Efficacy of Headgear Compared with Pendulum Appliance in the Treatment of Malocclusion: A Systematic Review and Meta-analysis

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Abstract Deciding between using pendulum appliance (PA) and headgear (HG) in patients with malocclusion (MA) is a critical one; it significantly influences treatment outcomes and patient experiences. This review explored the advantages and limitations of PA and HG in treating MA, providing valuable insights to both orthodontic professionals and patients in making informed treatment decisions. A systematic review and meta-analysis was conducted on quantitative randomized and nonrandomized trials published between 2003 and 2015. The publications were retrieved from five electronic databases: Web of Science, Cochrane Central, PubMed, Embase, and Medline. The effectiveness of various treatment modalities in addressing MA was measured by analyzing changes in the following parameters: maxillary skeletal position (SNA), mandibular skeletal position (SNB), maxillomandibular relationship (ANB), vertical components (SN.GoGn), and soft tissue (nasolabial). The pooled results were calculated using a random effects model, and Egger’s regression and funnel plots were employed to determine publication bias. One randomized controlled trial (RCT) and five non-RCTs with a total of 304 patients were included. The pooled results revealed nonsignificant differences in SNA (mean difference ratio: −0.35, P = 0.24, I 2 = 84.58%), ANB (mean difference ratio: −0.37, P = 0.43, I 2 = 91.60%), SN.GoGn (mean difference ratio: −0.24, P = 0.11, I 2 = 0%), SNB (mean difference ratio: 0.10, P = 0.45, I 2 = 0%), and nasolabial angle (mean difference ratio: −0.06, P = 0.72, I 2 = 0%). The absence of significant differences between these treatment modalities’ impact on the measured parameters challenges conventional orthodontic knowledge and highlights the complexity of MA correction. This study underscores the importance of personalized treatment planning and emphasizes that the choice between HG and PA should be guided by individual patient needs, treatment goals, and the specific characteristics of their MA.