Non-Cochrane · intervention · PM41877683
Efficacy of clear functional orthodontic appliances versus traditional functional appliances in the treatment of Class II malocclusion: A systematic review and meta-analysis.
Sohn Byung-Joo, Han Yoo-Kyung, Kim Na Jin, et al. · Korean journal of orthodontics · 2026 · PubMed · doi:10.4041/kjod25.197
Findings
Population Patients with skeletal Class II malocclusion
11 findings
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | ANB angle (anteroposterior skeletal relationship) Change from baseline to end of treatment · Trim-and-fill, before correction (k=5) | SMD -2.2304 [-3.1474, -1.3134] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | SNB angle (mandibular position) Change from baseline to end of treatment · Overall | SMD 0.29 [-0.34, 0.93] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Mandibular plane angle Change from baseline to end of treatment · Overall | SMD -0.59 [-1.46, 0.29] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | ANB angle (anteroposterior skeletal relationship) Change from baseline to end of treatment · Overall | SMD 0.33 [-0.43, 1.09] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Wits appraisal Change from baseline to end of treatment · Overall | SMD -0.03 [-0.92, 0.86] GRADE not reported 3 studies · 120 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | ANB angle (anteroposterior skeletal relationship) Change from baseline to end of treatment · Trim-and-fill, after correction (k=7, two studies imputed) | SMD -2.4011 [-3.2078, -1.5943] GRADE not reported 7 studies |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | SNA angle (maxillary position) Change from baseline to end of treatment · Overall | SMD 0.54 [-0.28, 1.36] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Maxillary incisor inclination Change from baseline to end of treatment · Overall | SMD 0.56 [-0.53, 1.66] GRADE not reported 4 studies · 142 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Mandibular incisor inclination (incisor-mandibular plane angle) Change from baseline to end of treatment · Overall | SMD 0.09 [-0.89, 1.07] GRADE not reported 5 studies · 166 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Mandibular length Change from baseline to end of treatment · Overall | SMD 0.01 [-0.36, 0.37] GRADE not reported 3 studies · 122 participants |
| Clear aligners with mandibular advancement (Invisalign) | Traditional functional appliances (Twin Block, Herbst, van Beek) | Overjet Change from baseline to end of treatment · Overall | SMD 0.17 [-0.61, 0.96] GRADE not reported 4 studies · 146 participants |
Included primary studies 5
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Caruso 2021 Mandibular advancement with clear aligners in the treatment of skeletal Class II. A retrospective controlled study. PMID:33719479 | 2021 | 1 other review | not stated | not extracted yet |
| He 2024 Comparison between clear aligners and twin-block in treating class II malocclusion in children: a retrospective study. PMID:39275829 | 2024 | 1 other review | not stated | not extracted yet |
| Hosseini 2024 A comparison of skeletal and dental changes in patients with a Class II relationship treated with clear aligner mandibular advancement and… PMID:37831020 | 2024 | 1 other review | not stated | not extracted yet |
| Lombardo 2024 Dentoskeletal effects of clear aligner vs twin block-a short-term study of functional appliances. PMID:36651930 | 2024 | 1 other review | not stated | not extracted yet |
| Wu 2023 Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances? PMID:36732724 | 2023 | 1 other review | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Comparative efficacy of clear aligner mandibular advancement versus traditional functional appliances for skeletal Class II malocclusion:… (2026) | 5 | 0.56 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with skeletal Class II malocclusion without trauma, orthognathic surgery, periodontal disease or systemic disorders | Growing patients with skeletal Class II malocclusion, 166 patients (n=5 studies) |
| Intervention | Clear aligners with mandibular advancement (Invisalign) | Clear aligner mandibular advancement, 77 patients (n=5) |
| Comparison | Traditional functional appliances (Twin Block, Herbst, van Beek) | Twin Block, Herbst or van Beek appliances, 89 patients (n=5) |
| Outcomes | Cephalometric skeletal and dental parameters: Wits, SNA, SNB, ANB, mandibular plane angle, overjet, maxillary and mandibular incisor inclination, mandibular length | SNA (n=5), SNB (n=5), ANB (n=5), overjet (n=4), Wits (n=3), mandibular plane angle (n=5), mandibular incisor inclination (n=5), maxillary incisor inclination (n=4), mandibular length (n=3) |
| Study designs | Non-randomized prospective and retrospective cohort studies published from 2017 | Non-randomized controlled studies, mostly retrospective (n=5) |
| Timing | Not specified | Treatment duration about 7 to 23 months where reported |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Yes · RCT: N/A | RCT: N/A · NRSI: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: No · RCT: N/A | RCT: N/A · NRSI: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |