Skeletal and dental effects of skeletally anchored forsus fatigue resistant devices during class II malocclusion treatment: A meta-analysis and systematic review.

Objective: To evaluate and compare the skeletal and dental treatment effects of Class II malocclusion cases using skeletally anchored Forsus (miniscrew-anchored FRD or miniplate-anchored FRD), with conventional Forsus FRD.

Materials and methods: Unrestricted electronic search of six databases and additional manual searches were performed up to July 2023. Randomized controlled trials having one treatment arm with skeletal anchored Forsus FRD in treatment of Class II malocclusion and another matched treatment group treated with conventional Forsus FRD were included in this review. Risk of bias assessment was performed using Cochrane's Risk of Bias Tool. No restrictions were set concerning treatment duration, or the cephalometric analysis used. Skeletal and dentoalveolar outcomes data were extracted by two authors independently.

Results: Three studies using miniscrews as means of skeletal anchorage were evaluated and qualified for the final review and meta-analysis. Three other studies using miniplates were considered in the systematic review but were not qualified for a meta-analysis. The data gathered from the miniscrews anchored FRD papers included a total of 93 Class II patients (46 treated with miniscrew-anchored Forsus FRD, 47 treated with conventional Forsus FRD). The meta-analysis showed a statistically significant reduction in the SNA angle in favor of miniscrew-anchored Forsus FRD (mean difference: -0.26, CI: -0.50 to -0.02), a nonsignificant difference in the SNB (mean difference: 0.17, CI: -0.06 to 0.39), a statistically significant increase in the SN-MP angle in favor of miniscrew-anchored Forsus FRD (mean difference: 0.53, CI: 0.06-1.00)-a statistically significant reduction in the L1-MP angle in favor of miniscrew-anchored Forsus FRD (mean difference: -2.12, CI: -4.96 to -2.12). Data from miniplate-anchored FRD included 31 Class II patients treated with mini plate anchored FRD. Although meta-analysis was not applicable to these studies, lower incisor inclination was observed to be less.

Conclusions: Based on the existing evidence, the use of skeletal anchorage could not enhance forward mandibular growth. However, miniscrew-anchored Forsus FRD could minimize mandibular incisor protrusion while miniplates could even retract the mandibular incisor position with a headgear effect on the maxilla.