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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