Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis.
OBJECTIVE
To assess the treatment effects of removable functional appliances (RFAs) in treated versus untreated patients with Class II malocclusion by means of lateral cephalometric radiographs.


METHODS
Unrestricted electronic search of 18 databases and manual searches up to October 2013.


METHODS
Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with RFAs and their matched controls.


METHODS
Skeletal, dental, and soft tissue changes were annualized and stratified to short- and long-term effects. Methodological limitations were evaluated with the Cochrane Risk of Bias tool and the Downs and Black checklist. Mean differences (MDs) with their 95% confidence intervals (CIs) were calculated from random-effects meta-analyses. Patient- or appliance-related subgroup analyses and sensitivity analyses were performed with mixed-effects models.


RESULTS
Seventeen studies were included (1031 patients; mean age: 10.6 years), with most of them originating from university clinics and reporting short-term effects (directly after the removal of RFAs). Treatment was associated with minimal reduction of SNA angle (11 studies, MD = -0.28 degree/year, 95% CI: -0.44 to -0.12 degree/year), minimal increase of SNB angle (11 studies, MD = 0.62 degree/year, 95% CI: 0.36-0.88 degree/year), and small decrease of ANB angle (10 studies, MD = -1.14 degree/year, 95% CI: -1.52 to -0.77 degree/year) compared to untreated Class II patients. RFAs caused significant dentoalveolar changes (predominantly retroclination of the upper incisors) and significant soft tissue changes. Skeletal changes were more pronounced with the Twin Block appliance. Various patient- or appliance-related factors influenced the results of the subgroup analyses, while the sensitivity analyses indicated robustness. Existing evidence was inadequate to assess the long-term effectiveness of RFAs.


CONCLUSIONS
The short-term evidence indicates that RFAs are effective in improving Class II malocclusion, although their effects are mainly dentoalveolar, rather than skeletal.
*Department of Orthodontics, School of Dentistry, University Medical Centre Regensburg, Germany.
Vasiliki
V
Koretsi
Dental Unit, Medical Company, 71st Airmobile Brigade, Nea Santa, Greece.
Vasileios F
VF
Zymperdikas
Department of Orthodontics, Department of Oral Technology, and Clinical Research Unit 208, University of Bonn, Germany.
Spyridon N
SN
Papageorgiou
Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece. mikepap@dent.auth.gr.
Moschos A
MA
Papadopoulos
D002508:Cephalometry / Q000379:methods; D006801:Humans; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D017289:Orthodontic Appliances, Functional; D009968:Orthodontic Appliances, Removable; D016896:Treatment Outcome