title: Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: A systematic review and meta-analysis.
abstract: BACKGROUND
  Our aim was to assess the skeletal mandibular changes (anteroposterior and vertical) in circumpubertal patients with fixed functional appliances installed on multibracket appliances compared with untreated patients.
  
  
  METHODS
  An open-ended electronic search of 4 databases (PubMed, Embase, Cochrane Library, and Web of Science) up to April 2014 was performed. Additional searches of relevant journals, reference lists of the retrieved articles, systematic reviews, and gray literature were performed. Specific inclusion and exclusion criteria were applied to identify relevant articles. Quality was evaluated using the Cochrane Collaboration risk of bias tool and the Newcastle-Ottawa scale for prospective controlled clinical trials. Meta-analyses were conducted with fixed and random effects models as appropriate. Statistical heterogeneity was also examined.
  
  
  RESULTS
  Seven articles were included in the qualitative synthesis and 5 in the meta-analysis. The included randomized controlled trials were at high risk of bias, and the methodologic quality of the prospective controlled clinical trials was high. Based on assessment of the fixed functional appliance phase in isolation, no difference in mandibular anteroposterior positional changes (SNB angle) (standard mean difference, 0.11°; 95% CI, -0.28, 0.50) was found between the treated and control groups. The vertical dimension was not influenced by the fixed functional appliance treatment.
  
  
  CONCLUSIONS
  There is little high-quality evidence concerning the relative influence of fixed functional appliances on skeletal and dentoalveolar changes. However, based on the limited evidence, it appears that they have little effect on the skeletal mandibular parameters.
authors.affiliation: Private practice. Sanaa, Yemen. Electronic address: ishaqramy@gmail.com.
authors.forename: Ramy Abdul Rahman
authors.initials: RA
authors.lastname: Ishaq
authors.affiliation: Assistant professor, Faculty of Dentistry, Ibb University, Ibb, Yemen.
authors.forename: Maged Sultan
authors.initials: MS
authors.lastname: AlHammadi
authors.affiliation: Professor, Department of Orthodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mona M S
authors.initials: MM
authors.lastname: Fayed
authors.affiliation: Professor, Department of Orthodontics; dean, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
authors.forename: Amr Abou
authors.initials: AA
authors.lastname: El-Ezz
authors.affiliation: Professor, Department of Orthodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
authors.forename: Yehya
authors.initials: Y
authors.lastname: Mostafa
mesh_terms: D006801:Humans; D008334:Mandible / Q000254:growth & development*; D016382:Orthodontic Appliance Design; D017289:Orthodontic Appliances, Functional; D016910:Orthodontic Brackets