Evidence map›Paper›PMID 40208272›Full record

SynthesisJournal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie2026

Coefficient of efficiency and effectiveness of functional appliances in class II malocclusion treatment : A systematic review.

Keerthi Venkatesan, Vignesh Kailasam, Sridevi Padmanabhan, Nikhillesh Vaiid

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Functional appliances and airway in class II malocclusion : An umbrella review and re-analysis of three meta-analyses.Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie · 2026
    Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Keerthi VenkatesanDepartment of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, 600116, Chennai, Tamil Nadu, India.ORCID http://orcid.org/0000-0001-9203-0511
Vignesh KailasamDepartment of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, 600116, Chennai, Tamil Nadu, India. vignesh.k@sriramachandra.edu.in.ORCID http://orcid.org/0000-0002-2848-9368
Sridevi PadmanabhanDepartment of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, 600116, Chennai, Tamil Nadu, India.ORCID http://orcid.org/0000-0002-0322-4136
Nikhillesh VaiidFaculty of Dentistry, National University of Singapore, Singapore, Singapore.ORCID http://orcid.org/0000-0001-8915-6033

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the coefficient of efficiency and effectiveness of removable and fixed functional appliances in class II malocclusion treatment. DATA SOURCES: Search of studies in five databases (Medline via PubMed, Cochrane library, LILACS, SCOPUS, and SciELO) that measured mandibular skeletal changes following functional therapy was conducted until 15 April 2024. STUDY SELECTION: All study designs including randomized and controlled clinical trials (RCT), prospective and retrospective studies were included. Data were extracted independently by two authors from studies that fulfilled the inclusion criteria. Mandibular length changes of class II patients treated with functional appliances were collated for each retrieved study.

resultsFrom 6796 potentially eligible studies, 90 were considered for this systematic review. Four were RCTs which were graded with the Cochrane risk of bias tool. Three were assessed as having low and one as having moderate risk of bias. The other 86 studies were graded with the modified Downs and Black tool which revealed that 47 showed low, 38 low/moderate, and 1 a moderate risk of bias. The most commonly assessed appliances were the Twin Block which was used on 783 patients, the Frankel appliance on 573, the Herbst appliance on 530, the Activator on 449, the Forsus appliance on 394, the MARA appliance on 202, and the Bionator on 133, for a total of 3064 treated patients.

conclusionThis systematic review provides conclusive evidence that the Twin Block appliance demonstrated the highest coefficient of efficiency among all the evaluated appliances (0.46 mm/month), while the Forsus fatigue resistant device (FFRD) had the highest coefficient of efficiency among the fixed functional appliances (0.41 mm/month).

Indexed as

Malocclusion, Angle Class IIOrthodontic Appliances, FunctionalOrthodontic Appliances, RemovableHumansOrthodontic Appliances, FixedRandomized Controlled Trials as TopicTreatment OutcomeDuration of treatmentFixed orthodontic appliancesMandibular lengthMandibular skeletal changesSystematic review

Identifiers

PMID40208272

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.