Treatment Effects of Removable Functional Appliances in Pre-Pubertal and Pubertal Class II Patients: A Systematic Review and Meta-Analysis of Controlled Studies

Abstract

BackgroundTreatment effects of removable functional appliances in Class II malocclusion patients according to the pre-pubertal or pubertal growth phase has yet to be clarified.ObjectivesTo assess and compare skeletal and dentoalveolar effects of removable functional appliances in Class II malocclusion treatment between pre-pubertal and pubertal patients.Search methodsLiterature survey using the Medline, SCOPUS, LILACS and SciELO databases, the Cochrane Library from inception to May 31, 2015. A manual search was also performed.Selection criteriaRandomised (RCTs) or controlled clinical trials with a matched untreated control group. No restrictions were set regarding the type of removable appliance whenever used alone.Data collection and analysisFor the meta-analysis, cephalometric parameters on the supplementary mandibular growth were the main outcomes, with other cephalometric parameters considered as secondary outcomes. Risk of bias in individual and across studies were evaluated along with sensitivity analysis for low quality studies. Mean differences and 95% confidence intervals for annualised changes were computed according to a random model. Differences between pre-pubertal and pubertal patients were assessed by subgroup analyses. GRADE assessment was performed for the main outcomes.ResultsTwelve articles (but only 3 RCTs) were included accounting for 8 pre-pubertal and 7 pubertal groups. Overall supplementary total mandibular length and mandibular ramus height were 0.95 mm (0.38, 1.51) and 0.00 mm (-0.52, 0.53) for pre-pubertal patients and 2.91 mm (2.04, 3.79) and 2.18 mm (1.51, 2.86) for pubertal patients, respectively. The subgroup difference was significant for both parameters (p<0.001). No maxillary growth restrain or increase in facial divergence was seen in either subgroup. The GRADE assessment was low for the pre-pubertal patients, and generally moderate for the pubertal patients.ConclusionsTaking into account the limited quality and heterogeneity of the included studies, functional treatment by removable appliances may be effective in treating Class II malocclusion with clinically relevant skeletal effects if performed during the pubertal growth phase.

Evaluation the Treatment Effects of Functional Appliances Used in Class II Malocclusions

“…fonksiyonel apareylerin tedavi zamanlaması bakımından ramus boyu ve mandibula uzunluğunu değerlendiren 12 makaleyi inceledikleri araştırmalarında 8 puberta öncesi ve 7 puberta sonrası iki grubu karşılaştırmışlardır. 38 Ramus boyu ve mandibula uzunluğunun puberta öncesi fonksiyonel tedavi gören grupta sırasıyla 0,95 mm ve 0,00 mm arttığını; puberta döneminde fonksiyonel tedavi gören grupta ise sırasıyla 2,91 mm ve 2,18 mm arttığını bildirmişlerdir. Ayrıca pubertal dönemde uygulanan fonksiyonel apareylerin klinik olarak belirgin iskeletsel etkiye sahip olduğu sonucuna varmışlardır.…”

Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

“…2 However, contrasting recommendations have been carried out from current research regarding the reliability of such methods. 3,4 Studies on the radiographical growth indicators are essentially of two types: the ones correlating the various stages of maturation with mandibular growth spurt, 5 and the ones evaluating skeletal effects obtained by functional treatment in Class II patients the timing of treatment has been based on such indicators (for review, see Perinetti et al 4 ) Interestingly, while many of the former types of investigations reported poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, 6 most of the latter type of investigations reported clinically relevant favourable effects when the growth indicators are used. 4 It is perhaps that investigations are still missing the relevant piece of evidence.…”

Diagnostic reliability of mandibular second molar maturation in the identification of the mandibular growth peak: A longitudinal study

“…Skeletal effects are maximized if treatment is performed during the pubertal growth spurt, irrespective whether removable 1 or fixed 2 appliances are used. Therefore, efforts have been made to find reliable indicators for predicting skeletal maturity in individual subjects.…”