Mandibular effects of temporary anchorage devices in Class II patients treated with Forsus Fatigue Resistant Devices: A systematic review

Objective: To determine whether temporary anchorage devices (TADs) could enhance the mandibular effects of Forsus Fatigue Resistant Devices (FFRD) in growing patients presenting with a Class II malocclusion.

Materials and methods: Without language restriction, electronic and manual searches were conducted through databases and relevant journals until the 20th February, 2020. Studies comparing the therapeutic effects in Class II patients treated with TA-anchored FFRD and patients receiving conventional FFRD were considered eligible. Two reviewers independently conducted the study inclusion, data extraction and risk of bias assessment following Cochrane guidelines. The outcomes were qualitatively synthesised and the level of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results: Six studies meeting the selection criteria were identified. All except one reported that a greater reduction in the proclination of the mandibular incisors was achieved in TAD-anchored groups compared with the conventionally-treated groups. Controversial results were found in the skeletal and soft tissue descriptions of positional change. The evidence quality varied from very low to moderate.

Conclusion: Moderate-quality evidence suggests that TADs are beneficial in reducing the proclination of the mandibular incisors caused by FFRD in Class II patients. Controversies related to the effects on mandibular growth and soft tissue positional change remain. There is a trend that miniplates may enhance the mandibular skeletal effects of FFRD better than miniscrews but further investigation is indicated.