, Pehlivanoglu M, Cakirer B. A comparative analysis of maxillary tooth movement produced by cervical headgear and pend‐x appliance. Angle Orthodontist 2003;73(6):686‐91. - PubMed
Thuer 1989 {published data only}
    1. Thuer U, Ingervall B, Burgin W. Does the mandible alter its functional position during activator treatment?. American Journal of Orthodontics and Dentofacial Orthopedics 1989;96(6):477‐84. - PubMed
Tumer 1999 {published data only}
    1. Tumer N, Gultan AS. Comparison of the effects of monoblock and twin‐block appliances on the skeletal and dentoalveolar structures. American Journal of Orthodontics and Dentofacial Orthopedics 1999;116(4):460‐8. - PubMed
Turkkahraman 2016 {published data only}
    1. Turkkahraman H, Eliacik SK, Findik Y. Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion. Angle Orthodontist 2016;86:1026–32. - PMC - PubMed
Ucem 1998 {published data only}
    1. Ucem TT, Yuksel S. Effects of different vectors of forces applied by combined headgear. American Journal of Orthodontics and Dentofacial Orthopedics 1998;113(3):316‐23. - PubMed
Ucuncu 2001 {published and unpublished data}
    1. Ucuncu N, Turk T, Carels C. Comparison of modified Teuscher and van Beek functional appliance therapies in high‐angle cases. Journal of Orofacial Orthopedics 2001;62(3):224‐37. - PubMed
Uzuner 2014 {published data only}
    1. Uzuner DF, Darendeliler N, Yucel E. Combined fixed‐functional treatment of skeletal class II malocclusions with the EVAA appliance: a preliminary study. Journal of Orofacial Orthopedics 2014;75(4):275‐86. - PubMed
Wey 2007 {published data only}
    1. Wey MC, Bendeus M, Peng L, Hagg U, Rabie AB, Robinson W. Stepwise advancement versus maximum jumping with headgear activator. European Journal of Orthodontics 2007;29(3):283‐93. - PubMed
Wieslander 1984 {published data only}
    1. Wieslander L. Intensive treatment of severe Class II malocclusions with a headgear‐Herbst appliance in the early mixed dentition. American Journal of Orthodontics 1984;86(1):1‐13. - PubMed
Witt 1999 {published data only}
    1. Witt E, Watted N. Effectiveness of intra‐ and extraoral aids to the bionator. A controlled study within the scope of the "Wuerzburg concept". Journal of Orofacial Orthopedics 1999;60(4):269‐78. - PubMed
Yang 2006 {published data only}
    1. Yang TT, Mi YJ. [Assessment of upper jaw extraction versus upper and lower jaw extraction treatment for class II division 1 malocclusion using peer assessment rating index]. Hua Xi Kou Qiang Yi Xue za Zhi [West China Journal of Stomatology] 2006;24(3):231‐3, 239. - PubMed
You 2006 {published data only}
    1. You Q L, Cai Z. A study of highpull extraoral traction on the treatment of growing patients with skeletal Class II malocclusion. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2006;15(4):375‐7. - PubMed

Additional references

Antonarakis 2007
    1. Antonarakis GS, Kiliaridis S. Short‐term anteroposterior treatment effects of functional appliances and extraoral traction on class II malocclusion. A meta‐analysis. Angle Orthodontist 2007;77(5):907‐14. - PubMed
Barnett 2008
    1. Barnett GA, Higgins DW, Major PW, Flores‐Mir C. Immediate skeletal and dentoalveolar effects of the crown‐ or banded type Herbst appliance on Class II division 1 malocclusion. Angle Orthodontist 2008;78(2):361‐9. - PubMed
Cozza 2006
    1. Cozza P, Baccetti T, Franchi L, Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics 2006;129(5):599.e1‐12; discussion e1‐6. - PubMed
Ehsani 2015
    1. Ehsani S, Nebbe B, Normando D, Lagravere MO, Flores‐Mir C. Short‐term treatment effects produced by the Twin‐block appliance: a systematic review and meta‐analysis. European Journal of Orthodontics 2015;37(2):170‐6. - PubMed
El‐Mangoury 1990
    1. El‐Mangoury NH, Mostafa YA. Epidemiologic panorama of dental occlusion. Angle Orthodontist 1990;60(3):207‐14. - PubMed
Flores‐Mir 2007
    1. Flores‐Mir C, Ayeh A, Goswani A, Charkhandeh S. Skeletal and dental changes in Class II division 1 malocclusions treated with splint‐type Herbst appliances. A systematic review. The Angle Orthodontist 2007;77(2):376‐81. - PubMed
Frujeri 2014
    1. Frujeri MdeLV, Frujeri JAJ, Bezerra ACB, Cortes MIde SG, Costa Jr ED. Socio‐economic indicators and predisposing factors associated with traumatic dental injuries in schoolchildren at Brasília, Brazil: a cross‐sectional, population‐based study. BMC Oral Health 2014;14:91. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Holmes 1992
    1. Holmes A. The prevalence of orthodontic treatment need. British Journal of Orthodontics 1992;19(3):177‐82. - PubMed
Johal 2007
    1. Johal A, Cheung MY, Marcene W. The impact of two different malocclusion traits on quality of life. British Dental Journal 2007;202:E2. - PubMed
Koretsi 2015
    1. Koretsi V, Zymperdikas VF, Papageorgiou SN, Papadopoulos MA. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta‐analysis. European Journal of Orthodontics 2015;37(4):418‐34. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Nguyen 1999
    1. Nguyen QV, Bezemer PD, Habets L, Prahl‐Andersen B. A systematic review of the relationship between overjet size and traumatic dental injuries. European Journal of Orthodontics 1999;21(5):503‐15. - PubMed
Pacha 2016
    1. Pacha MM, Fleming PS, Johal A. A comparison of the efficacy of fixed versus removable functional appliances in children with Class II malocclusion: A systematic review. European Journal of Orthodontics 2016;38(6):621‐30. - PubMed
Perillo 2012
    1. Perillo L, Cannavale R, Ferro F, Franchi L, Masucci C, Chiodini P, et al. Meta‐analysis of skeletal mandibular changes during Frankel appliance treatment. European Journal of Orthodontics 2012;33(1):84‐92. - PubMed
Proffit 1993
    1. Proffit WR, Fields HW Jr. Contemporary Orthodontics. 2nd Edition. St Louis, USA: Mosby‐Year Book, Inc, 1993.
Seehra 2011
    1. Seehra J, Fleming PS, Newton T, DiBiase AT. Bullying in orthodontic patients and its relationship to malocclusion, self‐esteem and oral health‐related quality of life. Journal of Orthodontics 2011;38(4):247‐56. - PubMed
Shaw 1980
    1. Shaw WC, Addy M, Ray C. Dental and social effects of malocclusion and effectiveness of orthodontic treatment: a review. Community Dentistry and Oral Epidemiology 1980;8(1):36‐45. - PubMed
Shaw 1991
    1. Shaw WC, Richmond S, O'Brien KD, Brook P, Stephens CD. Quality control in orthodontics: indices of treatment need and treatment standards. British Dental Journal 1991;170(3):107‐12. - PubMed
Silva 2001
    1. Silva RG, Kang DS. Prevalence of malocclusion among Latino adolescents. American Journal of Orthodontics and Dentofacial Orthopedics 2001;119(3):313‐5. - PubMed
Silva 2016
    1. Silva LF, Thomaz EB, Freitas HV, Pereira AL, Ribeiro CC, Alves CM. Impact of malocclusion on the quality of life of Brazilian adolescents: A population‐based study. PLoS One 2016;11(9):e0162715. - PMC - PubMed
Worthington 2015
    1. Worthington H, Clarkson J, Weldon J. Priority oral health research identification for clinical decision‐making. Evidence‐based Dentistry 2015;16(3):69‐71. - PubMed
Yang 2016
    1. Yang X, Zhu Y, Long H, Zhou Y, Jian F, Ye N, Gao M, Lai W. The effectiveness of the Herbst appliance for patients with Class II malocclusion: a meta‐analysis. European Journal of Orthodontics 2016;38(3):324‐33. - PMC - PubMed
Zymperdikas 2016
    1. Zymperdikas VF, Koretsi V, Papageorgiou SN, Papadopoulos MA. Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta‐analysis. European Journal of Orthodontics 2016;38(2):113‐26. - PMC - PubMed

References to other published versions of this review

Version 1
    1. Harrison JE, O'Brien KD, Worthington HV, Bickley SR, Scholey JM, Shaw WC. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD003452] - DOI - PubMed
Version 2
    1. Harrison JE, O'Brien KD, Worthington HV. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database of Systematic Reviews 2007, Issue 7. [DOI: 10.1002/14651858.CD003452.pub2] - DOI - PubMed
Version 3
    1. Thiruvenkatachari B, Harrison JE, Worthington HV, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database of Systematic Reviews 2013, Issue 11. [DOI: 10.1002/14651858.CD003452.pub3] - DOI - PubMed

Publication types

MeSH terms