Cited by 191Orthodontics and Dentofacial OrthopedicsCleft Lip and Palate ResearchCraniofacial Disorders and Treatments

Treatment effects of removable functional appliances in patients with class II malocclusion: a systematic review and meta-analysis

Koretsi, Vasiliki, Zymperdikas, Vasileios F., Papageorgiou, Spyridon N., Papadopoulos, Moschos A.·2015·The European Journal of Orthodontics

Abstract

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. SEARCH METHODS: Unrestricted electronic search of 18 databases and manual searches up to October 2013. SELECTION CRITERIA: Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with RFAs and their matched controls. DATA COLLECTION AND ANALYSIS: 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.

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  1. Creekmore, T.D. and Radney, L.J. (1983) Fränkel appliance therapy: ortho- pedic or orthodontic? American Journal of Orthodontics and Dentofacial Orthopedics, 83, 89-108.
  2. Rasool, G., Bashir, U. and Kundi, I. (2010) Comparative evaluation between cervical vertebrae and hand-wrist maturation for assessment of skeletal maturity orthodontic patients. Pakistan Oral & Dental Journal, 30, 85-95.
  3. Harmelink, K. (2010) Effects of neurolytic blocks (botulinum toxin type A and motor branch block) in patients with a Stiff Knee Gait: A systematic review. Master Thesis, Utrecht University.
  4. Morissette, K., Tricco, A.C., Horsley, T., Chen, M.H. and Moher, D. (2011) Blinded versus unblended assessments of risk of bias in studies included in a sys- tematic review. The Cochrane Database of Systematic Reviews, 9, MR000025.
  5. Andreoli, F.A.M. (2008) Avaliação cefalométrica da estabilidade do trata- mento com o regulador de função Fränkel-2. Master Thesis, Methodist University of São Paulo.
  6. Brunharo, I.H.V.P., Quintão, C.A., Almeida, M.A.D.O., Motta, A. and Barreto, S.Y.N. (2011) Dentoskeletal changes in Class II malocclusion patients after treatment with the Twin Block functional appliance. Dental Press Journal of Orthodontics, 16, e1-e8.

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Authors
Koretsi, V., Zymperdikas, V. F., Papageorgiou, S. N., & Papadopoulos, M. A.
Affiliations
  • University Hospital Regensburg (DE)
  • Hellenic Air Force (GR)
  • University of Bonn (DE)
  • Aristotle University of Thessaloniki (GR)
Venue
The European Journal of Orthodontics
Published
2014-11-13
Volume
37
Issue
4
Pages
418-434
ISSN
  • 0141-5387 (ISSN-L)
  • 1460-2210
OpenAlex
W4249036357
Cited by
191
References
93
Citations by year
2026: 19 · 2025: 18 · 2024: 20 · 2023: 18 · 2022: 18 · 2021: 20 · 2020: 23 · 2019: 16 · 2018: 14 · 2017: 8 · 2016: 10 · 2015: 7
FWCI
1.94
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Orthodontics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Cleft Lip and Palate Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
Keywords
removable functional appliances, Class II malocclusion, cephalometric changes, SNA angle, SNB angle, ANB angle, Twin Block appliance, dentoalveolar changes, skeletal changes, soft tissue changes, pediatric orthodontic treatment
MeSH terms
Cephalometry, Humans, Malocclusion, Angle Class II, Mandible, Maxilla, Orthodontic Appliances, Removable, Treatment Outcome, Orthodontic Appliances, Functional

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