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Three-dimensional condylar and glenoid fossa changes following functional appliance therapy in class II malocclusion:
Sunidhi Kamboj1, Nishi Joshi2, Akhil Shetty1
1Department of Orthodontics and Dentofacial Orthopedics, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangalore, India.
Background:
Functional appliance therapy is widely used for the management of Class II malocclusion in growing patients, aiming to enhance mandibular growth through anterior repositioning of the mandible. This forward positioning is believed to induce adaptive remodeling within the temporomandibular joint (TMJ), particularly in the condyle and glenoid fossa. With the advent of cone-beam computed tomography (CBCT), three-dimensional evaluation of these structures has become more precise, however, existing evidence remains heterogeneous and inconclusive.
Objective:
To systematically evaluate three-dimensional changes in condylar morphology, position, and glenoid fossa remodeling following functional appliance therapy in growing patients with Class II malocclusion.
Methods:
This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420261379151). Electronic databases including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched up to December 2025. Studies involving growing patients treated with functional appliances and assessed using CBCT were included. Data extraction and quality assessment were performed independently by two reviewers using the Newcastle-Ottawa Scale and RoB 2 tool. Due to heterogeneity, a narrative synthesis was undertaken.
Results:
Seven studies comprising 258 patients were included. Twin Block appliances demonstrated significant increases in condylar volume and forward positioning, whereas Herbst appliances showed modest increases in condylar dimensions with relatively stable condyle-fossa relationships. Glenoid fossa remodeling was inconsistently reported. Overall, TMJ changes were mild to moderate, with variability across studies.
Conclusion:
Functional appliances induce adaptive three-dimensional changes in the condyle, while glenoid fossa remodeling is limited and inconsistent. Skeletal correction in Class II malocclusion appears multifactorial, with TMJ adaptation contributing modestly to treatment outcomes.
