Non-Cochrane · intervention · PM41923072
Comparative efficacy of clear aligner mandibular advancement versus traditional functional appliances for skeletal Class II malocclusion: a systematic review and meta-analysis.
Huang Xinqi, Tao Yun, Huang Zhimao, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08175-z
Findings
Population Growing patients with skeletal Class II malocclusion (mandibular retrognathism)
18 findings
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal skeletal: Wits appraisal End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.15 [-5.68, 5.38] GRADE not reported 2 studies · 80 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal skeletal: SNA angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD 0.01 [-0.66, 0.68] GRADE not reported 5 studies · 172 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal dental: lower incisor inclination (IMPA) End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.9 [-1.38, -0.42] GRADE not reported 5 studies · 208 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal dental: overjet End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.46 [-0.86, -0.06] GRADE not reported 3 studies · 126 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Vertical dental: overbite End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -1.04 [-2.63, 0.54] GRADE not reported 2 studies · 102 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal skeletal: SNB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.09 [-0.93, 0.74] GRADE not reported 5 studies · 172 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Vertical skeletal: ANS-Me (lower facial height) End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.2 [-1.25, 0.85] GRADE not reported 2 studies · 86 participants |
| Clear aligner mandibular advancement (CAMA) | Traditional Twin Block (TB) | Sagittal skeletal: ANB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.1 [-0.36, 0.15] GRADE not reported 5 studies · 172 participants |
| Clear aligner mandibular advancement (CAMA) | Herbst appliance | Sagittal skeletal: SNB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.5 [-1.22, 0.21] GRADE not reported 2 studies · 65 participants |
| Clear aligner mandibular advancement (CAMA) | Herbst appliance | Sagittal skeletal: SNA angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD 0.13 [-0.35, 0.62] GRADE not reported 2 studies · 65 participants |
| Clear aligner mandibular advancement (CAMA) | Herbst appliance | Sagittal skeletal: ANB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD 0.53 [-0.15, 1.21] GRADE not reported 2 studies · 65 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal skeletal: ANB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months · Leave-one-out sensitivity analysis excluding Al Subaie 2024 | MD -1.55 [-2.16, -0.94] GRADE not reported 2 studies · 62 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal skeletal: ANB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.16 [-2.88, 2.55] GRADE not reported 3 studies · 132 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Vertical dental: overbite End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.68 [-1.63, 0.27] GRADE not reported 2 studies · 106 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal skeletal: SNA angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -0.05 [-0.52, 0.43] GRADE not reported 3 studies · 132 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal skeletal: Wits appraisal End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -2.51 [-4.98, -0.03] GRADE not reported 2 studies · 97 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal skeletal: SNB angle End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD 1.0 [0.34, 1.65] GRADE not reported 3 studies · 132 participants |
| Clear aligner mandibular advancement (CAMA) | Untreated Class II control (CON) | Sagittal dental: overjet End of treatment minus baseline (T2-T1 change); observation 11 to 20 months | MD -2.16 [-4.4, 0.08] GRADE not reported 2 studies · 106 participants |
Included primary studies 9
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 |
| Al Subaie 2024 Assessment of dental, skeletal, and soft tissue changes following mandibular advancement with Invisalign in skeletal Class II. PMID:38375387 | 2024 | this review only | not stated | not extracted yet |
| Behroozian 2025 Comparison of dental effects of traditional and clear twin block: A randomized clinical trial. PMID:40464027 | 2025 | this review only | not stated | not extracted yet |
| Feng 2024 Evaluation of modified clear Twin Block aligner in treating adolescents with skeletal class II malocclusion: A two-centre cephalometric… PMID:38558502 | 2024 | this review only | not stated | not extracted yet |
| Sun 2022 Comparison of cephalometric measurements of the Twin Block and A6 appliances in the treatment of Class II malocclusion: a retrospective… PMID:36111042 | 2022 | this review only | 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 |
|---|---|---|
| Efficacy of clear functional orthodontic appliances versus traditional functional appliances in the treatment of Class II malocclusion: A… (2026) | 5 | 0.56 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Growing patients with skeletal Class II malocclusion (mandibular retrognathism) confirmed by CVM or hand-wrist radiographs | Growing patients with skeletal Class II malocclusion, mean age 11.2 to 13.0 years (n=465) |
| Intervention | Clear aligner mandibular advancement (Invisalign MA, Angelalign A6 or similar with precision wings) | CAMA (Invisalign MA, Angelalign A6, Clear Twin Block) |
| Comparison | Traditional functional appliances (Twin Block, Herbst, Activator) or untreated Class II controls | Twin Block (TB); Herbst; Vanbeek Activator; untreated controls |
| Outcomes | SNB, ANB, SNA, Wits (primary); IMPA or L1-MP, overjet, overbite (secondary); protocol also planned soft tissue profile and mandibular dimensions (Co-Go, Go-Gn, Co-Gn) | Sagittal skeletal (Wits, SNA, SNB, ANB), sagittal dental (overjet, IMPA), vertical (overbite, ANS-Me); mandibular dimensions and soft tissue not synthesized |
| Study designs | RCTs and non-randomized studies of interventions (prospective and retrospective cohorts) | 9 studies: 1 RCT, 8 NRSIs |
| Timing | Change from pre-treatment (T1) to post-treatment (T2) | Treatment observation periods 11 to 20 months |