Dental and Skeletal Effects of Herbst Appliance, Forsus Fatigue Resistance Device, and Class II Elastics-A Systematic Review and Meta-Analysis

Stefanos Matthaios, Apostolos I Tsolakis, Anna-Bettina Haidich, Ioannis Galanis, Ioannis A Tsolakis, Stefanos Matthaios, Apostolos I Tsolakis, Anna-Bettina Haidich, Ioannis Galanis, Ioannis A Tsolakis

Abstract

Background: Our study aimed to systematically summarize the dentoskeletal effects of Herbst appliance; Forsus fatigue resistance device; and Class II elastics in adolescent Class II malocclusion. Methods: Five databases; unpublished literature; and reference lists were last searched in August 2022. Randomized clinical trials and observational studies of at least 10 Class II growing patients that assessed dentoskeletal effects through cephalometric/CBCT superimpositions were eligible. The included studies quality was assessed with the RoB 2 and ROBINS-I tools. A random-effects model meta-analysis was performed. Heterogeneity was explored with subgroup and sensitivity analyses. Results: Among nine studies (298 patients); two-to-three studies were included in each meta-analysis. Less post-treatment upper incisor retroclination (<2) and no overbite; overjet; SNA; SNB; and lower incisor inclination differences were found between Herbst/Forsus and Class II elastics. No differences in maxilla; condyle; glenoid fossa; and most mandibular changes were found between Herbst and Class II elastics; except for a greater 1.5 mm increase in mandibular length and right mandibular ramus height (1.6 mm) with Herbst. Conclusions: Herbst and Class II elastics corrected the molar relationship; but Herbst moved the lower molars more mesially. Apart from an additional mandibular length increase; no other dental and anteroposterior skeletal difference was found. Forsus was more effective in molar correction; overjet reduction; and upper incisor control than Class II elastics. Trial registration number OSF: 10.17605/OSF.IO/8TK3R.

Keywords: class II elastics; class II malocclusion; forsus fatigue resistance device; functional appliances; herbst appliance; meta-analysis; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources [33].
Figure 2
Figure 2
Forest plot of the overjet changes using the random effects model [39,41,46].
Figure 3
Figure 3
Forest plot of the overbite changes using the random effects model [39,46].
Figure 4
Figure 4
Forest plot of the upper incisor inclination changes using the random effects model [39,41,46].
Figure 5
Figure 5
Forest plot of the lower incisor inclination changes using the random effects model [39,41,46].
Figure 6
Figure 6
Forest plot of the SNA angle changes using the random effects model [39,46].
Figure 7
Figure 7
Forest plot of the A point anteroposterior changes using the random effects model [43,44].
Figure 8
Figure 8
Forest plot of the ANS point anteroposterior changes using the random effects model [43,44].
Figure 9
Figure 9
Forest plot of the SNB angle changes using the random effects model [39,46].
Figure 10
Figure 10
Forest plot of the B point anteroposterior changes using the random effects model [43,44].
Figure 11
Figure 11
Forest plot of Pg point anteroposterior changes using the random effects model [43,44].
Figure 12
Figure 12
Forest plot of the right gonial angle changes using the random effects model [43,44].
Figure 13
Figure 13
Forest plot of the left gonial angle changes using the random effects model [43,44].
Figure 14
Figure 14
Forest plot of the right mandibular corpus length changes using the random effects model [43,44].
Figure 15
Figure 15
Forest plot of the left mandibular corpus length changes using the random effects model [43,44].
Figure 16
Figure 16
Forest plot of the left mandibular ramus height changes using the random effects model [43,44].
Figure 17
Figure 17
Forest plot of the right mandibular length changes using the random effects model [43,44].
Figure 18
Figure 18
Forest plot of the left mandibular length changes using the random effects model [43,44].
Figure 19
Figure 19
Forest plot of the right mandibular ramus height changes using the random effects model [43,44].
Figure 20
Figure 20
Forest plot of the right Co point anteroposterior changes using the random effects model [43,44].
Figure 21
Figure 21
Forest plot of the left Co point anteroposterior changes using the random effects model [43,44].
Figure 22
Figure 22
Forest plot of right anterior glenoid fossa anteroposterior changes using the random effects model [43,44].
Figure 23
Figure 23
Forest plot of the left anterior glenoid fossa anteroposterior changes using the random effects model [43,44].
Figure 24
Figure 24
Forest plot of right posterior glenoid fossa anteroposterior changes using the random effects model [43,44].
Figure 25
Figure 25
Forest plot of left posterior glenoid fossa anteroposterior changes using the random effects model [43,44].
Figure 26
Figure 26
Forest plot of the sensitivity analysis on upper incisor inclination changes using the random effects model [39,46].
Figure 27
Figure 27
Forest plot of the sensitivity analysis on lower incisor inclination changes using the random effects model [39,46].

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