Cozza Paola, Baccetti Tiziano, Franchi Lorenzo, De Toffol Laura, McNamara James A
Department of Orthodontics, University of Rome Tor Vergata, Rome, Italy.
Am J Orthod Dentofacial Orthop. 2006 May;129(5):599.e1-12; discussion e1-6. doi: 10.1016/j.ajodo.2005.11.010.
The aim of this systematic review of the literature was to assess the scientific evidence on the efficiency of functional appliances in enhancing mandibular growth in Class II subjects. A literature survey was performed by applying the Medline database (Entrez PubMed). The survey covered the period from January 1966 to January 2005 and used the medical subject headings (MeSH). The following study types that reported data on treatment effects were included: randomized clinical trials (RCTs), and prospective and retrospective longitudinal controlled clinical trials (CCTs) with untreated Class II controls. The search strategy resulted in 704 articles. After selection according to the inclusion/exclusion criteria, 22 articles qualified for the final analysis. Four RCTs and 18 CCTs were retrieved. The quality standards of these investigations ranged from low (3 studies) to medium/high (6 studies). Two-thirds of the samples in the 22 studies reported a clinically significant supplementary elongation in total mandibular length (a change greater than 2.0 mm in the treated group compared with the untreated group) as a result of overall active treatment with functional appliances. The amount of supplementary mandibular growth appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation. None of the 4 RCTs reported a clinically significant change in mandibular length induced by functional appliances; 3 of the 4 RCTs treated subjects at a prepubertal stage of skeletal maturity. The Herbst appliance showed the highest coefficient of efficiency (0.28 mm per month) followed by the Twin-block (0.23 mm per month).
本系统文献综述的目的是评估功能矫治器促进安氏II类患者下颌生长有效性的科学证据。通过应用Medline数据库（Entrez PubMed）进行文献检索。检索涵盖1966年1月至2005年1月期间，并使用医学主题词（MeSH）。纳入以下报告治疗效果数据的研究类型：随机临床试验（RCT），以及以未经治疗的安氏II类患者为对照的前瞻性和回顾性纵向对照临床试验（CCT）。检索策略共得到704篇文章。根据纳入/排除标准筛选后，22篇文章符合最终分析要求。检索到4项RCT和18项CCT。这些研究的质量标准从低（3项研究）到中/高（6项研究）不等。22项研究中三分之二的样本报告称，由于使用功能矫治器进行全面积极治疗，下颌总长度出现了具有临床意义的补充性伸长（治疗组与未治疗组相比变化大于2.0mm）。如果在骨骼成熟的青春期高峰进行功能治疗，下颌补充性生长量似乎明显更大。4项RCT中没有一项报告功能矫治器引起下颌长度有临床意义的变化；4项RCT中有3项在骨骼成熟的青春期前阶段对受试者进行治疗。Herbst矫治器显示出最高的效率系数（每月0.28mm），其次是Twin-block矫治器（每月0.23mm）。
