Efficacy of clear functional orthodontic appliances versus traditional functional appliances in the treatment of Class II malocclusion: A systematic review and meta-analysis.

Abstract

<h4>Objective</h4>This study aimed to conduct a comprehensive meta-analysis of the cephalometric and dental repositioning outcomes in patients with skeletal Class II malocclusion treated with either traditional functional appliances or clear aligners with mandibular advancement.<h4>Methods</h4>A systematic literature search was performed using four major electronic databases: PubMed, Embase, the Cochrane Library, and Web of Science. Two independent reviewers selected studies based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework. Eligible studies were screened according to the predefined inclusion and exclusion criteria, and relevant data were extracted.<h4>Results</h4>After a multi-stage screening and selection process, five studies were included. Skeletal and dental parameters were analyzed to compare the treatment outcomes. For the SNA angle, the standardized mean difference (SMD) was 0.54 (95% confidence interval [CI]: -0.28 to 1.36; <i>P</i> = 0.1943); for the SNB angle, the SMD was 0.29 (95% CI: -0.34 to 0.93; <i>P</i> = 0.3607); and for the ANB angle, the SMD was 0.33 (95% CI: -0.43 to 1.09; <i>P</i> = 0.3970). The two treatment modalities showed no significant difference in the change in maxillary incisor angulation. Similarly, changes in the mandibular incisor angle and mandibular length did not differ significantly between the two treatment modalities.<h4>Conclusions</h4>Treatment outcomes showed no clinically significant differences between clear aligners with mandibular advancement and traditional functional appliances. This meta-analysis suggests that clear aligners with mandibular advancement may serve as alternatives for the treatment of skeletal Class II malocclusion, although high-quality randomized controlled trials are needed to confirm these preliminary findings.