Abstract
Data sources
PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS and Google Scholar.
Study selection
Randomised controlled trials(RCTs) that assessed functional appliance therapy in Class II malocclusions were included where they; analysed treatment effects not confounded by additional and concomitant treatments (headgear, extractions or fixed appliances); used cephalometric analysis at the start of treatment and just after removal of the functional appliances; and measured mandibular anteroposterior changes using the anatomic condylion. No language restrictions were applied.
Data extraction and synthesis
The selection process was conducted by two independent reviewers. The data were synthesised using a random-effects model with heterogeneity being assessed using the Cochrane test and the I2 statistic. A sensitivity analysis was conducted.
Results
Four trials were finally included involving 338 patients (168 treated vs 170 controls). Three of the four were assessed as having medium-high level statistical methods. The results of the meta-analysis from the random-effects model showed a statistically significant difference of 1.79 mm in annual mandibular growth of the treatment group compared with the control group (SMD 5 0.61, 95% CI, 0.30 to −0.93; chi-square test, 5.34; 3 df; P 5 0.15; I2 5 43.9%; test for overall effect, Z 5 3.83 and P 5 0.0001). The sensitivity analysis showed a substantially similar outcome of 1.91 mm (SMD 5 0.65, 95% CI, 0.25 to 1.25; chi-square test, 4.96; 2 df; P 5 0.08; I2 5 59.7%; test for overall effect, Z 5 3.19 and P 5 0.001).
Conclusions
The analysis of the effect of treatment with functional appliances compared with an untreated control group showed that skeletal changes were statistically significant but unlikely to be clinically significant.
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Address for correspondence: Elvira Marsico, Vle Boccetta, 14, 98122 Messina, Italy. E-mail: elvira.marsico@alice.it
Marsico E, Gatto E, Burrascano M, Matarese G, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term. Am J Orthod Dentofacial Orthop 2011; 139: 24–36.
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Flores-Mir, C. Limited evidence of a small effect on mandibular growth using functional appliances. Evid Based Dent 13, 23 (2012). https://doi.org/10.1038/sj.ebd.6400845
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DOI: https://doi.org/10.1038/sj.ebd.6400845
