title: Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess skeletal and dentoalveolar effects of fixed functional appliances, alone or in combination with multibracket appliances (comprehensive treatment), on Class II malocclusion in pubertal and postpubertal patients.
  
  
  METHODS
  Literature survey was conducted using the Medline, SCOPUS, LILACS, and SciELO databases and The Cochrane Library, and through a manual search. The studies retrieved had to have a matched untreated control group. No restrictions were set regarding the type of fixed appliance, treatment length, or to the cephalometric analysis used. Data extraction was mostly predefined at the protocol stage by two authors. Supplementary mandibular elongation was used for the meta-analysis.
  
  
  RESULTS
  Twelve articles qualified for the final analysis of which eight articles were on pubertal patients and four were on postpubertal patients. Overall supplementary total mandibular elongations as mean (95% confidence interval) were 1.95 mm (1.47 to 2.44) and 2.22 mm (1.63 to 2.82) among pubertal patients and -1.73 mm (-2.60 to -0.86) and 0.44 mm (-0.78 to 1.66) among postpubertal patients, for the functional and comprehensive treatments, respectively. For pubertal subjects, maxillary growth restraint was also reported. Nevertheless, skeletal effects alone would not account for the whole Class II correction even in pubertal subjects with dentoalveolar effects always present.
  
  
  CONCLUSIONS
  Fixed functional treatment is effective in treating Class II malocclusion with skeletal effects when performed during the pubertal growth phase, very few data are available on postpubertal patients.
authors.affiliation: a  Research Fellow, Department of Medical, Surgical and Health Sciences, School of Dentistry, University of Trieste, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Perinetti
authors.forename: Jasmina
authors.initials: J
authors.lastname: Primožič
authors.forename: Giovanna
authors.initials: G
authors.lastname: Furlani
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franchi
authors.forename: Luca
authors.initials: L
authors.lastname: Contardo
mesh_terms: D006801:Humans; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008334:Mandible / Q000254:growth & development; D016382:Orthodontic Appliance Design; D017289:Orthodontic Appliances, Functional; D016910:Orthodontic Brackets; D011627:Puberty; D016896:Treatment Outcome
keywords: Class II; Functional treatment; Growth phase; Systematic review; Timing