Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis

Abstract

Objective: To assess skeletal and dentoalveolar effects of fixed functional appliances, alone or in combination with multibracket appliances (comprehensive treatment), on Class II malocclusion in pubertal and postpubertal patients. Materials and Methods: Literature survey was conducted using the Medline, SCOPUS, LILACS, and SciELO databases and The Cochrane Library, and through a manual search. The studies retrieved had to have a matched untreated control group. No restrictions were set regarding the type of fixed appliance, treatment length, or to the cephalometric analysis used. Data extraction was mostly predefined at the protocol stage by two authors. Supplementary mandibular elongation was used for the meta-analysis. Results: Twelve articles qualified for the final analysis of which eight articles were on pubertal patients and four were on postpubertal patients. Overall supplementary total mandibular elongations as mean (95% confidence interval) were 1.95 mm (1.47 to 2.44) and 2.22 mm (1.63 to 2.82) among pubertal patients and 21.73 mm (22.60 to 20.86) and 0.44 mm (20.78 to 1.66) among postpubertal patients, for the functional and comprehensive treatments, respectively. For pubertal subjects, maxillary growth restraint was also reported. Nevertheless, skeletal effects alone would not account for the whole Class II correction even in pubertal subjects with dentoalveolar effects always present. Conclusions: Fixed functional treatment is effective in treating Class II malocclusion with skeletal effects when performed during the pubertal growth phase, very few data are available on postpubertal patients. (Angle Orthod. 2015;85:480-492.)

Optimization of Class II Malocclusion Treatments Using the Forsus™ Fatigue Resistance Device and Its Post-Treatment Effect in Adult Patients: A Case Report

“…Such considerations occurred due to the lack of studies comparing the control group, presenting the same malocclusion, to the treated group [5,6], the lack of patient's cooperation [7][8][9], the use of removable orthopedic devices in growing patients [8], the high breakage rate of fixed orthopedic appliances [10][11][12][13], and, discomfort caused to patients by the use of removable and fixed orthopedic devices [10,11,13]. In the twenty-first century, the launch of the Forsus™ Fatigue Resistant Device brought a new proposal to treatments, considering patient comfort in the set-up day and along the treatment, due to the lack of mandibular postural change and easiness of performing the functional mandibular movements [7,11,[14][15][16][17].…”

“…However, the effective growth of the mandible will rarely be considered an effect genuinely generated by the stimulus of the mandibular anterior growth [1,5,10,15,35,36], although there are authors that report some potential for effective growth in the mandibular body and ramus, when functional fixed devices are used in the pubertal growth peak stage [1,3,6,9,13].…”

“…The mandible may undergo anterior shift, improving the maxillomandibular relationship [1,3,5,6,11,13,15]. However, the effective growth of the mandible will rarely be considered an effect genuinely generated by the stimulus of the mandibular anterior growth [1,5,10,15,35,36], although there are authors that report some potential for effective growth in the mandibular body and ramus, when functional fixed devices are used in the pubertal growth peak stage [1,3,6,9,13].In the literature, it has been shown that dentoalveolar changes overcome the skeletal changes when any fixed functional device is used [4][5][6]21]. The mechanism of the dentoalveolar action of such devices over the upper anterior [2,[5][6][7][8][9][10][11]14,15,17,28,36,37] and posterior teeth [3,6,[8][9][10][11]13,35,36] and over the lower anterior …”

“…The mechanism of the dentoalveolar action of such devices over the upper anterior [2,[5][6][7][8][9][10][11]14,15,17,28,36,37] and posterior teeth [3,6,[8][9][10][11]13,35,36] and over the lower anterior [5,6,8,[9][10][11][13][14][15]17,28,[35][36][37] and posterior teeth [3,8,[9][10][11]14,17] are often responsible for the clockwise shift of the occlusal [5,9,10,16,17,35] and palatal [2] planes, generating a clockwise resultant on the mandibular plane …”

Gingival crevicular fluid alkaline phosphatase activity in relation to pubertal growth spurt and dental maturation: A multiple regression study

“…On the contrary, in Class II subjects the amount of supplementary mandibular growth induced by functional appliances appears to be significantly greater when the treatment is performed during the pubertal growth phase. 5,6 For this reason, several indicators of the skeletal maturity have been investigated over the last five decades. 1,2,7,8 While chronological age showed to be an unreliable indicator of the onset of the pubertal growth spurt, 2,7 other radiographical methods proved a good reliability and diagnostic performance.…”