IADR Abstract Archives
Orthopedic correction for adolescents with retrognatic mandibular position. A systematic review and Meta-analysis.
Objectives: to establish whether the stepwise advancement orthopedic treatment is better than the traditional one bite jump method.
Methods: A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent and adolescent humans with Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with stepwise mandibular advancement; the control group received Bite jumping 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.
Results: 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 increased reduction of the ANB (mean difference [MD] –0.95°, 95% confidence interval [CI] –1.80 to –0.10°; I2= 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in stepwise advanced mandibles (MD 0.27°; 95% CI –0.47 to 1.00°; I2= 38%). Stepwise advancement tended to reduce the undesired side effect of lower incisor proclination (MD= –1.59°; 95% CI –3.98 to 0.8°; I2= 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement.
Conclusions: There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with Stepwise advancement compared to Bite jumping, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers.
Methods: A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent and adolescent humans with Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with stepwise mandibular advancement; the control group received Bite jumping 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.
Results: 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 increased reduction of the ANB (mean difference [MD] –0.95°, 95% confidence interval [CI] –1.80 to –0.10°; I2= 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in stepwise advanced mandibles (MD 0.27°; 95% CI –0.47 to 1.00°; I2= 38%). Stepwise advancement tended to reduce the undesired side effect of lower incisor proclination (MD= –1.59°; 95% CI –3.98 to 0.8°; I2= 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement.
Conclusions: There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with Stepwise advancement compared to Bite jumping, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers.