Table I.
Search strategy used for PubMed.
| Search history | Number of results | |
|---|---|---|
| #1 | Maxillary protraction OR facemask OR face mask OR facial mask OR reverse headgear | 6340 |
| #2 | Class III OR Class 3 | 189199 |
| #3 | Malocclusion, Angle class III [Mesh] | 3528 |
| #4 | #2 OR #3 | 189199 |
| #5 | Primary dentition OR deciduous dentition | 15204 |
| #6 | Early mixed dentition OR late mixed dentition OR mixed dentition OR early permanent dentition | 3589 |
| #7 | #5 OR #6 | 17327 |
| #8 | #1 AND #4 AND #7 | 78 |
Figure 1.
Flow Diagram.
Table II.
Characteristics of the included studies.
| Study | Location | Study design | Dentition (year of age) | Sample size | Appliance |
|---|---|---|---|---|---|
| Kajiyama 2004 | Japan | CCT | Primary (5.6) Early mixed (8.7) | Primary (N=34) Early mixed (N=29) | FM |
| Lee 2010 | South Korea | CCT | Primary (6.1) Early mixed (8.4) | Primary (N=26) Early (N=23) | FM |
| Saadia 2000 | Mexico | CCT | Primary (3-6) Early mixed (6-9) Late mixed (9-12) | Primary (N=38) Early mixed (N=55) Late mixed (N=19) | FM+RME |
| Saadia 2001 | Mexico | CCT | Primary (3-6) Early mixed (6-9) Late mixed (9-12) | Primary (N=38) Early mixed (N=55) Late mixed (N=19) | FM+RME |
| Fareen 2017 | Malaysia | CCT | Early mixed (8-9) Late mixed (10-11) | Early mixed (N=20) Late mixed (N=26) | FM |
| Atalay 2010 | Turkey | CCT | Early mixed (8.18) Late mixed (11.75) | Early mixed (N=15) Late mixed (N=15) | FM |
| Cha 2003 | South Korea | CCT | Early 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 2002 | China | CCT | Early mixed (7.3) Late mixed (11.7) | Early mixed (N=32) Late mixed (N=11) | FM+RME |
| Baccetti 2000 | Italy | CCT | Early mixed (5.5-7.8) Late mixed (7.8-10) | Early mixed (N=16) Late mixed (N=13) | FM+RME |
| Baccetti 1998 | Italy | CCT | Early mixed (6.9) Late mixed (10.3) | Early mixed (N=23) Late mixed (N=23) | FM+RME |
| Merwin 1997 | Hong Kong | CCT | Early mixed (6.8) Late mixed (10.2) | Early mixed (N=15) Late mixed (N=15) | FM+RME |
| Liu 2013 | China | CCT | No information (8-15) | Late mixed (N=14) Early permanent (N=15) | FM |
| Yuksel 2001 | Turkey | CCT | Late mixed (9.8) Early permanent (12.6) | Late mixed (N=17) Early permanent (N=17) | FM |
| Takada 1993 | Japan | CCT | Early mixed (7.8) Late mixed (10.3) Early permanent (12) | Early mixed (N=20) Late mixed (N=22) Early permanent (N=19) | FM |
| Baik 1995 | South Korea | CCT | Early mixed (<10) Late mixed (10-12) Early permanent (>12) | Early mixed (N=11) Late mixed (N=21) Early permanent (N=15) | FM+RME |
| Kapust 1998 | America | CCT | Primary 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 |
Table III.
Risk of bias of the included studies assessed by ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions).
| Study | Bias due to confounding | Bias in selection of participants into the study | Bias in classification of interventions | Bias due to deviations from intended interventions | Bias due to missing data | Bias in measurement of outcomes | Bias in selection of the reported result | Overall risk of bias |
|---|---|---|---|---|---|---|---|---|
| Kajiyama 2004 | Moderate | Moderate | Low | Low | Low | No information | Low | Moderate |
| Lee 2010 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Saadia 2000 | Serious | Moderate | Low | Low | Low | No information | Low | Serious |
| Saadia 2001 | Serious | Moderate | Low | Low | Low | No information | Low | Serious |
| Fareen 2017 | Low | Low | Low | Low | Low | Low | Low | Low |
| Atalay 2010 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Cha 2003 | Moderate | Serious | Low | Low | Low | Low | Low | Serious |
| Wang 2002 | Serious | Serious | Low | Low | Low | Low | Low | Serious |
| Baccetti 2000 | Moderate | Low | Low | Low | Low | No information | Low | Moderate |
| Baccetti 1998 | Low | Low | Low | Low | Low | No information | Low | Low |
| Merwin 1997 | Serious | Serious | Low | Low | Low | Low | Low | Serious |
| Liu 2013 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Yuksel 2001 | Moderate | Moderate | Low | Low | Low | No information | Low | Moderate |
| Takada 1993 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Baik 1995 | Moderate | Moderate | Low | Low | Low | Moderate | Low | Moderate |
| Kapust 1998 | Low | Low | Low | Low | Low | Low | Low | Low |
Table IV.
Egger’s test for the analysis of small study effects on publication bias.
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).
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).
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).
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).
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).