Table I.
Search strategies for electronic database.
| Step | PubMed | Embase, Scopus, WOS | CENTRAL, SIGLE, ProQuest |
|---|---|---|---|
| 1 | Fatigue Resistant Device* OR FRD OR Forsus | Fatigue Resistant Device* OR FRD OR Forsus | Forsus |
| 2 | Orthodontic Anchorage Procedures [MESH] OR miniscrew OR miniplate OR anchor* OR mini-implant* OR implant* OR TAD OR skeletal anchor* | Miniscrew OR miniplate OR anchor* OR mini-implant* OR implant* OR TAD OR skeletal anchor* | |
| 3 | 1 AND 2 | 1 AND 2 |
Figure 1.
PRISMA flow diagram of study inclusion.
Table II.
General information about included studies.
| Study ID | Study design | Patients characteristics | Grouping | Intervention protocol | Sample loss | Measurement modality | Outcomes reported |
|---|---|---|---|---|---|---|---|
| Aslan et al., 2014 (23) | RCT | n=33, M15:F18 Angle Class II (26 division 1, 7 division 2) | E: n=16, M5:F11, age:13.68±1.09y C: n=17, M10:F7, age:14.64±1.56y | E: FFRD+Miniscrew C: FFRD | None | Lateral Cephalogram T1: Before FFRD insertion (16*22 stainless-steel wires engaged) T2: After Class I molar relationship was achieved | Skeletal, dento-alveolar, soft tissue |
| Elkordy et al., 2016 (25) | RCT | n=31, M0:F31 Angle Class II division 1 | E: n=15, M0:F15, age:13.07±1.41y C: n=16, M0:F16, age:13.45±1.12y | E: FFRD+Mini-implant C: FFRD | None | CBCT T1: Before FFRD insertion (19*25 stainless-steel wires engaged) T2: After an edge-to-edge incisor relationship was achieved | Skeletal, dento-alveolar |
| Turkkahraman et al., 2016 (27) | CCT | n=30, M20:F10 Angle Class II division 1 | E: n=15, M13:F2, age:12.77±1.24y C: n=15, M7:F8, age:13.26±0.82y | E: FFRD+Miniplate C: FFRD | None | Lateral Cephalogram T1: Before FFRD insertion (16*22 stainless-steel wires engaged) T2: Class I molar relationship and overjet elimination achievement | Skeletal, dento-alveolar, soft tissue |
| Eissa et al.,2017 (24) | RCT | n=30, M11:F19 Angle Class II division 1* | E: n=15, M5:F10, age:12.53±1.12y C: n=15, M6:F9, age:12.76±1.00y* | E: FFRD+Miniscrew C: FFRD | 1 sample lost in the FFRD group | Lateral Cephalogram T1: Before FFRD insertion (19*25 stainless-steel wires engaged) T2: Class I or overcorrected Class I canine and molar relationship achievement | Skeletal, dento-alveolar, soft tissue |
| Elkordy et al.,2019 (26) | RCT | n=32, M0:F32 (allocated, 30 analysed) Angle Class II division 1 | E: n=16, M0:F16, age:12.5±0.9y C: n=16, M0:F16, age:12.1±0.9y | E: FFRD+Miniplate C: FFRD | Both groups have 1 sample lost | CBCT T1: Before FFRD insertion (19*25 stainless-steel wire engaged) T2: After an edge-to-edge incisor relationship was achieved or 10 months | Skeletal, dento-alveolar |
| Gandedkar et al.,2019 (28) | CCT | n=16, M0:F16 Angle Class II division 1 | E: n=8, M0:F8, age: 12.96±0.38y C: n=8, M0:F8, age: 13.11±0.38y | E: FFRD+Miniplate C: FFRD | None | CBCT T0: Pre-treatment T1: Class I molar relationship achievement (After removal of FFRD) T2: One-year post-treatment | Skeletal, dento-alveola, TMJ |
Table III.
Intervention details of included studies.
| Study ID | Brackets | Bonding protocol | TAD clinical protocol | Pushrod insertion site | Additional control |
|---|---|---|---|---|---|
| Aslan et al., 2014 (23) | Roth Slot size: 0.018-inch | E: Both arches (0.018*0.018-inch vertical slot brackets were bonded on lower canines) C: Both arches | Indirect anchorage One 1.5*8mm miniscrew(Spider, Fla) was inserted between lower canine and first premolar on each side; The miniscrew was connected to the vertical slot of lower canine by a 0.018*0.025 SS wire segment. | E: Mandibular archwires distal to canines C: Mandibular archwires distal to canines | Not mentioned |
| Elkordy et al., 2016 (25) | MBT (3M) Slot size: 0.022-inch | E: Both arches C: Both arches | Indirect anchorage One 1.6*10 mm mini-implant (3M Unitek) was inserted between lower canine and first premolar on each side; The mini-implant was connected to the labial surface of lower canine by a 0.019*0.025 SS wire segment. | E: Mandibular archwires distal to canines C: Mandibular archwires distal to canines | TPA: Cemented to upper first molars |
| Turkkahraman et al., 2016 (27) | Roth Slot size: 0.018-inch | E: Maxilla only C: Both arches | Direct anchorage Biforous miniplate was fixed on the mandible with head perforating at the canine region | E: The miniplate heads C: Mandibular archwires distal to canines | Not mentioned |
| Eissa et al., 2017 (24) | MBT (Ormco) Slot size: 0.022-inch | E: Both arches (Damon 3MX brackets with 0.018*0.018-inch vertical slot were bonded on lower canines) C: Both arches | Indirect anchorage One 1.6*10 mm miniscrew (MCT, Korea) was inserted between lower canine and first premolar on each side; The miniscrew was connected to the vertical slot of lower canine by a 0.016*0.016 SS wire segment. | E: Mandibular archwires distal to canines C: Mandibular archwires distal to canines | TPA: Cemented to upper first molars |
| Elkordy et al., 2019 (26) | MBT (3M) Slot size: 0.022-inch | E: Maxilla only C: Both arches | Direct anchorage Two Y shaped miniplate (Stryker, Germany) were fixed on the mandibular region between lower canines with head perforating at the canine region; | E: The miniplate heads C: Mandibular archwires distal to canines | TPA: Cemented to upper first molars |
| Gandedkar et al., 2019 (28) | Not specific*
Slot size: 0.022-inch | E: Both arches C: Both arches | Direct anchorage Two triangular miniplate (S.K. Surgical, India) were fixed in the anterior region of mandible with head perforating at the canine region** | E: The miniplate heads C: Mandibular archwires distal to canines*** | TPA: Cemented to upper first molars |
2* The type and brand of brackets were not specifically mentioned. Based on the pictures provided, the brackets used in the experimental group might be conventional brackets while those used in the controlled group might be SmartClip (3M) self-ligated brackets.
Figure 2.
Risk of bias summary for RCTs.
Table IV.
Risk of bias assessment for CCTs following Newcastle-Ottawa Scale.
| Selection (maximum 4 stars) | Comparability (maximum 2 stars) | Outcome (maximum 3 stars) | Total score (maximum 9 stars) | |
|---|---|---|---|---|
| Turkkahraman et al., 2016 (27) | 4 | 1 | 3 | 8 |
| Gandedkar et al., 2019 (28) | 3 | 1 | 2 | 6 |
Table V.
Definition of cephalometric values.
| Cephalometric value | Definition |
|---|---|
| Mandibular skeletal measurement | |
| Co-Gn | The linear distance between Condylion point and Gnathion point |
| Ar-Pog | The linear distance between Articulare point and Pogonion point |
| Go-Pog | The linear distance between Gonion point and Pogonion point |
| MP/SN | The angle formed between mandibular plane and line S-N |
| GoMe/FH | The angle formed between line Go-Me and Frankfort plane |
| Lower incisors inclination | |
| L1/MP | The angle formed between the L1 long axis and the mandibular plane |
| L1/NB | The angle formed between the L1 long axis and line N-B |
| L1/FP | The angle formed between the L1 long axis and the frontal plane |
| Soft tissue position measurement | |
| Lbinf-VRL | The distance from lower lip to a self-defined vertical reference line |
| Li-E | The distance from lower lip to E line |
| Li-S | The distance from lower lip to S line |
Table VI.
GRADE assessment for quality of available evidence.
| Quality assessment | Patients(n) | Relative effect (95% CI) | Quality | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Studies | Risk of bias | Inconsistency | Indirectness | Imprecision | Other | C* | E* | ||
| Mandibular length | |||||||||
| 6 | Not Serious | Serious | Not serious | Not serious | None | 86 | 85 | Not pooled | ⨁⨁⨁◯ Moderate |
| Mandibular rotation | |||||||||
| 6 | Not Serious | Serious | Not serious | Not serious | None | 86 | 85 | Not pooled | ⨁⨁⨁◯ Moderate |
| Lower incisors inclination | |||||||||
| 6 | Not Serious | Serious | Not serious | Not serious | None | 86 | 85 | Not pooled | ⨁⨁⨁◯ Moderate |
| Soft tissue position change | |||||||||
| 3 | Serious | Serious | Not serious | Serious** | None | 47 | 46 | Not pooled | ⨁◯◯◯ Very low |