Knösel Michael, Espinoza-Espinoza Gerardo Enrique, Sandoval-Vidal Paulo, Zaror Carlos
Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera (UFRO), Temuco, Chile.
Private Practice, Hamburg, Germany.
J Orofac Orthop. 2020 Jul;81(4):286-300. doi: 10.1007/s00056-020-00226-6. Epub 2020 May 20.
There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional appliances (FFA; RFA) for correction of Angle class II malocclusion is advantageous to produce dental, skeletal or condylar effects and has the lowest rate of undesired dental or technical side-effects.
A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent, adolescent, and adult humans with initial (pretreatment) Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with FFA or RFA in SW mandibular advancement; the control group received BJ advancement. Search terms included prospective randomized and nonrandomized trials in English, German, Spanish, and Portuguese with the primary outcomes of skeletal and dental class II correction, effects on condylar growth, lower incisor proclination, overjet and overbite reduction. The risk of bias (ROB) was assessed using the Cochrane Collaboration's ROB2 tool. Mean differences were calculated and pooled by a meta-analysis using a random effects model.
Data from five randomized controlled trials (RCT) with 401 participants (mean age 13.84 years; SD 1.53) were included; 331 derived from four studies were included in the meta-analysis. The ROB in the selected articles was high. We detected a slightly increased reduction of the ANB (mean difference [MD] -0.95°, 95% confidence interval [CI] -1.80 to -0.10°; I = 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in SW-advanced mandibles (MD 0.27°; 95% CI -0.47 to 1.00°; I = 38%). SW advancement tended to reduce the undesired side effect of lower incisor proclination (MD = -1.59°; 95% CI -3.98 to 0.8°; I = 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement.
There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with SW advancement compared to BJ, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers.
Prospero #CRD42017075469 (www.crd.york.ac.uk/prospero).
对于固定或可摘功能性矫治器（FFA；RFA）采用何种激活方式或下颌前伸方式（逐步前伸[SW]或最大咬跳前伸[BJ]）来矫治安氏II类错牙合更有利于产生牙齿、骨骼或髁突效应，且产生不良牙齿或技术副作用的发生率最低，目前尚无共识。
截至2019年10月20日，在MEDLINE、EMBASE、Scopus、Cochrane中央图书馆和BBO数据库中进行了系统检索。纳入对象为初诊（治疗前）安氏II类错牙合的儿童、青少年和成人，无进一步限制。干预组由接受FFA或RFA逐步下颌前伸治疗的受试者组成；对照组接受咬跳前伸治疗。检索词包括英文、德文、西班牙文和葡萄牙文的前瞻性随机和非随机试验，主要结局指标为骨骼和牙齿II类错牙合的矫治、对髁突生长的影响、下切牙前倾、覆盖减小和覆牙合减小。使用Cochrane协作网的ROB2工具评估偏倚风险（ROB）。采用随机效应模型通过荟萃分析计算并汇总平均差异。
纳入了5项随机对照试验（RCT）的数据，共401名参与者（平均年龄13.84岁；标准差1.53）；荟萃分析纳入了4项研究中的331名参与者。所选文章中的ROB较高。我们发现ANB减小略有增加（平均差异[MD] -0.95°，95%置信区间[CI] -1.80至-0.10°；I² = 72%），这可能归因于逐步前伸下颌时SNB角增加更为明显（MD 0.27°；95% CI -0.47至1.00°；I² = 38%）。逐步前伸倾向于减少下切牙前倾的不良副作用（MD = -1.59°；95% CI -3.98至0.8°；I² = 0%），表明咬跳前伸时下颌切牙变化更明显。
有微弱证据表明，与咬跳前伸相比，逐步前伸时ANB减小略有增加，下切牙前倾减少，但由于总体幅度较小且高质量论文数量较少，其临床相关性存在争议。
Prospero #CRD42017075469（www.crd.york.ac.uk/prospero）
