Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term

Article · January 2011with146 Reads
DOI: 10.1016/j.ajodo.2010.04.028 · Source: PubMed
The aim of this study was to analyze the current literature for the best evidence (randomized clinical trials) about the efficacy of functional appliances on mandibular growth in the short term. A survey of articles published up to September 2009 was performed by using the following electronic databases: PubMed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar. The reference lists of the retrieved articles were hand-searched for possible missing articles. No language restriction was applied during the identification of the published studies. A methodologic scoring process was developed to identify which randomized clinical trials were stronger methodologically. The selection process and the quality assessment were undertaken independently and in duplicate by 2 authors. A meta-analysis was attempted by using random-effects models. Clinical and statistical heterogeneity was examined, and a sensitivity analysis was performed. Electronic searches identified the following items: 146 articles were retrieved from PubMed, 45 from Cochrane Central Register of Controlled Trials, 29 from Ovid, 42 from LILACS, 628 from Web of Science, and 1000 from Google Scholar. Thirty-two articles fulfilled the specific inclusion criteria and were identified as potentially appropriate randomized clinical trials to be included in this meta-analysis. Only 4 articles, based on data from 338 patients (168 treated vs 170 controls) with Class II malocclusion in the mixed dentition, were selected for the final analysis. The quality analysis of these studies showed that the statistical methods were at the medium-high level. The outcome measurements chosen to evaluate the efficacy of the various functional appliances were Co-Pg, Pg/Olp + Co/Olp, and Co-Gn and the values were annualized and standardized to a uniform scale with the standardized mean differences (SMD). 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 = 0.61, 95% CI, 0.30 to -0.93; chi-square test, 5.34; 3 df; P = 0.15; I(2) = 43.9%; test for overall effect, Z = 3.83 and P = 0.0001). The sensitivity analysis showed a substantially similar outcome of 1.91 mm (SMD = 0.65, 95% CI, 0.25 to 1.25; chi-square test, 4.96; 2 df; P = 0.08; I(2) = 59.7%; test for overall effect, Z = 3.19 and P = 0.001). The analysis of the effect of treatment with functional appliances vs an untreated control group showed that skeletal changes were statistically significant, but unlikely to be clinically significant.
    • However, when studies are grouped and analyzed together in systematic reviews and meta-analysis, controversies appear. Some reviews have found no statistically or clinically significant differences between groups treated with functional appliances and controls [8], while other authors have observed those differences to be statistically significant [9]. Additionally, studies have found other results for the treatment with functional appliances , such as secondary statistically significant mandibular elongation [10] and changes in the facial profile, due to incisal inclination [11] .
    [Show abstract] [Hide abstract] ABSTRACT: Background Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism. MethodsA systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances’ effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports’ structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model. ResultsFive studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15–1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69–5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices. Conclusions All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.
    Full-text · Article · Dec 2017
    • Evidence shows that favourable growth responses are not always achieved with functional therapy; some authors reported increases in overall mandibular length (Mills 1991) and changes in the amount of condylar growth,(Baltromejus et al. 2002)but others believe that mandibular length cannot be altered by such therapy (Creekmore & Radney 1983) It has been claimed that most of the correction of the malocclusion is due to dentoalveolar changes with a small but statistically significant amount of skeletal effects.(Jansen et al. 2003)Marsico et al (Marsico et al. 2011) did a systematic review of the available literature on the effect of removable functional appliances. Their search started with more than 1500 articles.
    [Show description] [Hide description] DESCRIPTION: Presentation as part of the M.Ch.D. course in Orthodontics at the University of the Western Cape. Not intended for publication as this is only a literature review for parties interested in this topic
    File · Presentation · Sep 2017 · PLoS ONE
    • Even though the research included was very heterogeneous, all authors stressed the positive effect of the Fränkel functional regulator on mandibular growth, especially total mandibular length, clinical effect reported being minimal to moderate. Another meta-analysis by Marisco et al.[21]analyzed the therapeutic effects of the Fränkel functional regulator, Bionator and several other functional appliances. All authors of included studies reported statistical significance of skeletal changes, but stated lack of their clinical significance.
    Article · Jan 2017
    • The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions, including those on the sagittal [1] and vertical dimensions [2, 3]. Although being a controversial issue [4][5][6], functional treatment for Class II malocclusion would induce clinically relevant mandibular elongation when performed during the pubertal growth phase [7, 8], while, Class III malocclusion requires early treatment [1]. Finally, both excessive vertical facial growth [2] and deepbite [3] have also been reported to be best treated during the pubertal growth phase.
    [Show abstract] [Hide abstract] ABSTRACT: The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions. This cross-sectional study was thus aimed at evaluating whether sagittal and vertical craniofacial growth has an association with the timing of circumpubertal skeletal maturation. A total of 320 subjects (160 females and 160 males) were included in the study (mean age, 12.3±1.7 years; range, 7.6–16.7 years). These subjects were equally distributed in the circumpubertal cervical vertebral maturation (CVM) stages 2 to 5. Each CVM stage group also had equal number of females and males. Multiple regression models were run for each CVM stage group to assess the significance of the association of cephalometric parameters (ANB, SN/MP, and NSBa angles) with age of attainment of the corresponding CVM stage (in months). Significant associations were seen only for stage 3, where the SN/MP angle was negatively associated with age (í µí»½ coefficient, −0.7). These results show that hyperdivergent and hypodivergent subjects may have an anticipated and delayed attainment of the pubertal CVM stage 3, respectively. However, such association remains of little entity and it would become clinically relevant only in extreme cases.
    Full-text · Article · Nov 2016
    • However, different removable appliances may have different modus operandi requiring differential treatment duration. A previous meta-analysis [4] reported no significant effects of functional treatment in Class II patients. This meta-analysis used standardised mean differences (obtained merging several parameters) for the estimation of the overall effects.
    [Show abstract] [Hide abstract] ABSTRACT: Treatment effects of removable functional appliances in Class II malocclusion patients according to the pre-pubertal or pubertal growth phase has yet to be clarified.To assess and compare skeletal and dentoalveolar effects of removable functional appliances in Class II malocclusion treatment between pre-pubertal and pubertal patients.Literature survey using the Medline, SCOPUS, LILACS and SciELO databases, the Cochrane Library from inception to May 31, 2015. A manual search was also performed.Randomised (RCTs) or controlled clinical trials with a matched untreated control group. No restrictions were set regarding the type of removable appliance whenever used alone.For 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.Twelve 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
    Full-text · Article · Oct 2015
    • Dental positions are modified, as well as muscles and soft tissue, in order to prevent extractions (FRÄNKEL et al., 1969; CHADWICK et al., 2001; SCANAVINI et al., 2012, PARANHOS et al., 2013). The literature shows promising results using Fränkel-2 (RF-2) function regulator appliance: increase in mandibular length, buccal inclination of the lower incisors, inclination of upper incisors to the lingual, restriction of maxillary growth, extrusion of upper molars, and increase in intercanine distance (MCNAMARA JÚNIOR et al., 1990; MARSICO et al., 2011). Fränkel-2 has been also related to expansion of the arches (maxillary and mandibular) and to reduction of crowding during teeth eruption – due to the action of vestibular shields (LITTLE et al., 1988).
    [Show abstract] [Hide abstract] ABSTRACT: Functional orthopedic appliances used for Class II malocclusion treatment, usually work by guiding jaws growth and modifying dental positions. Among these dentoalveolar effects, it is the lower incisors buccal tipping, that helps to improve the overjet, but may cause gingival recessions, especially when associated with other etiological factors. The objective of this study was to evaluate the clinical crown length of the lower anterior teeth in individuals with Angle’s Class II malocclusion, after treatment with Fränkel-2 function regulator appliance (RF-2). Fifty Class II-malocclusion individuals were divided into 2 groups: G1 – 14 male, and 11 female, treated with the Fränkel-2 function regulator appliance for 18 months, with average pre-treatment age (T1) of 11 years (sd=7 months) and average post-treatment age (T2) of 12 years and 7 months (sd=7 months); and G2 – a control group with 25 individuals (12 male and 13 female) with average age at T1 of 10 years and 3 months (sd=11 months) and at T2 of 12 years and 1 month (sd=11 months), which was part of a normal occlusion sample. The 100 dental cast models were analyzed at T1 and T2, with a digital caliper, measuring the distance from the incisal edge to the most concave portion of the gingival margin of lower incisors and canines. Data were checked by a Student’s t-test and a paired t-test. Considering T2, the group 1 presented a significant increase in the crown length of all lower anterior teeth. On the other hand, in the group 2, this was observed only for the teeth 33, 42 and 43, suggesting that patients treated with RF-2 had more gingival recession than the control group. © 2015, Universidade Federal de Uberlandia. All rights reserved.
    Full-text · Article · Sep 2015 · PLoS ONE
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Our patients should be treated with the best available evidence. Due to methological flaws systematic reviews do not provide the best available evidence for clinical decision making. In order to cr…" [more]
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