Dentoalveolar And Skeletal Effects Of Fixed Functional Appliances – A Systematic Review And Meta-Analysis

Abstract

Objective: To appraise the difference between treatment effects of fixed functional appliances (FFA) and untreated class II (UclII) malocclusion on skeletodental cephalometric measurements.

Material and Methods: Literature search was conducted across PubMed, MEDLINE, DOAJ, Cochrane Library, and Scopus until August 2023. Using MeSH and free text terms based on the PICOS framework with Boolean operators. Additional searches involved cross-referencing, citation chasing, and exploring grey literature through Google Scholar, Greylist, OpenGrey, and hand searching specialty journals.

Results: 16 studies were included. Studies assessing SNA revealed a pooled value of -0.44[-0.78, -0.11], indicating a (p=0.008) reduction in SNA values with FFA compared UclII. Mandibular changes reported a combined SNB value of -0.10[-0.43, 0.223], suggesting higher SNB with FFA vs UclII. ANB angle reported a notable decrease (-0.95[-1.79, -0.11], p=0.03) at 90% heterogeneity. Overjet displayed reduction (-2.08[-2.62, -1.54]mm) with 75% heterogeneity, while overbite, demonstrated a significant decrease (-1.08[-1.79, -0.37]mm) with 85% heterogeneity.

Conclusion: Analysis of 16 studies comparing the effects of Functional Appliance (FFA) and UclII revealed significant findings. Studies assessing SNA indicated a notable reduction in SNA values with FFA compared to UclII (p=0.008). Mandibular changes, particularly the SNB value, suggested higher values with FFA versus UclII. The ANB angle showed a significant decrease with FFA (p=0.03).