Influence of ceramic (feldspathic) surface treatments on the micro-shear bond strength of composite resin

Objective:To test the null hypothesis that surface treatment has no influence on the micro-shear bond strength between orthodontic composite resin cement and ceramics (feldspathic porcelain).Materials and Methods:Circular specimens of feldspathic porcelain were fabricated and randomly divided into six groups: (1) no treatment; (2) treatment with a mixture of acidic primer and silane agent for 20 seconds; (3) etching with 9.5% hydrofluoric acid; (4) etching with 9.5% hydrofluoric acid and coating with a mixture of acidic primer and silane agent for 20 seconds; (5) airborne-particle abrasion with 50-μm aluminum oxide; and (6) airborne-particle abrasion and coating with a mixture of acidic primer and silane agent for 20 seconds. The porcelain disks were then bonded to resin cylinders with composite resin cement. A micro-shear bond test was carried out to measure the bond strength. Moreover, each ceramic surface was observed morphologically by scanning electron microscopy. One-way analysis of covariance was used to compare the groups for differences in micro-shear bond strength.Results:The mean micro-shear bond strength varied as a function of surface treatment. It ranged from 3.7 to 20.8 MPa. The highest values for micro-shear bond strength were found when the surface was acid-etched with hydrofluoric acid and coated with silane. On the other hand, the control group (no treatment) had significantly lower micro-shear bond strength than all the other groups.Conclusion:The null hypothesis that the surface treatment has no influence on the micro-shear bond strength of orthodontic composite resin was rejected. The bond strength between ceramics and orthodontic resin cement is affected by the ceramic surface treatment. The bond failure was of the adhesive type, except with the hydrofluoric acid + silane group, where it was a cohesive bond failure.     

Effects of different etching methods and bonding procedures on shear bond strength of orthodontic metal brackets applied to different CAD/CAM ceramic materials

Objective:To investigate the shear bond strength (SBS) of orthodontic metal brackets applied to different types of ceramic surfaces treated with different etching procedures and bonding agents.Materials and Methods:Monolithic CAD/CAM ceramic specimens (N = 120; n = 40 each group) of feldspathic ceramic Vita Mark II, resin nanoceramic Lava Ultimate, and hybrid ceramic Vita Enamic were fabricated (14 × 12 × 3 mm). Ceramic specimens were separated into four subgroups (n = 10) according to type of surface treatment and bonding onto the ceramic surface. Within each group, four subgroups were prepared by phosphoric acid, hydrofluoric acid, Transbond XT primer, and Clearfill Ceramic primer. Mandibular central incisor metal brackets were bonded with light-cure composite. The SBS data were analyzed using three-way analysis of variance (ANOVA) and Tukey HSD tests.Results:The highest SBS was found in the Vita Enamic group, which is a hybrid ceramic, etched with hydrofluoric acid and applied Transbond XT Adhesive primer (7.28 ± 2.49 MPa). The lowest SBS was found in the Lava Ultimate group, which is a resin nano-ceramic etched with hydrofluoric acid and applied Clearfill ceramic primer (2.20 ± 1.21 MPa).Conclusions:CAD/CAM material types and bonding procedures affected bond strength (P < .05), but the etching procedure did not (P > .05). The use of Transbond XT as a primer bonding agent resulted in higher SBS.     

Tensile bond strength of ceramic orthodontic brackets bonded to porcelain surfaces

The aim of this study was to compare various surface treatment methods to define the procedure that produces adequate bond strength between ceramic brackets and porcelain. The specimens used in this study, 60 porcelain tabs, were produced by duplication of the labial surface of a maxillary first premolar. The 6 different preparation procedures tested were: (1) sandblasting with 50 microm aluminum oxide in a sandblasting device, (2) application of silane to the porcelain and the bracket base, (3) sandblasting followed by application of silane, (4) acid etching with 9.6% hydrofluoric acid, (5) acid etching with 9.6% hydrofluoric acid followed by application of silane, and (6) sandblasting followed by application of 4-Meta adhesive. The ceramic brackets were bonded with no-mix orthodontic bonding material. A bonding force testing machine was used to determine tensile bond strengths at a crosshead speed of 0.5 mm per second. The results of the study showed that porcelain surface preparation with acid etching followed by silane application resulted in a statistically significant higher tensile bond strength (P < .05). Sandblasting the porcelain surface before silane treatment provided similar bond strengths, but sandblasting or acid etching alone were less effective. Silane application was recommended to bond a ceramic bracket to the porcelain surface to achieve bond strengths that are clinically acceptable.     

Evaluation of 24-hour shear bond strength of resin composite to porcelain according to surface treatment

PURPOSE: The purpose of the present in vitro study was to examine shear bond strengths of resin composite to porcelain according to surface treatment. MATERIALS AND METHODS: One hundred eight feldspathic porcelain blocks were prepared. Specimens were divided into nine surface treatment groups: sandblasting with 50- or 110-microm Al2O3, acid etching with hydrofluoric acid, applying silane agent, and combinations of these treatments. Microhybrid resin composite was condensed and light cured for 40 seconds on the porcelain specimens, which were then stored in distilled water at 37 degrees C for 24 hours before mechanical testing. RESULTS: The bond strengths were significantly different according to one-way ANOVA. The lowest bond strength was observed in the silane group (4.09 MPa); the highest bond strengths were observed with acid etching + silane (11.97 MPa) and sandblasting with 50-microm Al2O3 + acid etching + silane (12.34 MPa) (no significant difference between groups). CONCLUSION: Acid etching with 9.6% hydrofluoric acid gel or sandblasting with 50- or 110-microm Al2O3 particles alone did not provide adequate bond strength. Silane agent was effective in increasing the shear bond strength of resin composite to porcelain after sandblasting or acid etching. Porcelain treatment with a combination of 50-microm Al2O3 air abrasion, 9.6% hydrofluoric acid, and silane agent provided higher bond strengths than treatment with any of these procedures alone.     

A comparative evaluation of shear bond strength of porcelain and composite using different bonding agents — An in vitro study

Objective

The purpose of the present in vitro study is to compare and evaluate the shear bond strength of porcelain and composite using different bonding agents.

Materials and methods

Sixty-three porcelain pellets were prepared and were divided into 9 groups. Three surface treatment and two bonding agents were evaluated. The surface treatment were: 1) sandblasting; 2) etching with 35% phosphoric acid; and 3) etching with 8% hydrofluoric acid. Applying bonding agents Scotch bond adhesive and clearfil liner bond 2V and combination of these treatments. Composite resin was condensed and light cured for 60 seconds on the porcelain specimens which were stored in distilled water at 37°C for 24 hours before mechanical testing.

Results

The bond strength were significantly different according to ANOVA F-test (F = 6.28, p < 0.01) and Duncan’s Multiple Range Test. Eight percent hydrofluoric acid showed higher bond strength when compared to 35% phosphoric acid etching and sandblasting by 50 micron aluminum oxide. Highest bond strength was observed with hydrofluoric acid + clearfil.

Conclusion

Etching with 8% hydrofluoric acid + clearfil liner bond showed higher bond strength when compared to hydrofluoric acid alone. This is indicative that effect of silane and etching can be use to improve mechanico chemical bonding. Among bonding agents used clearfil liner showed higher bond strength when compared to scotch bond adhesive.     

Cleaning methods of contaminated zirconia: A systematic review and meta-analysis

ObjectivesThe aims of this study were to systematically review the literature and statistically analyze the effectiveness of different cleaning methods on the bond strength of resin cement to zirconia in short- and long-term aging conditions.Data/SourcesThe literature was electronically searched in PubMed (MEDLINE), EMBASE, Wiley, Scopus, and Open Access Theses and Dissertations databases to select relevant articles that evaluated the bond strength between contaminated zirconia and resin cements. A manual search was performed by scanning the reference lists of included studies.Study selectionAll articles were published online before April 2022 and in English. Meta-analyses were conducted using random effects models to calculate standardized mean differences (SMD) between uncontaminated zirconia and various cleaning methods in two aging conditions (short- and long-term). Statistical heterogeneity was assessed using I-square statistics. The risk of bias of all included studies was assessed. All statistical analyses were conducted using STATA (StataCorp, College Station, Texas).ResultsOf the 1181 studies, 25 studies met the inclusion criteria for qualitative analyses. In short-term aging condition, cleaning contaminated zirconia with water, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. For long-term aging condition, cleaning contaminated zirconia with water, cleaning agents, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. Alumina air-abrasion or cleaning with sodium hypochlorite were comparable to uncontaminated zirconia for both short- and long-term aging conditions.ConclusionsThis meta-analysis appeared to indicate that the cleaning methods of contaminated zirconia restoration have an effect on zirconia bonding.     

Influence of surface conditions and silane agent on the bond of resin to IPS Empress 2 ceramic

PURPOSE: The aim of this study was to evaluate the effect of different ceramic surface treatments on the tensile bond strength between IPS Empress 2 ceramic framework and Rely X adhesive resin cement, with or without the application of a silane coupling agent. MATERIALS AND METHODS: One hundred twenty disks were made, embedded in resin, and randomly divided into six groups: group 1 = sandblasting (100 microm), no silanation; group 2 = sandblasting (100 microm), silane treatment; group 3 = sandblasting (50 microm), no silanation; group 4 = sandblasting (50 microm), silane treatment; group 5 = hydrofluoric acid etching, no silanation; and group 6 = hydrofluoric acid etching, silane treatment. The disks were bonded into pairs with adhesive resin cement. All samples were stored in distilled water at 37 degrees C for 24 hours and then thermocycled. The samples were submitted to tensile testing. RESULTS: The use of silane improved the bond strength in relation to the groups in which silane was not applied (P < .05). The most effective surface treatment was etching with 10% hydrofluoric acid, both with (25.6 MPa) and without silane application (16.4 MPa); these values showed a statistically significant difference compared to sandblasting with 50- and 100-microm Al2O3. Sandblasting with 50-microm Al2O3, with (11.8 MPa) and without silane (5.4 MPa), demonstrated significantly higher tensile bond strength than sandblasting with 100-microm Al2O3, with (8.3 MPa) and without silane (3.8 MPa). CONCLUSION: Combined application of 10% hydrofluoric acid and silane enhanced the bond strength between the IPS Empress 2 ceramic framework and resin agent.     

Long-term skeletal stability after maxillary advancement with distraction osteogenesis in cleft lip and palate patients: A systematic review

Objective:To systematically review the long-term skeletal stability after maxillary advancement with distraction osteogenesis (DO) in cleft lip and palate (CLP) patients.Materials and Methods:Electronic databases, grey literature, and reference list searches were conducted. The inclusion criteria were stability of maxillary advancement with distraction osteogenesis assessed at the posttreatment follow-up ≥ 1 year in CLP patients. Full articles were retrieved from abstracts or titles that appear to meet the inclusion criteria or lacked sufficient detail for immediate exclusion. Once full articles were collected, they were again reviewed considering more detailed inclusion criteria for a final selection decision. A methodologic quality assessment tool was utilized.Results:Thirty abstracts/titles met the initial search criteria, and 13 articles were finally selected. Overall, methodologic quality scores were high in only one randomized clinical trial. After maxillary advancement with DO in CLP patients, the long-term horizontal relapse in A-point was less than 15% in eight studies and between 20% and 25% in four studies. The study that was judged as a high-quality study reported 8.2% horizontal relapse in A-point. The relapse rate was higher in DO with external distracter device than DO with internal distracter device.Conclusions:Current evidence suggests maxillary advancement with DO has good stability in CLP patients with moderate and severe maxillary hypoplasia.     

Association of genetic polymorphism and external apical root resorption

Objective:To evaluate the relationship between genetic polymorphism and external apical root resorption.Methodology:The protocol was prepared and registered on PROSPERO. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched.Results:Thirteen studies met the inclusion criteria. Four studies were classified as low-quality studies (score <10), and nine studies were classified as high-quality studies.Discussion:The results of the present review suggest that, although some authors have reported that genetic polymorphism may play a role in external apical root resorption, others have not supported this association. Future studies should be more consistent in their research methodologies to determine with clarity whether an association exists.Conclusion:Future investigations should include larger sample sizes with matching cases/controls, adjust for confounders, provide power calculation and odds ratios, and report genetic analyses with the Hardy-Weinberg equilibrium. The current investigation suggests guidelines and recommendations for future investigators studying genetic polymorphism in patients undergoing orthodontic treatment.     

The evaluation of commercially available silane coupling agents for porcelain adhesion

We investigated the effectiveness of commercially available silane coupling agents on the adhesion between the composite resin and the porcelain. As silane coupling agents, we used Cosmotech primer. Clearfil porcelain bond. Porcelain liner M, and Scotchprime. As porcelain, we used Cosmotech porcelain DA2 which was etched either with hydrofluoric acid or with phosphoric acid gel. The tensile bond strengths between composite resin and the porcelain treated with silane coupling agents were measured after one day immersion in 37 degrees C water. Among the silane coupling agents, Clearfil porcelain bond gave the highest bond strength of about 175 kgf/cm2. When any of these silane coupling agents were used, the bond strengths were increased more by hydrofluoric acid etching than by phosphoric acid etching. Especially in the case of Scotchprime treatment, hydrofluoric acid etching was remarkably effective on the increase in the bond strengths. The value in hydrofluoric acid etching was 3 times higher than that in phosphoric acid etching. From SEM observation, hydrofluoric acid etching gave greater roughness to the porcelain surface, which resulted in greater mechanical interlocking of the resin. In the case of Cosmotech primer treatment, the combination with GC bonding agent did not increase the bond strengths, while combination with Clearfil new bond did. The phosphoric acid ester monomer in Clearfil new bond, which is known as strong acid, was supposed to catalyze the activation of silane coupling agent.     

Bonding to industrial indirect composite blocks: A systematic review and meta-analysis

ObjectiveThe aim of this systematic review and meta-analysis was to evaluate the effect of surface conditioning methods on the bond strength of industrial indirect composite blocks (ICs).MethodsBased on the PICOS strategy, the Medline via PubMed, Embase and Web of Science (ISI – Web of Knowledge) electronic databases were searched for peer-reviewed articles in both English and Chinese, with no publication year limit. In vitro studies evaluating the effects of surface conditioning on the bond strength of ICs were selected. The meta-analysis was conducted to calculate the mean difference between surface-conditioned ICs and unconditioned controls. Subgroup analysis was performed to evaluate the different surface conditioning methods, separately for polymer-infiltrated ceramic network (PICN) material and the ICs with dispersed fillers (ICDFs). Meta-analyses were performed with a random-effects model at a significance level of 0.05.Results and SignificanceFrom 802 relevant studies, 25 were selected for full-text analysis. Nineteen studies were eligible for inclusion in this systematic review, whereas 9 studies were included in the meta-analysis. A manual search of the principal periodicals specific to the area resulted in no additional articles. The meta-analysis indicated a significant difference in bond strength between the surface-conditioned ICs and controls under both non-aged and aged conditions. The combination of mechanical and chemical conditioning yielded the highest bond strength of ICs. This meta-analysis suggests that chemical etching followed by a universal primer and alumina air abrasion followed by a silane coupling agent could be considered the best strategy for optimizing the bond strength of PICN materials and ICDFs under aged conditions, respectively.     

Micro-shear bond strength and surface micromorphology of a feldspathic ceramic treated with different cleaning methods after hydrofluoric acid etching

Objective

The aim of this study was to evaluate the effect of feldspathic ceramic surface cleaning on micro-shear bond strength and ceramic surface morphology.

Material and Methods

Forty discs of feldspathic ceramic were prepared and etched with 10% hydrofluoric acid for 2 minutes. The discs were randomly distributed into five groups (n=8): C: no treatment, S: water spray + air drying for 1 minute, US: immersion in ultrasonic bath for 5 minutes, F: etching with 37% phosphoric acid for 1 minute, followed by 1-minute rinse, F+US: etching with 37% phosphoric acid for 1 minute, 1-minute rinse and ultrasonic bath for 5 minutes. Composite cylinders were bonded to the discs following application of silane and hydrophobic adhesive for micro-shear bond strength testing in a universal testing machine at 0.5 mm/min crosshead speed until failure. Stereomicroscopy was used to classify failure type. Surface micromorphology of each treatment type was evaluated by scanning electron microscopy at 500 and 2,500 times magnification.

Results

One-way ANOVA test showed no significant difference between treatments (p=0.3197) and the most common failure types were cohesive resin cohesion followed by adhesive failure. Micro-shear bond strength of the feldspathic ceramic substrate to the adhesive system was not influenced by the different surface cleaning techniques. Absence of or less residue was observed after etching with hydrofluoric acid for the groups US and F+US.

Conclusions

Combining ceramic cleaning techniques with hydrofluoric acid etching did not affect ceramic bond strength, whereas, when cleaning was associated with ultrasound, less residue was observed.     

Durability of resin bonding to lithium disilicate using different self-etching and conventional ceramic primers after long-term aging

ObjectivesTo evaluate the bonding durability after artificial aging provided by a self-etching and a no-etching ceramic primer compared to primers, which are applied by the etch and rinse method.MethodsLithium disilicate blocks were bonded to a composite resin (Clearfill Core, Kuraray) using 5 bonding methods (N = 24). Specimens of group MEP were bonded using a self-etching primer and the corresponding luting resin (Monobond Etch&Prime/Variolink Esthetic, Ivoclar Vivadent) Specimens of group UBE were bonded using a two-bottle silane solution (Universal Primer/Estecem, Tokuyama) without hydrofluoric acid ceramic etching. Specimens of the other 3 groups were bonded using etch and rinse bonding systems with prior hydrofluoric acid ceramic etching (MPV: Monobond Plus/Variolink Esthetic, Ivoclar Vivadent; SUR: Scotchbond Universal/RelyX Ultimate, 3 M; GML: G-Multi Primer/G-CEM LinkForce, GC). Each group was divided into 3 subgroups (n = 8) according to the storage conditions (3 days water storage (37 °C), 30 days water storage, 7,500 thermal cycles (5–55 °C) and 150 days water storage, 37,500 thermal cycles). The tensile bond strength (TBS) was measured and the data was statistically analyzed.ResultsAfter 3 days the median TBS ranged from 14.6 to 41.7 MPa, after 30 days from 4.2 to 39.0 MPa and after 150 days from 0 to 29.7 MPa. Both bonding systems utilizing a self-etching primer showed a significantly lower TBS than group MPV using a conventional ceramic bonding system.SignificanceEspecially after long-term storage with additional thermal cycling the bonding systems using primers without hydrofluoric acid ceramic etching do not provide a high bond strength.     

The effect of different surface treatments on bond strength between leucite reinforced feldspathic ceramic and composite resin

Objectives

The aim of this study was to evaluate the effect of different surface treatments on the microtensile bond strength between a leucite reinforced glass–ceramic and composite resin.

Methods

Leucite reinforced ceramic blocks (n = 24) were constructed using the hot pressing technique. The blocks were assigned to 4 groups, which received the following surface treatments: G1: hydrofluoric (HF) acid and silane; G2: silane alone; G3: HF acid and silane then dried with warm air (100 °C); G4: silane alone then dried with warm air (100 °C). Unfilled resin was applied, followed by composite resin. Specimens were prepared and loaded in tension to determine the microtensile bond strength. Failure modes were classified by stereo- and scanning electron microscopy (SEM). Data was analysed using Kruskal–Wallis test followed by the Dunn's multiple range test.

Results

The groups including the warm air step (G3 and G4) achieved a significantly stronger adhesion than G1 and G2. Pre-treatment of the surface with hydrofluoric acid in G1 resulted in significantly higher bond strength than G2. Failures were mostly cohesive in the luting resin for G1, G3 and G4 and mainly adhesive at the ceramic–resin interface in G2.

Conclusions

The method of application of silane to the ceramic surface can have a significant influence on the adhesion between the ceramic restoration and the resin cement. Enhancing the condensation reaction by drying the silane with a 100 ?C warm air stream significantly improved the microtensile bond strength, possibly eliminating the need for the hydrofluoric acid etching step.     

三种酸蚀剂联合偶联剂对Cerinate瓷与树脂粘结强度的影响

目的：评价三种陶瓷酸蚀剂联合偶联剂对Cerinate瓷与树脂粘结强度的影响。方法：将252个Cerinate瓷试件分为3组,每组84个试件,分别用自制A配方（含2.5%氢氟酸）﹑B配方（含6%氢氟酸）、C配方（含10%氢氟酸）陶瓷酸蚀剂处理0 s﹑30 s﹑60 s﹑90 s、120 s、150 s、180 s后,一半使用偶联剂,另一半不使用偶联剂,与树脂粘结后测试其粘结强度。结果：无偶联剂组酸蚀30 s后C配方的剪切强度为27.46 MPa,偶联剂组在酸蚀30 s后C配方剪切强度可达31.08 MPa,酸蚀时间对粘结强度无明显影响。结论：C配方配合偶联剂较短酸蚀时间内可获得较理想的粘结强度。     

Do resin cement viscosity and ceramic surface etching influence the fatigue performance of bonded lithium disilicate glass-ceramic crowns?

ObjectiveTo assess the effects of a resin cement in high and low viscosity and distinct conditioning of the intaglio surface of lithium disilicate glass-ceramic crowns on fatigue performance of the crowns.MethodsProsthetic preparations (full-crown) in resin epoxy and crowns in lithium disilicate glass-ceramic were machined and allocated considering 2 factors (n = 10): “surface treatment” (HF – 5% hydrofluoric acid etching, followed by silane application; or E&P–self-etching ceramic primer) and “resin cement” (high or low viscosity). The preparations were etched with 10% hydrofluoric acid and an adhesive was applied. The intaglio surfaces of the ceramic crowns were treated as aforementioned (HF or E&P) and luted with high or low viscosity. The bonded sets were subjected to fatigue testing (step-stress approach: initial load of 200 N, step-size of 50 N, 10,000 cycles/step, 20 Hz) and complementary analyses (fractographic, topographic, and cross-sectional bonded interfacial zone analyses) were performed.ResultsTreatment with HF and silane with high viscosity resin cement (955 N/156,000 cycles) and E&P with low viscosity resin cement (1090 N/183,000 cycles) showed the best fatigue performance (statistical similarity between them). The failures originated from defects of the cement-ceramic interface, and the HF treatment induced a more pronounced topographical alteration.SignificanceDistinct topographical patterns from the HF and E&P treatments induced better fatigue results for the specific viscosity of the resin cement. Therefore, the fatigue performance depended on the existing topography, type of intaglio surface’s defects/irregularities after surface treatment, and how the luting agent filled the irregularities.     

Adhesive bonding of a lithium disilicate ceramic material with resin-based luting agents

This study evaluates the bonding characteristics of a lithium disilicate-based ceramic material (IPS Empress 2). Two sizes of disk specimens of the material were made, and three groups of disk pairs were separately surface-prepared using three techniques; etching with phosphoric acid, etching with hydrofluoric acid, and air-abrasion with alumina. Each group was further divided into four sub-groups; group (i) was bonded with the Variolink II composite, (ii) was treated with the Monobond-S silane primer and bonded with the Variolink II composite, (iii) was bonded with the Super-Bond acrylic adhesive and (iv) was treated with the Porcelain Liner M silane primer and bonded with the Super-Bond acrylic adhesive. Shear bond strengths were determined before and after 100 000 thermocycles. Bond strength varied from 10.6 to 71.5 MPa before thermocycling, whereas post-thermocycling bond strength ranged from 0 to 61.2 MPa. Among the three surface preparations, hydrofluoric acid etching (HF) was most effective in enhancing bond strength of both luting materials, especially for unsilanized specimens. Application of the silane primer elevated bond strength of both luting agents regardless of surface preparation method. It can be concluded, for both luting agents, that durable bond to the Empress 2 ceramic material can be achieved through the combined application of HF and the proprietary silane primer.     

Changes in apical base sagittal relationship in Class II malocclusion treatment with and without premolar extractions: A systematic review and meta-analysis

Objective:To evaluate the changes in apical base sagittal relationship in Class II treatment with and without premolar extractions.Materials and Methods:Controlled studies evaluating ANB angle changes after Class II Division 1 malocclusion treatment with or without premolar extractions were considered. Electronic databases (PubMed, Embase, Web of Science, Scopus, The Cochrane Library, Lilacs, and Google Scholar) without limitations regarding publication year or language were searched. Risk of bias was assessed with Risk Of Bias in Non-randomized Studies—of Interventions tool of the Cochrane Collaboration. Mean difference (MD) and 95% confidence interval (CI) were calculated from the random-effects meta-analysis. Subgroup and sensitivity analyses were also performed.Results:Twenty-five studies satisfied the inclusion criteria and were included in the qualitative synthesis. Eleven nonextraction and only one extraction Class II treatment studies presented untreated Class II control group. Therefore, meta-analysis was performed only for the nonextraction protocol. In treated Class II nonextraction patients, the average of the various effects was a reduction in the ANB angle of 1.56° (95% CI: 1.03, 2.09, P < .001) compared with untreated Class II subjects. Class II malocclusions treated with two maxillary-premolar extractions and four-premolar extractions produced estimated mean reductions in ANB of −1.88° and −2.55°, respectively. However, there is a lack of low-risk-of-bias studies.Conclusions:According to the existing low quality evidence, the apical base sagittal relationship in nonextraction, two-maxillary and four-premolar extractions Class II treatments decreases −1.56°, 1.88° and 2.55°, respectively. Further studies are necessary to obtain more robust information.