Despite on-going debates about their efficacy, functional appliances are still widely accepted and used by clinicians. According to the RCTs and their interpretations, the end result would be the same and you will not have more than 2 mm of difference between different treatment modalities; however it has been repeatedly proven that there are significant variations between individuals in relation to their dental and skeletal changes and that is the most important common finding of all the studies in this field. This aspect of individual variation to treatment has to be considered and discussed in detail with patients and parents. We should not forget that the patient has 25% chance of obtaining a very good skeletal result and 25% chance of a very poor result or in between in 50% of the cases, instead of basing our treatment decision on the averages. Despite extensive research including the RCTs in the area of Class II correction using different treatment modalities many questions remain unanswered. Future research in growth and genetics has the potential to clarify important points in patient selection and treatment outcome.
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