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Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis

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Abstract

Objective

The objective of this study was to evaluate the stability of treatment effects of maxillary protraction therapy in Class III children.

Materials and methods

Multiple electronic databases were searched from 01/1996 to 10/2016. Randomized clinical trials, controlled clinical trials, and cohort studies with untreated Class III controls and a follow-up over 2 years were considered for inclusion. The methodological quality of the studies and publication bias were evaluated. Mean differences and 95% confidence intervals (CI) of six variables (SNA, SNB, ANB, mandibular plane angle, overjet, and lower incisor angle) were calculated.

Results

Ten studies were included in the qualitative analysis, and four studies were included in the quantitative analysis. Compared with the control group, after treatment, the treated group showed significant changes: SNA +1.79° (95% CI: 1.23, 2.34), SNB −1.16° (95% CI −2.08, −0.24), ANB +2.92° (95% CI 2.40, 3.44), mandibular plane angle +1.41° (95% CI 0.63, 2.20), overjet +3.94 mm (95% CI 2.17, 5.71) and lower incisor angle −3.07° (95% CI −4.92, −1.22). During follow-up, the changes in five variables reflected significant relapse. Overall, the treated group showed significant changes only in ANB +1.66° (95% CI 0.97, 2.35) and overjet +2.41 mm (95% CI 1.60, 3.23).

Conclusions

Maxillary protraction can be a short-term effective therapy and might improve sagittal skeletal and dental relationships in the medium term. But some skeletal and dental variables showed significant relapse during the follow-up period. Long-term studies are still required to further evaluate its skeletal benefits.

Clinical relevance

The study evaluated the medium-term stability of skeletal and dental effects of maxillary protraction in Class III children and discussed whether the therapy can reduce the need for orthognathic surgery.

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Authors and Affiliations

  1. Department of Orthodontics, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, China

    Yifan Lin, Runzhi Guo, Liyu Hou, Zhen Fu & Weiran Li

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Appendix

Appendix

Table 4 Assessment of risk of bias for the RCT using Cochrane’s risk of bias tool
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Table 5 Quality assessment for non-randomized studies using MINORS
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Table 6 Egger’s test for the analysis of small study effects or publication bias
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Lin, Y., Guo, R., Hou, L. et al. Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis. Clin Oral Invest 22, 2639–2652 (2018). https://doi.org/10.1007/s00784-018-2363-8

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