Meta-analysis on the mandibular dimensions effects of the MARA appliance in patients with Class II malocclusions

Abstract

Objectives: To evaluate the short-and long-term effects of the mandibular anterior repositioning appliance (MARA) on mandibular dimensions in patients with Class II malocclusion and to assess the stability of the MARA results. Materials and Methods: Multiple electronic databases were searched for articles published in any language until March 2014. A manual search was also performed of reference lists of retrieved articles. The primary outcomes were the short-and long-term effects of the MARA appliance on mandible dimensions. The secondary outcome was postretention stability. Outcome measures were total mandibular unit length, corpus length, and ramus height. Two reviewers examined all articles independently and assessed their methodologic quality. Meta-analyses were conducted using random-effects models. The Cochrane test and the I 2 statistic were used to assess heterogeneity. Sensitivity analyses were performed and publication bias was evaluated. Results: Seven retrospective clinical controlled studies that compared MARA with controls were included. Three of the studies were medium quality; the rest were low quality. Meta-analysis of the short-term effects revealed a significant increase in total mandibular unit length (1.16 mm/y) and ramus height (1.58 mm/y) with MARA and a nonsignificant increase in corpus length (0.21 mm/y). Analyses of the long-term effects showed a statistically significant advantage of MARA over controls for all three variables, but the effect sizes were small. More high-quality studies are warranted. Conclusions: The MARA appliance produced statistically significant mandibular growth enhancement in the short-and long-term. These findings, however, may not be clinically significant. (Angle Orthod. 2015;85:706-714.)

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

“…Some evidence has shown how functional treatment for skeletal Class II malocclusion may be effective in terms of mandibular elongation [ 17 , 18 , 132 , 133 ] or dentoalveolar compensation [ 15 , 16 ]. On the contrary, other evidence reported minimal effects for such treatment [ 11 , 13 , 131 ]. The reason for this apparent inconsistency might reside in the different interventions performed [ 19 , 134 ], in the large variation in individual responsiveness to functional treatment [ 17 , 18 ] in conjunction with the absence of an analysis of potential prognostic factors [ 135 ], type of appliance [ 14 , 17 , 18 , 131 , 132 ], and patient's compliance for the removable appliances.…”

“…Herein, to report and evaluate critically current evidence on functional treatment for skeletal Class II malocclusion, data from most recent meta-analyses has been reviewed. Several meta-analyses on the efficiency of functional treatment for Class II malocclusion (skeletal or not) [ 11 – 19 , 131 – 133 ] have been published reporting contrasting results. Some evidence has shown how functional treatment for skeletal Class II malocclusion may be effective in terms of mandibular elongation [ 17 , 18 , 132 , 133 ] or dentoalveolar compensation [ 15 , 16 ].…”

“…The reason for this apparent inconsistency might reside in the different interventions performed [ 19 , 134 ], in the large variation in individual responsiveness to functional treatment [ 17 , 18 ] in conjunction with the absence of an analysis of potential prognostic factors [ 135 ], type of appliance [ 14 , 17 , 18 , 131 , 132 ], and patient's compliance for the removable appliances. Most recent meta-analyses [ 14 – 18 , 131 , 133 ] including untreated matched Class II control subjects with contrasting outcomes have been herein summarized ( Table 9 ). In particular, these meta-analyses have been analysed according to the main sources of controversies such as design of clinical trials, definition of Class II malocclusion, and skeletal maturity.…”

Optimization of Class II Malocclusion Treatments Using the Forsus™ Fatigue Resistance Device and Its Post-Treatment Effect in Adult Patients: A Case Report

“…The decision to treat this case using the Forsus hybrid functional appliance was taken due to the patient's main complaint, the characteristics of the malocclusion and, mainly, the facial features that have shown facial asymmetry within the normal standards, i.e., convex profile, but with passive lip seal, harmonic nasolabial angle and horizontal growth pattern [1,2,[4][5][6]8,9,12,25,28,30,33,34,35]. Other treatment options were considered unfavorable due to the presented clinical condition and the patient's main complaint and treatment choice.…”

“…The Forsus hybrid functional appliance is not as stiff as the orthopedic devices such as the Herbst [10,22,26], the APM [27,28] and the Mara [29,30], furthermore, it is not as fragile as the "Jasper Jumper" [10,11,31]. It is a comfortable device [7], as it does not completely limit the mandible movement and, in the current version, it shows a very low breakage rate [10,14,[32][33][34].…”