{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T18:13:13Z","timestamp":1778609593805,"version":"3.51.4"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Class II malocclusion is primarily caused by mandibular retrusion and has significant functional, aesthetic, and psychological implications. Although there are many non-surgical treatment options available, their actual skeletal effects are still mild, varied, and not always reported. Clear conclusions have been limited by overlapping data and variable quality, despite these interventions being the subject of numerous systematic reviews (SRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To synthesize and critically appraise evidence from published SRs of the efficacy of orthodontic and dentofacial orthopaedic interventions for skeletal Class II malocclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Methods<\/jats:title>\n                    <jats:p>PubMed, Scopus, Embase and Google Scholar were systematically searched till May 2025. A manual citation search was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>SRs involving children or adolescents with clinically and\/or radiographically confirmed sagittal skeletal discrepancies, assessing non-surgical interventions against any comparator, and evaluating outcomes including skeletal changes, patient-reported measures, or operator-related measures, using qualitative, quantitative, or mixed synthesis, without restrictions on language or publication year, were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>Two independent reviewers selected the included reviews, initially by screening titles and abstracts, and then by reading the full texts. Methodological quality was evaluated using the AMSTAR-2, and the risk of bias was assessed using the ROBIS. Overlap of primary studies was quantified using the GROOVE tool. When second-order meta-analysis (meta-meta-analysis or MMA) was feasible, random-effects models were used; otherwise, narrative synthesis was performed. The certainty of evidence was rated using the GRADE method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-eight SRs were included. The most consistent skeletal improvements, particularly in ANB and SNB angles and mandibular length, were shown by removable functional appliances (RFAs), especially the Twin Block. Fixed functional appliances produced favourable but more variable effects, while headgear reduced maxillary growth but was compliance-dependent. Incremental mandibular advancement offered little advantage over single-step protocols, and no clear benefit was observed for early versus late treatment. Considerable heterogeneity and overlap across reviews limit confidence in pooled estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RFAs show the most consistent direction of skeletal improvement, although the magnitude of change is modest and the certainty of evidence is predominantly low. Findings for other approaches remain inconsistent and methodologically limited. Future research must incorporate standardized protocols, age-stratified outcomes, and patient-centred measures through rigorously designed randomized controlled trials to strengthen clinical guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO: CRD42024565809.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejo\/cjaf109","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:08:57Z","timestamp":1765458537000},"source":"Crossref","is-referenced-by-count":0,"title":["Non-surgical treatment of skeletal Class II malocclusion in children and adolescents: an umbrella review"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3724-9414","authenticated-orcid":false,"given":"Mayuri","family":"Mundhe","sequence":"first","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, 4th Floor, Prof. CP Govilla Memorial Dental Building, Faculty of Dental Sciences, King George\u2019s Medical University , Lucknow 226003 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6399-1513","authenticated-orcid":false,"given":"Abhisek","family":"Bhattacharjee","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, 4th Floor, Prof. CP Govilla Memorial Dental Building, Faculty of Dental Sciences, King George\u2019s Medical University , Lucknow 226003 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitesh","family":"Tewari","sequence":"additional","affiliation":[{"name":"Pediatric and Preventive Dentistry, Room Number 608, 6th Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences , New Delhi 110029 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richa","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, 4th Floor, Prof. CP Govilla Memorial Dental Building, Faculty of Dental Sciences, King George\u2019s Medical University , Lucknow 226003 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, 4th Floor, Prof. CP Govilla Memorial Dental Building, Faculty of Dental Sciences, King George\u2019s Medical University , Lucknow 226003 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"2026051213473421100_cjaf109-B1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1043\/0003-3219(1981)051&lt;0177:COCIMI&gt;2.0.CO;2","article-title":"Components of class II malocclusion in children 8\u201310\u2005years of age","volume":"51","author":"McNamara","year":"1981","journal-title":"Angle Orthod"},{"key":"2026051213473421100_cjaf109-B2","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/0002-9416(53)90082-7","article-title":"Cephalometrics for you and me","volume":"39","author":"Steiner","year":"1953","journal-title":"Am J Orthod"},{"key":"2026051213473421100_cjaf109-B3","author":"ABO"},{"key":"2026051213473421100_cjaf109-B4","doi-asserted-by":"publisher","first-page":"40.e1","DOI":"10.1590\/2177-6709.23.6.40.e1-10.onl","article-title":"Global distribution of malocclusion traits: a systematic review","volume":"23","author":"Alhammadi","year":"2018","journal-title":"Dent Press J Orthod"},{"key":"2026051213473421100_cjaf109-B5","doi-asserted-by":"publisher","first-page":"342","DOI":"10.4103\/jioh.jioh_305_21","article-title":"Class II division 1 malocclusion treatment trends in the last 10\u2005years by skeletal classification: a review article","volume":"15","author":"Ardani","year":"2023","journal-title":"J Int Oral Health"},{"key":"2026051213473421100_cjaf109-B6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ajodo.2015.01.030","article-title":"Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: results of a Cochrane systematic review","volume":"148","author":"Thiruvenkatachari","year":"2015","journal-title":"Am J Orthod Dentofac Orthop"},{"key":"2026051213473421100_cjaf109-B7","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1016\/j.ajodo.2003.06.001","article-title":"Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. 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