Efficacy of Bone Anchored Pendulum Appliance Over Conventional Pendulum Appliance during Molar Distalization in the Orthodontic Management of Class II Malocclusion : A Systematic Review

Abstract

Background: Pendulum appliance used commonly used to achieve molar distalization in the management of borderline class II malocclusion is associated with mesial tipping of the maxillary premolars and proclination of maxillary incisors post-distalization, resulting in round tripping and increased treatment time. Bone Anchored Pendulum Appliance (BAPA) is one of the modifications of the pendulum that could effectively prevent anchorage loss. Aim: To evaluate the effectiveness of Bone Anchored Pendulum Appliance(BAPA) over the Conventional Pendulum Appliance(CPA) for the distalization of maxillary molar in the management of  Class II malocclusion. Materials and Methods: A  web search was done in Google Scholar, MEDLINE, Web of Science, LILAC and COCHRANE Library  databases using PRISMA guidelines. The search included RCTs and Non RCTs  (Both  Prospective and Retrospective studies) comparing distalization achieved by BAPA with CPA in Class II malocclusion. The Risk of bias was assessed using the ROBINS - I tool.  Results: Of the initial 745 articles, 5 studies met the inclusion criteria and were included to the systematic review. The BAPA showed between 4.8 -6.4 mm of molar distalization and between  9 °-11.3° of distal tipping of molars while the distalization achieved with CPA was between 2mm -6.4mm with 6.67° -14.50° of distal tipping. While CPA groups showed mesial tipping of premolars, distal tipping of premolars was observed with the BAPA appliances. Conclusions: BAPA were found to significantly reduce anterior anchorage loss, distalise the premolars and molars. There is moderate evidence that BAPA provides greater distalization with reduced incidence of unwanted tooth movements.