title: Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis.
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.
  
  
  METHODS
  Unrestricted electronic search of 18 databases and additional manual searches up to October 2014.
  
  
  METHODS
  Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with FFAs and their matched untreated controls.
  
  
  METHODS
  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.
authors.affiliation: *Dental Unit, Medical Company, 71st Airmobile Brigade, Nea Santa, Greece.
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Zymperdikas
authors.affiliation: **Department of Orthodontics, School of Dentistry, University Medical Centre Regensburg, Germany, Departments of.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Koretsi
authors.affiliation: ***Orthodontics and ****Oral Technology, University of Bonn, Germany, *****Clinical Research Unit 208, University of Bonn, Germany.
authors.forename: Spyridon N
authors.initials: SN
authors.lastname: Papageorgiou
authors.affiliation: ******Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece mikepap@dent.auth.gr.
authors.forename: Moschos A
authors.initials: MA
authors.lastname: Papadopoulos
mesh_terms: D000539:Alveolar Process / Q000473:pathology; 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; D014070:Tooth / Q000473:pathology; D016896:Treatment Outcome