Comparison of stepwise vs single-step advancement with the Functional Mandibular Advancer in Class II division 1 treatment

Aras, Isil; Paşaoğlu, Aylin; Olmez, Sultan; Ünal, İdil; Tuncer, Ali; Aras, Aynur

doi:10.2319/032416-241.1

Cited by 24 publications

(31 citation statements)

References 25 publications

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“…In this systematic review, only two of the studies included tried to standardize pre-treatment variables 3,11 . The Herbst, Forsus, and Forestadent devices, also known as functional appliances, are usually used in young patients to modify growth [18][19][20][21] . However, according to the literature, they can also be useful in patients who have already completed their growth period in order to change mainly dental positions.…”

Section: Discussionmentioning

confidence: 99%

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Raposo

Peleteiro

Paço

et al. 2018

International Journal of Oral and Maxillofacial Surgery

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Abstract. This systematic review was performed to compare dental, skeletal, and aesthetic outcomes between orthodontic camouflage and surgical-orthodontic treatment, in patients with a skeletal class II malocclusion and a retrognathic mandible who have already finished their growth period. A literature search was conducted, and a modified Downs and Black checklist was used to assess methodological quality. The meta-analysis was conducted using the DerSimonianLaird random-effects method to obtain summary estimates of the standardized mean differences and corresponding 95% confidence intervals. Nine articles were included in the qualitative synthesis and seven in the meta-analysis. The difference between treatments was not statistically significant regarding SNA angle, linear measurement of the lower lip to Ricketts' aesthetic line, convexity of the skeletal profile, or the soft tissue profile excluding the nose. In contrast, surgical-orthodontic treatment was more effective with regard to ANB, SNB, and ML/NSL angles and the soft tissue profile including the nose. Different treatment effects on overjet and overbite were found according to the severity of the initial values. These results should be interpreted with caution, due to the limited number of studies included and because they were non-randomized clinical trials. Further studies with larger sample sizes and similar pre-treatment conditions are needed.

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Section: Discussionmentioning

confidence: 99%

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Raposo

Peleteiro

Paço

et al. 2018

International Journal of Oral and Maxillofacial Surgery

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“…Three RCTs were included, with a final sample evaluation of 117 individuals in the incremental advance group and 101 individuals in the maximal advance group. Two studies evaluated different bite constructions in fixed FAs, one using Herbst appliance 8 and the other using functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany), 4 and one evaluated removable appliance (Twin‐Block) 18 . In fixed appliances, construction bite in the incremental group was performed with initial advancement about 4‐5 mm, followed by subsequent 2 mm advancements bimonthly.…”

Section: Resultsmentioning

confidence: 99%

“…In two instances, two references pertaining to the same trial were grouped together (Aras et al 4,16 and Amuk et al 8,17 ) to avoid data repetition during the analysis. The study with the newest or more inclusive sample was considered.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Treatments with removable appliances were performed at an early age, 6,[18][19][20] whereas treatments with fixed appliances were performed at a later age (with patients at peak or post-peak growth). 4,8 No study reported long-term outcomes and patient experiences and perceptions according to the type of construction bite used.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Frequently, a single major activation is performed to simplify the clinical management of the appliances. Nevertheless, some studies show that incremental advancement causes greater skeletal mandibular changes with similar 4,5 or lower dento-alveolar changes than single-step advancement. 6 On the other hand, greater skeletal effects 7 and lower proclination of mandibular incisor 8,9 with single-step mandibular advancement to incisor edge-to-edge position were reported.…”

Section: Introductionmentioning

confidence: 99%

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Incremental or maximal mandibular advancement in the treatment of class II malocclusion through functional appliances: A systematic review with meta‐analysis

Santana

Avelar

Flores‐Mir

et al. 2020

Orthod Craniofacial Res

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To systematically review the effects of functional appliances (FA) using incremental vs maximal mandibular advancement regarding cephalometric measurements in class II malocclusion individuals and to assess patient-centred-outcomes. Six electronic databases were searched without restrictions up to April 2020. We included randomized and non-randomized controlled trials using identical FA. Trials involving participants who used adjunct appliances, inter-maxillary elastics, who received surgical treatment or that recruited individuals with cleft lip/palate or craniofacial deformity/syndrome were excluded. Risks of bias assessments were performed using the Cochrane risk of bias tool-2 and ROBINS-I tools. Mean differences (MD) with their 95% confidence intervals were calculated from random-effects meta-analyses. The GRADE tool was used to assess the certainty of the evidence. Six studies were included. Low to very low certainty of evidence indicated that incremental mandibular advancement resulted in greater gains in mandibular length (MD = 0.89 [0.38, 1.34], P = .0005), anterior mandibular displacement (MD = 0.73 [0.40, 1.06], P < .0001) and SNB angle (MD = 0.44 [0.02, 0.85], P = .04). No significant differences were found for maxillary, dento-alveolar and upper airway outcomes between construction bite protocols (P > .05). Study design and appliance-related factors influenced the results of the subgroup analyses. Existing evidence is inadequate to assess patient-related response and long-term outcome could not be assessed. Currently, there are a heterogeneous number of studies with low quality and methodological issues can lead to biases that strongly limit an evidence-based conclusion. Weak evidence suggests gains in mandibular skeletal parameters in the short term using FA with incremental mandibular advancement. Randomized trials evaluating key topics such as patientcentred outcomes need to be conducted to guide clinical management. PROSPERO (CRD42019147436).

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Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

Batista

Thiruvenkatachari

Harrison

et al. 2018

Cochrane Database of Systematic Reviews

121

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Comparison of stepwise vs single-step advancement with the Functional Mandibular Advancer in Class II division 1 treatment

Abstract: Objective: To compare two groups of subjects at the peak of the pubertal growth period treated with the Functional Mandibular Advancer (FMA; Forestadent, Pforzheim, Germany) appliance using either single-step or stepwise mandibular advancement.

Cited by 24 publications

References 25 publications

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Incremental or maximal mandibular advancement in the treatment of class II malocclusion through functional appliances: A systematic review with meta‐analysis

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

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