Table 4 Summary of the studies included in the qualitative analysis

Ozbilek et al. [32]

Prospective study

(1) Full Class II molar relationship, (2) minimum 5 mm overjet, (3) horizontal or normal growth pattern, (4) minimal crowding, (5) no extracted or missing permanent teeth (excluding third molars)

15 patients/ Study 6 / Control 6 / Dropout 3

Study (3 boys, 3 girls), Control (3 boys, 3girls)

Study (12.9 ± 1.5 years), Control (12.3 ± 1.6 years)

Study: miniplates anchored Class II elastics

Control: monobloc appliance

In an active growth period (peak stage of pubertal growth determined according to the methods of Bjork, and Grave and Brown) MP3cap of the middle finger

Two miniplates were placed bilaterally at the ramus of the mandible and another two miniplates were placed at the aperture piriformis area of the maxilla

Study: direct

control: monobloc appliance

Al-Dumaini et al. [7]

Prospective study

(1) 10 to 13 years; (2) ANB ≥ 5°); (3) deficient mandible; (4) NAPg ≥ 190; (5) average or vertical pattern of growth; (6) ≥ 1/2 Class II molar and canine; (7) overjet ≥ 5 mm

54 patients /Study 28/Control 24/Dropout 2

Study (14 boys, 14 girls), Control (11 boys, 13 girls)

Study (11.83 ± 0.85 years), Control (11.75 ± 0.75 years)

Study: miniplates

Control: No treatment

Before the pubertal growth spurt (according to cervical vertebrae maturational index)

Two miniplates were placed bilaterally in the posterior buccal area above the external oblique ridge and another two miniplates were placed at the aperture piriformis area of the maxilla

Study: direct

control: no treatment

Manni et al. [33]

Prospective study

(1) Class II skeletal relationships (ANB ≥ 4◦), (2) overjet ≥ 4 mm, (3) bilateral Class II molar relationships ≥ half a cusp

26 patients / Study 13 /Control 13 / Dropout (-)

Study (10 boys, 3 girls), Control (3 boys,10 girls)

Study (12.8 ± 1.5 years), Control (12.2 ± 1.3 years)

Study: skeletally anchored Herbst appliance with miniscrews

Control: standard Herbst appliance without miniscrews

Patients near the pubertal growth spurt (determined by the cervical vertebral maturation [CVM] method; stage CVM 3)

In the maxillary and mandibular arch, miniscrews were placed between the mandibular first and second premolars or between the second premolars and the first molars in the attached gingiva depending on the subject's anatomy

Study: indirect

control: no miniscrew

Kochar et al. [34]

Prospective study

(1) Skeletal class II malocclusion due to mandibular retrognathism, (2) Angle class II division 1 malocclusion, (3) positive visualized treatment objective (VTO), (4) overjet greater than 6 mm, (5) average or horizontal growth pattern, (6) minimal crowding (< 3 mm) in both arches

32 patients / Study 16 / Control 16 / Dropout (-)

Study (8 boys, 8 girls), Control (9 boys,7 girls)

Study (12.37 ± 1.09 years), Control (12.06 ± 1.34 years)

Study: bimaxillary skeletal anchorage supported fixed function appliance

Control: No treatment

Peak of pubertal growth spurt (determined by the cervical vertebral maturation [CVM] method; stage CVM 3)

In the maxilla, “L” shaped bone plates were placed 4–5 mm above the apices of maxillary first molar and in the mandible “T” shaped plates were positioned along the mandibular canine

Study: direct

control: no treatment

Ozbilek et al. [32]

2 mm diameter × 7 mm length

500 g

2D (lateral cephalometry)

Angular measurements: SNA, SNB, ANB, angle of convexity, SN-Go-Gn, SN-PP, SN-OP, FMA, U1-PP, IMPA, U1-L1

Linear measurements Co-A, A-VRL, A-HRL, Co-Gn, B-VRL, B-HRL, Pog-VRL, Pog-HRL, Witts, U1-VRL, L1-VRL, overjet, overbite, Ls-VRL, Li-VRL, Pog(s)- VRL

Mean duration time was 0.68 ± 0.05 years for the elastics group and 0.65 ± 0.09 years for the monobloc group

1- Effective mandibular length was significantly greater in the miniplate-anchored group

2- Mandibular incisor retrusion was observed in the miniplate-anchored, whereas mandibular incisor protrusion was found in the monobloc group

Al-Dumaini et al. [7]

2 mm diameter × 6 mm length

450 g

250 g per side for the first 3 weeks followed by 350 g per side for the next 3 weeks to reach 450 g per side for the rest of the functional treatment phase

2D (lateral cephalometry)

Angular measurementsSNA, SNB, ANB, SNPog, NAPog, ArGoMe, SN-PP, SN-GoMe, U1-SN, L1-GoMe, U1-L1

A-Y axis, Ar-Go, Go-Me, Co-Go, Co-Pog, Pog-Y axis, B-Y axis, S-Go, N-Me, overjet, overbite

The initial alignment and leveling phase lasted for an average of 7 months followed by a functional phase for an average of 9 months

Bimaxillary miniplates-based skeletal anchorage results to increase in mandibular ramal and body lengths and counter-clockwise mandibular positioning

Manni et al. [33]

1.4 diameter mm × 8 mm length

Not reported

2D (lateral cephalometry)

Angular measurements SNA, SNB, ANB, SN/GoGn, Is/PP, Ii/GoGn,

Linear measurements Wits, A-OLp, Pg-OLp, Co-OLp, Is-OLp, Ii-OLp, Overjet, Ms-OLp, Mi-OLp

The mean treatment times were 10.0 ± 0.8 months in the treatment group and 10.8 ± 2.1 months in the control group

1- Anchorage reinforcement using miniscrews reduced flaring of the mandibular incisor

2- The upper molars showed a slightly forward movement in HA with miniscrew anchorage

Kochar et al. [34]

2 mm diameter × 7 mm length

Not reported

2D (lateral cephalometry)

Angular measurements SNA, SN-Pal Pl, NA-Pal Pl, SNB, FMA, SN-GoGn, IMPA, ANB, NA-Pog, interincisal angle

Linear measurements A-VP, N-ANS (perpendicular to HP), N-PNS (perpendicular to HP), U1-VP, U1-HP, U6-VP, U6-HP, B-VP, Pog-VP, Co-Gn, Go-Pog, L1-VP, L1-GoMe, L6-VP, L6-GoMe, overjet, overbite

The mean treatment time was 7.44 ± 1.06 months

Bimaxillary skeletal anchorage supported fixed functional appliance showed significant skeletal changes. The changes in the maxilla included retrusion and restricted posterior vertical growth. Mandibular changes included significantly increased mandibular growth with negligible effect on growth pattern