Interceptive Treatment of Class II Malocclusion in Pediatric Patients Using Clear Aligner Mandibular Advancement: A Systematic Review Following PRISMA Guidelines.

Abstract

While conventional functional appliances have been widely used to manage Class II malocclusion in growing pediatric patients, advancements in interceptive treatments have introduced aligner mandibular advancement as a modern and aesthetic alternative. Despite its increasing popularity, the effectiveness of aligner mandibular advancement has not been systematically evaluated. This systematic review aimed to evaluate the effectiveness of interceptive aligner mandibular advancement in the treatment of Class II malocclusion in pediatric patients, focusing on skeletal, dental, and soft tissue outcomes. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses or PRISMA guidelines. Studies evaluating pediatric patients with Class II malocclusion treated with aligner mandibular advancement were included. The databases searched included PubMed, Cochrane Library, Web of Science, Embase, and Scopus, with searches conducted up to November 30, 2024, to identify relevant articles addressing the PICOS framework (Population, Intervention, Comparison, Outcome, and Study design). The focus questions were: How effective is clear aligner mandibular advancement in the treatment of pediatric patients with Class II malocclusion? What are its associated treatment outcomes? The ROBINS-I tool was used to assess the risk of bias. Data were synthesized narratively due to heterogeneity in study designs and outcomes. Nine studies with 426 participants were included, conducted between 2021 and 2024. Seven studies adopted retrospective designs, one study used a prospective design, and one relied on a survey-based design. Aligner mandibular advancement demonstrated effectiveness in reducing overjet and ANB while maintaining lower incisor inclination compared to conventional functional appliances. Soft tissue improvements were also reported. Patients favored aligner mandibular advancement over conventional functional appliances for its superior comfort, better aesthetics, and less breakage. However, most studies were retrospective, and the lack of randomized controlled trials limited the strength of the evidence. Clear aligner mandibular advancement appears to be an effective approach for managing Class II malocclusions in growing pediatric patients, offering the distinct advantage of maintaining lower incisor inclination compared to other conventional functional appliances. However, the evidence remains limited due to methodological constraints, including the lack of randomized controlled trials, small sample sizes, and inconsistencies in study designs.