Introduction
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.
Methods
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.
Results
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; I2 = 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; I2 = 59.7%; test for overall effect, Z = 3.19 and P = 0.001).
Conclusions
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.
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Article Info
Publication History
Accepted:
April 2010
Received in revised form:
April 2010
Received:
December 2009
Footnotes
The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.
Identification
Copyright
© 2011 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
