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| Title |
Fixed Functional Appliances in Combination with Temporary Anchorage Devices Promote Mandibular Growth in Adolescents with Class II Malocclusion |
| Clinical Question |
For mandibular recessive Class II patients, will fixed functional appliances (FFAs) in conjunction with temporary anchorage devices (TADs) as compared to FFAs alone enhance the skeletal changes and minimize adverse dental effects? |
| Clinical Bottom Line |
Using fixed functional appliances (FFAs) in conjunction with temporary anchorage devices (TADs) could enhance skeletal changes (promoting mandibular growth and restricting maxillary growth) in class II patients. In addition, they provide better control of lower incisor inclination as compared to FFAs alone. However, additional well-designed studies are needed to evaluate the long-term effect of using FFAs along with TADs. |
| 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) 33785320 | Huang/2021 | 10 studies / 281 patients | Meta-Analysis | | Key results | For patients treated with FFAs and TADs, meta-analyses showed significant changes in both skeletal and dentoalveolar parameters. For skeletal effects, there was a significant increase in both SNB and Co-Gn with mean difference 0.67 (95% CI: 0.04–1.29) and 1.57 (95% CI: 0.22–2.92), respectively. In addition, there was a significant reduction in the ANB with mean difference -1.22 (95% CI: –2.04 to –0.39). For dentoalveolar effects, there was a significant decrease in both lower and upper incisor inclination with mean difference -5.64 (95% CI: 7.78 to –3.50) and -1.91 (95% CI: –3.69 to –0.13), respectively. | |
| Evidence Search |
(temporaries"[All Fields] OR "temporary"[All Fields]) AND ("anchorage"[All Fields] OR "anchorages"[All Fields]) AND ("devices"[All Fields] AND ("orthodontic appliances, fixed"[MeSH Terms]. |
Comments on
The Evidence |
Huang and her co-workers systematically reviewed literature up to August 2020. Electronic databases Pubmed, EMBASE, CENTRAL, Web of Science, Google Scholar, CBM, and CNKI were searched for randomized clinical trials (RCTs) and controlled clinical trials (CCTs). Ten studies met the inclusion criteria; four were RCTs and six were CCTs. For the type of FFAs, five studies used Herbst, while the others used Forsus. For the type of TADs, seven articles used miniscrews, while the others used miniplates. The modified Cochrane risk-of-bias tool (ROB 2.0) and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) were used to assess the risk of bias in RCTs and CCTs, respectively. The evidence shows moderate to high risk of bias. The meta-analyses showed substantial heterogeneity, with I2 ranging from 88-93%. Also, according to GRADE assessments, the quality of evidence ranged from very low to moderate. |
| Applicability |
The focus of this systematic review was to compare FFAs in combination with TADs to FFAs alone in treating growing patients with class II malocclusion due to deficient mandible. This combination not only controls lower incisor inclination but also promotes mandibular growth. Within the subgroup, Herbst showed greater skeletal changes compared to Forsus. In addition, the type of skeletal anchorage affected the impact of the TADs on treatment effect. On application of orthopedic forces, miniplates were shown to have more reliable anchorage than miniscrews. Low bone density and poor oral hygiene are factors affecting the use of TDAs in adolescent patients. However, the review reported low failure rates of TADs and that stability of TADs could be improved by “delicate operation, oral hygiene instructions, and application of appropriate force during orthodontic treatment”. |
| Specialty/Discipline |
(Orthodontics) |
| Keywords |
fixed functional appliances, TADs, class II malocclusion
|
| ID# |
3470 |
| Date of submission: |
11/22/2021 |
| E-mail |
althenyan@livemail.uthscsa.edu |
| Author |
Turki Althenyan, BDS |
| Co-author(s) |
Brandy Evans, DDS |
| Co-author(s) e-mail |
evansb1@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
Ravikumar Anthony, BDS, MDS, MS |
| Faculty mentor/Co-author e-mail |
anthonyr@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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