Abstract
BACKGROUND: Skeletal Class II malocclusion, often associated with mandibular deficiency, is commonly treated with functional appliances. Precision Wings are a functional appliance that provides an alternative approach by combining mandibular advancement with dental alignment. OBJECTIVE: This systematic review aimed to evaluate the effectiveness of Precision Wings in treating skeletal Class II malocclusion in growing patients. ELIGIBILITY CRITERIA: Studies assessing the correction of skeletal Class II malocclusion in growing patients treated with Precision Wings were selected according to the PICOS strategy. The PRISMA guidelines were followed. INFORMATION SOURCES: Unrestricted electronic searches were conducted across seven databases up to February 2025. RISK OF BIAS AND SYNTHESIS OF RESULTS: The ROBINS-I tool was used to assess the risk of bias (RoB) in non-randomized studies. A random-effects meta-analysis was performed, and the certainty of the evidence was evaluated using the GRADE approach. RESULTS: Seven studies were included, and data were extracted. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. The findings suggest that Precision Wings may be effective in treating skeletal Class II malocclusion in growing patients through both dental and skeletal changes. Regarding skeletal effects, sagittal changes were limited to the mandible and were of small magnitude, with a reduction in ANB° (MD = -0.81; 95% CI: -1.04 to -0.58; p < 0.001) occurring exclusively due to an increase in SNB° (MD = 0.55; 95% CI: 0.11 to 0.98; p = 0.01), while no significant changes were observed in SNA° (MD = -0.02; 95% CI: -0.42 to 0.38; p = 0.91). The included studies did not report significant vertical effects. Meta-analyses comparing Precision Wings with other functional appliances were not feasible due to the small number of studies evaluating each comparison and the substantial clinical and methodological heterogeneity across the included studies. CONCLUSION: Although the available scientific evidence on this topic is limited, treatment with Precision Wings appears to offer minimal clinical improvement in mandibular growth for the correction of skeletal Class II malocclusion. To obtain more conclusive findings, future research should prioritize well-structured randomized clinical trials with standardized treatment protocols, extended follow-ups, and consistent cephalometric assessment methods.