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Table 5 Summary of findings table according to the GRADE approach

From: What effect does functional appliance treatment have on the temporomandibular joint? A systematic review with meta-analysis

  Anticipated absolute effects (95% CI)   
Outcome (follow-up) Studies (patients) Controla FA Difference with FA Quality of the evidence (GRADE)b What happens with FAs
Anterior joint space (6.0–9.4 mos) 54 patients (2 studies) < 0.1 mm 0.7 mm smaller (0.5 to 0.9 smaller) ⃝⃝⃝ very lowc Due to bias Might shrink anterior joint space
Posterior joint space (6.0–9.4 mos) 54 patients (2 studies) − 0.1 mm 1.0 mm larger (0.9 to 1.2 larger) ⃝⃝⃝ very lowc Due to bias Might enlarge posterior joint space
Superior joint space (6.0–9.4 mos) 54 patients (2 studies) − 0.2 mm 0.7 mm larger (0.5 to 1.0 larger) ⃝⃝⃝ very lowc Due to bias Might enlarge superior joint space
Anterior angle (6.0 mos) 58 patients (2 studies) − 0.8° 0.6° larger (3.9 smaller to 5.0 larger) ⃝⃝⃝ very lowc, d Due to bias, imprecision Little to no difference in anterior angle
Posterior angle (6.0 mos) 88 patients (3 studies) − 1.4° 7.3° smaller (16.7 smaller to 1.1 larger) ⃝⃝⃝ very lowc, d Due to bias, imprecision Little to no difference in posterior angle
Condylar coronary width (6.0–9.4 mos) 76 patients (2 studies) − 0.1 mm 1.1 mm wider (0.1 to 2.2 wider) ⃝⃝⃝ very lowc, d Due to bias, imprecision Might increase condylar coronary width
GleFo sagittal displacement (9.4–11.0 mos) 164 patients (2 studies) − 0.9 mm (posterior) 0.3 mm more posterior (0.7 less to 0.1 more) ⃝⃝⃝ very lowc Due to bias Little to no difference in glenoid fossa sagittal displacement
GleFo vertical displacement (9.4–11.0 mos) 164 patients (2 studies) 0.7 mm (superior) 0.4 mm more inferior (0.7 to 0.1 more) ⃝⃝⃝ very lowc Due to bias Little to no difference in glenoid fossa vertical displacement
Sagittal concentricity index (6.0–18.0 mos) 86 patients (2 studies) 1.3% 1.3% greater (22.3 smaller to 24.9 greater) ⃝⃝⃝ very lowc, d, e Due to bias, imprecision, inconsistency Little to no difference in sagittal concentricity
  1. Intervention: functional appliance treatment (Activator, Bionator, Forsus Nitinol Flat-Spring, Fränkel, Herbst, Twin Block) versus control (observation)/population: Class II adolescent patients/setting: university clinics, private practice (Brazil, Egypt, India, Thailand, Turkey, USA)
  2. CI confidence interval, FA functional appliance, GleFo glenoid fossa, GRADE Grading of Recommendations Assessment, Development and Evaluation, mos months
  3. aResponse in the control group is based on average response of included studies
  4. bStarts from “low,” due to the inclusion of randomized studies
  5. cDowngraded by one point for risk of bias (serious/critical risk of bias due to methodological limitations)
  6. dDowngraded by one point due to imprecision, as the optimal information size was judged not to be met and/or the summary estimate was strewn across different categories of effect magnitude
  7. eDowngraded one for inconsistency (I2 > 75%), which can affect our decision about the treatment effects