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Dental developmental stage affects the treatment outcome of maxillary protraction in skeletal Class III children: A systematic review and meta-analysis

Australasian Orthodontic Journal
Volume 37 (2021): Issue 1 (January 2021)
By:
Open Access
|Jul 2021

Figures & Tables

Figure 1.

Flow Diagram.
Flow Diagram.

Figure 2.

Meta-analysis between primary dentition and early mixed dentition. The efficacy assessment of the primary dentition group for Class III malocclusion versus the early mixed dentition group. The comparison was performed using five indices. 1: Angle SNA. The primary dentition group presented a greater increase in SNA than the early mixed dentition group (MD = 1.23, 95% CI = 0.19 – 2.27, P = 0.02). 2: Angle SNB. There were no significant differences in SNB between the primary dentition group and the early mixed dentition group (MD = -0.61, 95% CI = -1.76 – 0.54, P = 0.30). 3: Angle ANB. The primary dentition group presented a greater increase in ANB than the early mixed dentition group (MD = 1.80, 95% CI = 0.39 – 3.20, P = 0.01). 4: SN/GoGn angle. The primary dentition group presented a greater increase in SN/GoGn angle than the early mixed dentition group (MD = 0.82, 95% CI = 0.29 – 1.34, P = 0.002). 5: ANS-Me length. The primary dentition group showed a greater increase in ANS-Me length than the early mixed dentition group (MD = 1.57 mm, 95% CI = 0.65 – 2.49, P < 0.001).
Meta-analysis between primary dentition and early mixed dentition. The efficacy assessment of the primary dentition group for Class III malocclusion versus the early mixed dentition group. The comparison was performed using five indices. 1: Angle SNA. The primary dentition group presented a greater increase in SNA than the early mixed dentition group (MD = 1.23, 95% CI = 0.19 – 2.27, P = 0.02). 2: Angle SNB. There were no significant differences in SNB between the primary dentition group and the early mixed dentition group (MD = -0.61, 95% CI = -1.76 – 0.54, P = 0.30). 3: Angle ANB. The primary dentition group presented a greater increase in ANB than the early mixed dentition group (MD = 1.80, 95% CI = 0.39 – 3.20, P = 0.01). 4: SN/GoGn angle. The primary dentition group presented a greater increase in SN/GoGn angle than the early mixed dentition group (MD = 0.82, 95% CI = 0.29 – 1.34, P = 0.002). 5: ANS-Me length. The primary dentition group showed a greater increase in ANS-Me length than the early mixed dentition group (MD = 1.57 mm, 95% CI = 0.65 – 2.49, P < 0.001).

Figure 3.

Meta-analysis between early mixed dentition and late mixed dentition. The efficacy assessment of the early mixed dentition group for Class III malocclusion versus the late mixed dentition group. The comparison was performed using six indices. 1: Angle SNA. There were no significant differences in SNA between the two groups (MD = -0.39, 95% CI = -0.82 – 0.05, P = 0.08). 2: Angle SNB. The early mixed dentition group presented a greater decrease in SNB than the late mixed dentition group (MD = -0.45, 95% CI = -0.85 – -0.06, P = 0.03). 3: Angle ANB. There were no significant differences in ANB between the two groups (MD = 0.01, 95% CI = -0.47 – 0.48, P = 0.98). 4: SN/GoGn angle. There were no significant differences in SN/GoGn angle between the two groups (MD = -0.21, 95% CI = -0.42 – 0.00, P = 0.05). 5: ANS-Me length. The late mixed dentition group presented a greater increase in ANS-Me length than the early mixed dentition group (MD = -1.13, 95% CI = -1.45 – -0.80, P <0.001). 6: overjet. The late mixed dentition group presented a greater increase in overjet than the early mixed dentition group (MD = -0.74, 95% CI = -0.98 – -0.50, P < 0.001).
Meta-analysis between early mixed dentition and late mixed dentition. The efficacy assessment of the early mixed dentition group for Class III malocclusion versus the late mixed dentition group. The comparison was performed using six indices. 1: Angle SNA. There were no significant differences in SNA between the two groups (MD = -0.39, 95% CI = -0.82 – 0.05, P = 0.08). 2: Angle SNB. The early mixed dentition group presented a greater decrease in SNB than the late mixed dentition group (MD = -0.45, 95% CI = -0.85 – -0.06, P = 0.03). 3: Angle ANB. There were no significant differences in ANB between the two groups (MD = 0.01, 95% CI = -0.47 – 0.48, P = 0.98). 4: SN/GoGn angle. There were no significant differences in SN/GoGn angle between the two groups (MD = -0.21, 95% CI = -0.42 – 0.00, P = 0.05). 5: ANS-Me length. The late mixed dentition group presented a greater increase in ANS-Me length than the early mixed dentition group (MD = -1.13, 95% CI = -1.45 – -0.80, P <0.001). 6: overjet. The late mixed dentition group presented a greater increase in overjet than the early mixed dentition group (MD = -0.74, 95% CI = -0.98 – -0.50, P < 0.001).

Figure 4.

Meta-analysis between late mixed dentition and early permanent dentition. The efficacy assessment of the late mixed dentition group for Class III malocclusion versus the early permanent dentition group. The comparison was performed using six indices. 1: Angle SNA. There were no significant differences in SNA between the two groups (MD = 0.61, 95% CI = -0.16 – 1.38, P = 0.12). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD =-0.10, 95% CI = -0.79 – 0.59, P = 0.78). 3: Angle ANB. There were no significant differences in ANB between the two groups (MD = 0.75, 95% CI = -0.48 – 1.99, P = 0.23). 4: SN/GoGn angle. There were no significant differences in SN/GoGn angle between the two groups (MD = 0.67, 95% CI = -0.83 – 2.18, P = 0.38). 5: overjet. There were no significant differences in overjet between the two groups (MD = 0.38, 95% CI = -0.45 – 1.22, P = 0.37). 6: Wits. There were no significant differences in Wits between the two groups (MD = -0.37, 95%CI = -2.07 – 1.32, P = 0.67).
Meta-analysis between late mixed dentition and early permanent dentition. The efficacy assessment of the late mixed dentition group for Class III malocclusion versus the early permanent dentition group. The comparison was performed using six indices. 1: Angle SNA. There were no significant differences in SNA between the two groups (MD = 0.61, 95% CI = -0.16 – 1.38, P = 0.12). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD =-0.10, 95% CI = -0.79 – 0.59, P = 0.78). 3: Angle ANB. There were no significant differences in ANB between the two groups (MD = 0.75, 95% CI = -0.48 – 1.99, P = 0.23). 4: SN/GoGn angle. There were no significant differences in SN/GoGn angle between the two groups (MD = 0.67, 95% CI = -0.83 – 2.18, P = 0.38). 5: overjet. There were no significant differences in overjet between the two groups (MD = 0.38, 95% CI = -0.45 – 1.22, P = 0.37). 6: Wits. There were no significant differences in Wits between the two groups (MD = -0.37, 95%CI = -2.07 – 1.32, P = 0.67).

Figure 5.

Meta-analysis between early mixed dentition and early permanent dentition. The efficacy assessment of the early mixed dentition group for Class III malocclusion versus the early permanent dentition group. The comparison was performed using three indices. 1: Angle SNA. The early mixed dentition group presented a greater increase in SNA than the early permanent dentition group (MD = 1.02, 95% CI = 0.05 – 2.0, P = 0.04). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD = -0.69, 95% CI = -2.08 – 0.70, P = 0.33). 3: Angle ANB. The early mixed dentition group presented a greater increase in ANB than the early permanent dentition group (MD = 1.89, 95% CI = 1.27 – 2.50, P < 0.001).
Meta-analysis between early mixed dentition and early permanent dentition. The efficacy assessment of the early mixed dentition group for Class III malocclusion versus the early permanent dentition group. The comparison was performed using three indices. 1: Angle SNA. The early mixed dentition group presented a greater increase in SNA than the early permanent dentition group (MD = 1.02, 95% CI = 0.05 – 2.0, P = 0.04). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD = -0.69, 95% CI = -2.08 – 0.70, P = 0.33). 3: Angle ANB. The early mixed dentition group presented a greater increase in ANB than the early permanent dentition group (MD = 1.89, 95% CI = 1.27 – 2.50, P < 0.001).

Figure 6.

Meta-analysis between primary dentition and late mixed dentition. The efficacy assessment of the primary dentition group for Class III malocclusion versus the late mixed dentition group. The comparison was performed using three indices. 1: Angle SNA. The primary dentition group presented a greater increase in SNA than the late mixed dentition group (MD = 0.62, 95% CI = 0.03 – 1.21, P = 0.04). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD = -0.44, 95% CI = -0.91 – 0.70, P = 0.04). 3: Angle ANB. The primary dentition group presented a greater increase in ANB than the late mixed dentition group (MD = 1.21, 95% CI = 0.51 – 1.92, P < 0.001).
Meta-analysis between primary dentition and late mixed dentition. The efficacy assessment of the primary dentition group for Class III malocclusion versus the late mixed dentition group. The comparison was performed using three indices. 1: Angle SNA. The primary dentition group presented a greater increase in SNA than the late mixed dentition group (MD = 0.62, 95% CI = 0.03 – 1.21, P = 0.04). 2: Angle SNB. There were no significant differences in SNB between the two groups (MD = -0.44, 95% CI = -0.91 – 0.70, P = 0.04). 3: Angle ANB. The primary dentition group presented a greater increase in ANB than the late mixed dentition group (MD = 1.21, 95% CI = 0.51 – 1.92, P < 0.001).

Risk of bias of the included studies assessed by ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions)_

StudyBias due to confoundingBias in selection of participants into the studyBias in classification of interventionsBias due to deviations from intended interventionsBias due to missing dataBias in measurement of outcomesBias in selection of the reported resultOverall risk of bias
Kajiyama 2004ModerateModerateLowLowLowNo informationLowModerate
Lee 2010ModerateModerateLowLowLowLowLowModerate
Saadia 2000SeriousModerateLowLowLowNo informationLowSerious
Saadia 2001SeriousModerateLowLowLowNo informationLowSerious
Fareen 2017LowLowLowLowLowLowLowLow
Atalay 2010ModerateModerateLowLowLowLowLowModerate
Cha 2003ModerateSeriousLowLowLowLowLowSerious
Wang 2002SeriousSeriousLowLowLowLowLowSerious
Baccetti 2000ModerateLowLowLowLowNo informationLowModerate
Baccetti 1998LowLowLowLowLowNo informationLowLow
Merwin 1997SeriousSeriousLowLowLowLowLowSerious
Liu 2013ModerateModerateLowLowLowLowLowModerate
Yuksel 2001ModerateModerateLowLowLowNo informationLowModerate
Takada 1993ModerateModerateLowLowLowLowLowModerate
Baik 1995ModerateModerateLowLowLowModerateLowModerate
Kapust 1998LowLowLowLowLowLowLowLow

Characteristics of the included studies_

StudyLocationStudy designDentition (year of age)Sample sizeAppliance
Kajiyama 2004JapanCCTPrimary (5.6)Early mixed (8.7)Primary (N=34)Early mixed (N=29)FM
Lee 2010South KoreaCCTPrimary (6.1)Early mixed (8.4)Primary (N=26)Early (N=23)FM
Saadia 2000MexicoCCTPrimary (3-6)Early mixed (6-9)Late mixed (9-12)Primary (N=38)Early mixed (N=55)Late mixed (N=19)FM+RME
Saadia 2001MexicoCCTPrimary (3-6)Early mixed (6-9)Late mixed (9-12)Primary (N=38)Early mixed (N=55)Late mixed (N=19)FM+RME
Fareen 2017MalaysiaCCTEarly mixed (8-9)Late mixed (10-11)Early mixed (N=20)Late mixed (N=26)FM
Atalay 2010TurkeyCCTEarly mixed (8.18)Late mixed (11.75)Early mixed (N=15)Late mixed (N=15)FM
Cha 2003South KoreaCCTEarly mixed (9.82)Late mixed (11.31)Early permanent (13.07)Early mixed (N=34)Late mixed (N=32)Early permanent (N=19)FM+RME
Wang 2002ChinaCCTEarly mixed (7.3)Late mixed (11.7)Early mixed (N=32)Late mixed (N=11)FM+RME
Baccetti 2000ItalyCCTEarly mixed (5.5-7.8)Late mixed (7.8-10)Early mixed (N=16)Late mixed (N=13)FM+RME
Baccetti 1998ItalyCCTEarly mixed (6.9)Late mixed (10.3)Early mixed (N=23)Late mixed (N=23)FM+RME
Merwin 1997Hong KongCCTEarly mixed (6.8)Late mixed (10.2)Early mixed (N=15)Late mixed (N=15)FM+RME
Liu 2013ChinaCCTNo information (8-15)Late mixed (N=14)Early permanent (N=15)FM
Yuksel 2001TurkeyCCTLate mixed (9.8)Early permanent (12.6)Late mixed (N=17)Early permanent (N=17)FM
Takada 1993JapanCCTEarly mixed (7.8)Late mixed (10.3)Early permanent (12)Early mixed (N=20)Late mixed (N=22)Early permanent (N=19)FM
Baik 1995South KoreaCCTEarly mixed (<10)Late mixed (10-12)Early permanent (>12)Early mixed (N=11)Late mixed (N=21)Early permanent (N=15)FM+RME
Kapust 1998AmericaCCTPrimary dentition (4-7)Early mixed (7-10)Late mixed (10-14)Primary dentition (N=15)Early mixed (N=32)Late mixed (N=16)FM+RME

Search strategy used for PubMed_

Search historyNumber of results
#1Maxillary protraction OR facemask OR face mask OR facial mask OR reverse headgear6340
#2Class III OR Class 3189199
#3Malocclusion, Angle class III [Mesh]3528
#4#2 OR #3189199
#5Primary dentition OR deciduous dentition15204
#6Early mixed dentition OR late mixed dentition OR mixed dentition OR early permanent dentition3589
#7#5 OR #617327
#8#1 AND #4 AND #778

Egger’s test for the analysis of small study effects on publication bias_

SNASNBANBSN/GoGnANS/MeOverjet
Primary dentition vs early mixed dentition0.5390.7040.6390.054N/AN/A
Early mixed dentition vs late mixed dentition0.0990.2170.1950.022* 0.001* 0.313
Late mixed dentition vs early permanent dentition0.7640.1440.5760.207N/A0.220
DOI: https://doi.org/10.21307/aoj-2021-004 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472
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Language: English
Page range: 37 - 49
Published on: Jul 13, 2021
Published by: Australian Society of Orthodontists Inc.
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2021 Wei Miao, Dan Zhou, Chunjie Li, Lichun Chen, Min Guan, Yiran Peng, Li Mei, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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