Comparison Between Skeletally-Anchored and Conventional Maxillary Protraction in Growing Class ΙΙΙ Patients: A Systematic Review and Meta-Analysis

IF 2.4 Q3 DENTISTRY, ORAL SURGERY & MEDICINE

Clinical and Experimental Dental Research Pub Date : 2026-09-27 DOI:10.1002/cre2.70466

Christianna Iris Papadopoulou, Nusha Paschaei, Giulia Brunello, Rebecca Jungbauer, Kathrin Becker

{"title":"Comparison Between Skeletally-Anchored and Conventional Maxillary Protraction in Growing Class ΙΙΙ Patients: A Systematic Review and Meta-Analysis","authors":"Christianna Iris Papadopoulou, Nusha Paschaei, Giulia Brunello, Rebecca Jungbauer, Kathrin Becker","doi":"10.1002/cre2.70466","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>The aim of this systematic review was to evaluate the skeletal and dental effects of skeletally-anchored (SA) maxillary protraction compared with conventional facemask (FM) therapy in growing patients with Class III malocclusion, while controlling for the confounding effect of rapid maxillary expansion (RME).</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>A systematic literature search (MEDLINE, Cochrane Library, Virtual Health Library, Web of Science, Google Scholar), which involved two screening stages, was performed until January 2026 and identified prospective clinical trials comparing SA with conventional tooth-borne FM therapy. Only studies in which expansion protocols were applied uniformly across groups were included. Risk of bias was assessed with RoB 2 and ROBINS-I tools, and random effects meta-analyses were conducted for cephalometric outcomes. The certainty of the evidence was evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) approach.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Five prospective trials (3 RCTs, 2 CCTs; <i>n</i> = 194 participants) met the inclusion criteria. Random-effects meta-analyses showed a modest but significant greater increase in SNA for SA (MD 0.65°; 95% CI 0.18–1.13, <i>I</i><sup>2</sup> = 0.0%) and consistently fewer dental side effects with SA: upper-molar mesialization (−1.14 mm; −2.12 to −0.17, <i>I</i><sup>2</sup> = 10.3%), molar extrusion (−0.74 mm; −1.07 to −0.40, <i>I</i><sup>2</sup> = 0.0%), and maxillary incisor proclination (−2.47°; −4.14 to −0.80, <i>I</i><sup>2</sup> = 0.0%). The mandibular plane rotation did not differ significantly (−0.38°; −1.67 to 0.91, <i>I</i><sup>2</sup> = 45.6%). Risk of bias was assessed as “some concerns” in RCTs and “serious” in non-randomized studies. The certainty of evidence ranged from very low to moderate according to GRADE.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Within the limitations of the available short-term evidence, and given the low-to-moderate certainty of the pooled estimates, SA was associated with fewer dental side effects and a statistically significant, though not clinically relevant, gain in skeletal efficacy. Future long-term, age-stratified randomized trials are needed to confirm the long-term stability of these findings.</p>\n </section>\n </div>","PeriodicalId":10203,"journal":{"name":"Clinical and Experimental Dental Research","volume":"12 5","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616234/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Dental Research","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cre2.70466","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The aim of this systematic review was to evaluate the skeletal and dental effects of skeletally-anchored (SA) maxillary protraction compared with conventional facemask (FM) therapy in growing patients with Class III malocclusion, while controlling for the confounding effect of rapid maxillary expansion (RME).

Materials and Methods

A systematic literature search (MEDLINE, Cochrane Library, Virtual Health Library, Web of Science, Google Scholar), which involved two screening stages, was performed until January 2026 and identified prospective clinical trials comparing SA with conventional tooth-borne FM therapy. Only studies in which expansion protocols were applied uniformly across groups were included. Risk of bias was assessed with RoB 2 and ROBINS-I tools, and random effects meta-analyses were conducted for cephalometric outcomes. The certainty of the evidence was evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

Results

Five prospective trials (3 RCTs, 2 CCTs; n = 194 participants) met the inclusion criteria. Random-effects meta-analyses showed a modest but significant greater increase in SNA for SA (MD 0.65°; 95% CI 0.18–1.13, I² = 0.0%) and consistently fewer dental side effects with SA: upper-molar mesialization (−1.14 mm; −2.12 to −0.17, I² = 10.3%), molar extrusion (−0.74 mm; −1.07 to −0.40, I² = 0.0%), and maxillary incisor proclination (−2.47°; −4.14 to −0.80, I² = 0.0%). The mandibular plane rotation did not differ significantly (−0.38°; −1.67 to 0.91, I² = 45.6%). Risk of bias was assessed as “some concerns” in RCTs and “serious” in non-randomized studies. The certainty of evidence ranged from very low to moderate according to GRADE.

Conclusions

Within the limitations of the available short-term evidence, and given the low-to-moderate certainty of the pooled estimates, SA was associated with fewer dental side effects and a statistically significant, though not clinically relevant, gain in skeletal efficacy. Future long-term, age-stratified randomized trials are needed to confirm the long-term stability of these findings.

查看原文本刊更多论文

骨骼固定与常规上颌牵引在生长级ΙΙΙ患者中的比较：系统回顾和荟萃分析。

目的：本系统综述的目的是在控制上颌快速扩张（RME）的混杂效应的同时，评估骨锚定（SA）上颌牵引与传统面罩（FM）治疗在生长中的III类错颌患者的骨骼和牙齿效果。材料和方法：系统的文献检索（MEDLINE， Cochrane图书馆，虚拟健康图书馆，Web of Science，谷歌Scholar），包括两个筛选阶段，进行到2026年1月，并确定了比较SA与传统牙源性FM治疗的前瞻性临床试验。仅纳入在各组间统一应用扩展方案的研究。使用rob2和ROBINS-I工具评估偏倚风险，并对头颅测量结果进行随机效应荟萃分析。根据推荐、评估、发展和评价（GRADE）分级方法评估证据的确定性。结果：5项前瞻性试验（3项随机对照试验，2项随机对照试验，n = 194名受试者）符合纳入标准。随机效应荟萃分析显示，SA的SNA增加幅度不大，但显著性更大（MD 0.65°；95% CI 0.18-1.13, I2 = 0.0%）， SA的牙齿副作用持续减少：上颌磨牙中牙化（-1.14 mm; -2.12至-0.17,I2 = 10.3%），磨牙挤压（-0.74 mm; -1.07至-0.40,I2 = 0.0%），上颌切牙前倾（-2.47°；-4.14至-0.80,I2 = 0.0%）。下颌平面旋转无明显差异（-0.38°；-1.67 ~ 0.91,I2 = 45.6%）。在随机对照试验中，偏倚风险被评估为“一些关注”，在非随机研究中，偏倚风险被评估为“严重”。根据GRADE，证据的确定性从非常低到中等。结论：在现有短期证据的限制下，考虑到汇总估计的低至中等确定性，SA与较少的牙齿副作用和统计学上显著的骨骼疗效相关，尽管与临床无关。未来的长期、年龄分层的随机试验需要证实这些发现的长期稳定性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical and Experimental Dental Research DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.30

自引率

5.60%

发文量

165

审稿时长

26 weeks

期刊介绍： Clinical and Experimental Dental Research aims to provide open access peer-reviewed publications of high scientific quality representing original clinical, diagnostic or experimental work within all disciplines and fields of oral medicine and dentistry. The scope of Clinical and Experimental Dental Research comprises original research material on the anatomy, physiology and pathology of oro-facial, oro-pharyngeal and maxillofacial tissues, and functions and dysfunctions within the stomatognathic system, and the epidemiology, aetiology, prevention, diagnosis, prognosis and therapy of diseases and conditions that have an effect on the homeostasis of the mouth, jaws, and closely associated structures, as well as the healing and regeneration and the clinical aspects of replacement of hard and soft tissues with biomaterials, and the rehabilitation of stomatognathic functions. Studies that bring new knowledge on how to advance health on the individual or public health levels, including interactions between oral and general health and ill-health are welcome.