Post-graduation Program of Dentistry, Federal University of Pará (UFPA), Belém, Pará, Brazil.
Specialization in Orthodontics, Brazilian Dentistry Association, Belém, Pará, Brazil.
Eur J Orthod. 2020 Apr 1;42(2):163-173. doi: 10.1093/ejo/cjz089.
The effects of mandibular propulsion appliances in adults have some controversial results. While some authors claim that its use in non-growing patients could produce some dentoskeletal effects, other studies indicate that Class II correction occurs only through significant dental effects.
To evaluate the effects in non-growing Class II patients with mandibular retrusion, promoted by the treatment with mandibular propulsion appliances and determine if they produce mandibular changes.
The research was carried out in nine electronic databases and additional manual searches up to July 2019. Selection criteria were no restriction was placed on date and publication language. Randomized or non-randomized clinical trials with/without control were included. They must evaluated non-growing patients with Class II malocclusion, treated with mandibular propulsion appliances; outcomes were assessed before and after treatment.
Data were extracted by two independent examiners in duplicate. The ROBINS-I tool was used to assess the methodological quality of the included studies.
Of the 2824 articles identified, 11 non-randomized clinical articles were selected for qualitative analysis and 8 for quantitative analysis. SNB (0.87°, CI 95% 0.08, 1.66), ANB (-0.82°, CI 95% -1.24 to 0.40) and Pg/OLp [2.3 to 1.2 mm (P < 0.001)] presented smallest but significant mandibular changes with some differences regarding the used appliance. The Herbst appliance showed the largest mandibular changes followed by the SUS appliance when evaluated through Ar-Pg. SNA showed non-significant changes. Overbite (-2.85. CI 95% -3.06, -2.64), Overjet (-5.00.CI 95% -5.45, -4.55) showed significant changes in all devices. Class II correction occurs through a significant labial movement of the mandibular incisors, some lingual inclination of the maxillary incisors and minor skeletal changes.
All mandibular propulsion appliances examined, showed efficiency in normalizing the Class II malocclusion in adult patients; however, changes were acquired mainly through dentoalveolar changes. Some minor mandibular forward changes was noted, mainly in patients treated with the Herbst appliance. Randomized clinical trials are needed to improve scientific evidence.
PROSPERO (code CRD42017067384).
下颌前伸矫治器在成人中的作用存在一些有争议的结果。一些作者声称，在非生长患者中使用它可能会产生一些牙颌骨骼效应，但其他研究表明，只有通过显著的牙齿效应才能纠正 II 类错牙合。
评估下颌后缩的非生长 II 类患者用下颌前伸矫治器治疗的效果，并确定其是否会产生下颌变化。
本研究在 9 个电子数据库和 2019 年 7 月前的额外手动搜索中进行。选择标准没有对日期和出版语言进行限制。纳入了随机或非随机对照临床试验。它们必须评估用下颌前伸矫治器治疗的 II 类错牙合的非生长患者；在治疗前后评估结果。
两名独立的审查员分别重复提取数据。使用 ROBINS-I 工具评估纳入研究的方法学质量。
在 2824 篇文章中，选择了 11 篇非随机临床文章进行定性分析，8 篇进行定量分析。SNB（0.87°，95%CI0.08，1.66）、ANB（-0.82°，95%CI-1.24 至 0.40）和 Pg/OLp[2.3 至 1.2mm（P<0.001）]下颌骨发生最小但有统计学意义的变化，使用的矫治器有所不同。Herbst 矫治器显示下颌骨变化最大，其次是 SUS 矫治器时，用 Ar-Pg 评估。SNA 显示无显著变化。覆牙合（-2.85，95%CI-3.06，-2.64）、覆盖（-5.00，95%CI-5.45，-4.55）在所有装置中均显示出显著变化。所有下颌前伸矫治器都能有效地纠正成年患者的 II 类错牙合；然而，变化主要是通过牙颌变化获得的。在接受 Herbst 矫治器治疗的患者中，发现了一些轻微的下颌前突变化。需要进行随机临床试验以提高科学证据水平。
下颌前伸矫治器在成人患者中对纠正 II 类错牙合有效，但改变主要通过牙颌骨骼变化获得。一些轻微的下颌向前变化被观察到，主要是在接受 Herbst 矫治器治疗的患者中。需要进行随机临床试验以提高科学证据水平。
PROSPERO（编号 CRD42017067384）。
