Comparative efficacy of mandibular advancement aligners and conventional orthopedic appliances in treating class II malocclusion: a systematic review
Résumé
Abstract Background While mandibular advancement aligners (MAAs) have emerged as a treatment option for skeletal Class II malocclusions, their comparative efficacy versus conventional functional appliances remains to be fully established. Methods This systematic review followed PRISMA guidelines, searching PubMed and Cochrane Library databases using the PICO framework. Included studies were evaluated for quality and risk of bias according to their respective designs. Results Analysis of 13 eligible studies revealed: Comparable effectiveness in mandibular advancement (mean difference: 0.8 mm, p = 0.12). Similar improvements in ANB angle (mean reduction: 1.5° ± 0.3). Equivalent oropharyngeal space gains (+ 3.2 mm average). Notable differences included: Greater vertical dimension changes with conventional appliances (p < 0.05). Significantly higher patient preference (78%) and compliance rates with MAAs. However, the current evidence is limited by the retrospective design of most studies, small sample sizes, and variability in outcome measures. These methodological heterogeneities prevented the performance of a meta-analysis and restrict the generalizability of the findings. Conclusion MAAs demonstrate clinically similar dentoalveolar effects and airway improvements compared to conventional functional appliances, while offering superior patient comfort. Although their skeletal impact may be slightly less pronounced, MAAs represent an effective and patient-friendly alternative for managing growing Class II malocclusions. Clinical trial number PROSPERO registration number: CRD42024622119.
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