Comparison of treatment outcomes with crowned and banded mandibular anterior repositioning appliance (MARA) in Class II pubertal subjects: A retrospective cohort study

Objective: To compare the skeletal and dentoalveolar changes in Angle Class II malocclusion subjects treated with the banded Mandibular Anterior Repositioning Appliance (Ba-MARA) and crowned MARA (Cr-MARA). Materials and methods: This retrospective cohort study included 40 consecutively treated pubertal adolescents with Class II division 1 malocclusion who received full-fixed orthodontic appliances with a phase of orthopedic treatment using Ba-MARA (n = 20) or Cr-MARA (n = 20). The samples were compared with 20 untreated Class II controls obtained from the Michigan Growth Study. Lateral cephalograms were obtained pre-treatment (T1), post-MARA removal (T2), and post-full-fixed orthodontic treatment (T3). Results: After MARA removal (T2-T1), the total mandibular length increased only in the Cr-MARA group compared to controls (Co-Gn = 5.4 mm; post-hoc P = 0.042). Overall dentoskeletal changes were less significant during the T3-T2 timepoint. After full-fixed orthodontic treatment (T3-T1), and after controlling for normal growth, both Ba- and Cr-MARA groups increased the total mandibular length by 3.1 mm and 3.8 mm respectively. Overjet decreased by 2.2 mm in Ba-MARA and 2.9 mm in Cr-MARA. The mandibular molars erupted and moved mesially in both treatment groups. The mandibular incisors proclined significantly in the Cr-MARA group in comparison to controls (IMPA = 7.1o, post-hoc P = 0.002). Conclusions: Both MARA designs were effective in correcting the malocclusion by a combination of small skeletal and dental changes. Although significant differences in dentoskeletal outcomes were observed between the MARA groups and the controls, the differences between the two MARA designs were small and did not achieve statistical/clinical significance.