Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

This Systematic Review (SR) aims to assess the quality of SRs and Meta-Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel-2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2-10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues.

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“…The 14 SRs included and the data extracted from each SR are shown in Table . One‐third of the included SRs (5 of 14) were integrated with MA .…”

Section: Resultsmentioning

confidence: 99%

“…The 14 SRs included and the data extracted from each SR are shown in Table 4 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). One-third of the included SRs (5 of 14) were integrated with MA (18,20,28,30,31).…”

Section: Papers Selectionmentioning

confidence: 99%

Class II functional orthopaedic treatment: a systematic review of systematic reviews

D’Antò

Bucci

Franchi

et al. 2015

J of Oral Rehabilitation

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“…[1][2][3][4] However, despite the potential for achieving desirable treatment results, the success of this treatment modality depends heavily on patient cooperation. 5,6 It has previously been shown that compliance with headgear use has a significant effect on treatment outcome and duration. [6][7][8] In the orthodontic specialty, there was a rapid increase in the use of headgear through the mid1980s followed by a decline in the routine use of this appliance from 1996 to present.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 It has previously been shown that compliance with headgear use has a significant effect on treatment outcome and duration. [6][7][8] In the orthodontic specialty, there was a rapid increase in the use of headgear through the mid1980s followed by a decline in the routine use of this appliance from 1996 to present. [9][10][11] Interestingly, over the years the headgear treatment modality has been in and out of favor.…”

Section: Introductionmentioning

confidence: 99%

Current trends in headgear use for the treatment of Class II malocclusions

Tüfekçi

Allen

Best

et al. 2015

The Angle Orthodontist

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Objective: To investigate American and Canadian orthodontists' opinions and perceptions on the use of headgear in the treatment of Class II malocclusions. Materials and Methods: An online survey was sent to randomly chosen orthodontists (n 5 1000). Results: The study was completed by 948 orthodontists; 62% of the orthodontists indicated that they were using headgear in their practice. Those who were not using the appliance (38%) reported that this was mainly due to the availability of better Class II correctors in the market and lack of patient compliance. Of those who use headgear, 24% indicated that the emphasis on headgear use during their residency was an influential aspect of their decision making (P , .05). Nearly a quarter of those who do not use headgear reported that learning about other Class II correctors through continuing education courses was an important factor (P , .05). There was no difference between the headgear users and nonusers in the year and location of practice. Compared with previous studies, this study showed a decline in the use of headgear among orthodontists. Conclusions: Despite a decline, more than half of the orthodontists (62%) believe headgear is a viable treatment. Availability of Class II correctors in the market and familiarity with these appliances though continuing education courses are the reasons for the remaining 38% of orthodontists to abandon use of the headgear. (Angle

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“…They were similar to reductions described for cervical-pull (À0.6 to À0.88/y) and high-pull (À0.5 to À1.18/y) headgear. 32,33 This was a dentoalveolar treatment effect. Since the Herbst appliance is attached with rigid steel arms to the first molars, the same force that displaces the mandible down and forward is reciprocally exerted on the maxilla.…”

Section: Discussionmentioning

confidence: 97%

Treatment changes of hypo- and hyperdivergent Class II Herbst patients

Rogers¹,

Campbell

Tadlock

et al. 2017

The Angle Orthodontist

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Objectives: To determine the relative effects of Herbst appliance therapy in hypo-and hyperdivergent patients. Materials and Methods: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo-or hyperdivergent based on their MPAs. Pre-and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures. Results: The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a ''headgear effect.'' Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo-and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients. Conclusions: Hypo-and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.

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Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

Cited by 19 publications

References 24 publications

Class II functional orthopaedic treatment: a systematic review of systematic reviews

Class II functional orthopaedic treatment: a systematic review of systematic reviews

Current trends in headgear use for the treatment of Class II malocclusions

Treatment changes of hypo- and hyperdivergent Class II Herbst patients

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