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Title Functional Appliances May Minimally Increase Mandibular Skeletal Growth
Clinical Question Are functional appliances effective in increasing skeletal mandibular growth in early adolescent patients with skeletal Class II malocclusions compared to a control with no appliance?
Clinical Bottom Line According to a meta-analysis of the best-evidence RCTs, functional appliance treatment provided to early-adolescent patients with skeletal Class II malocclusions can be expected to result in statistically significant, but not clinically significant, increases in mandibular growth.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21195273Marisco / 2011338 adolescent humansSystematic review with meta-analysis
Key resultsMeta-analysis of four best-evidence RCTs demonstrated a statistically significant difference of 1.79 mm annual mandibular growth of patients treated with a functional appliance compared with control groups (SMD = 0.61, 95% CI, 0.30 to -0.93).
Evidence Search (("Mandible/growth and development"[MAJR]) AND "Orthodontic Appliances, Functional"[MAJR])
Comments on
The Evidence
This meta-analysis was performed on a systematic review of RCTs found using a comprehensive, detailed search for relevant trials. Studies that did not meet the specific inclusion/exclusion criteria were not considered, leaving four RCTs for this review. Individual studies were assessed for validity and treatment was evaluated on 338 patients (168 treated, 170 controls). It is important to note that hyper-divergent, normal, and hypo-divergent phenotypes were blended in these studies. Furthermore, the horizontal component of mandibular growth was not determined.
Applicability Mean ages of the included subjects ranged from 8.5 to 11.6 years. Assessment of the sex of the patients was not possible due to the data not being available in some studies. Treatment/observation times ranged from 15-18 months and there was large variation in the time of daily appliance wear.
Specialty/Discipline (Orthodontics)
Keywords Skeletal Class II, Class II malocclusion, Orthodontics, Functional appliances, Growth, Facial growth
ID# 2129
Date of submission: 09/15/2011spacer
E-mail escott@uthscsa.edu
Author Christopher Escott
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail BRYKC@uthscsa.edu
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Shadzi Jebraeili, DDS, Fauzia Dadarkar, DDS (San Antonio, TX) on 11/13/2015
A Pubmed and Trip database search on this question in November 2015, found a more recent publication by Perinetti et. al (2015, Pubmed ID: 26510187). This systematic review and meta-analysis of controlled studies looked at 12 selected articles (3 RCTs) and found a significant difference in overall mandibular length and ramus height after functional appliance therapy. This study further strengthens the conclusions of this CAT.

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