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Title Frankel III Appliance Improves Mandibular Position and Overjet in Class III Malocclusions
Clinical Question In patients with class III malocclusions, does the Frankel III (FR-3) appliance improve the dentoalveolar positioning of teeth compared to untreated controls during phase 1 orthodontic treatment?
Clinical Bottom Line For patients with Class III malocclusion, the FR-3 appliance provides long term improvement in overjet and mandibular position as represented by SNB when compared to untreated controls.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25085296Yang/20147 included cohort studies Meta-Analysis
Key resultsShort term and long-term improvement in overjet compared to untreated controls was statistically significant (95% CI 2.93-4.01 mm and 3.78-5.35 mm, respectively). No significant improvement of overbite was seen in the short term (-0.53 to 0.65 mm) or long term (-3.71 to 1.58 mm). Statistically significant improvement of mandibular position as represented by SNB in long-term (95% CI, -2.12° to -.88°).
#2) 18929269Levin/200832 patients with Class III malocclusion treated with FR-3Prospective Cohort Study
Key resultsThe FR-3 appliance compared to controls included increased midfacial length 1.3 mm (p<0.01), SNA and Pt A-Na perp improved by 1.3° (p<0.001) and 0.8 mm (p<0.01). Overjet increased by 3.9 mm more than controls (p<0.001). No significant changes were seen in vertical dimension. Increase midface length continued in post-treatment phase, resulted in 3.5 mm increase over controls.
#3) 8686678Firatli/199620 patients with Class III malocclusion treated with FR-3Case Control Study
Key resultsFR-3 appliance caused significant (p<0.05) increase of intermolar (95% CI 0.3-0.7) and inter-premolar (95% CI 0.09-0.2) width in maxilla compared to untreated controls. There was no increase in nasal cavity width or stimulation of growth of maxilla.
Evidence Search “Frankel 3” AND “Orthodontics” “FR-3” AND “Orthodontics”
Comments on
The Evidence
When using the CEBM Systematic Review Analysis, the results from the systematic review were valid. They appropriately stated the clinical question, detailed comprehensive search strategies and inclusion/exclusion criteria, and used forest plots to show heterogeneity between the studies in various outcome measures.
Applicability While the literature supports statistically significant improvements with FR-3 treatment, the clinician needs to consider whether these changes are clinically significant enough to warrant implementation. The FR-3 appliance will have some cost associated with it, and it requires compliance by the patient over the course of years. In the Levin study, patients had to wear the appliance full time for 2.5 years and retention for 3 years. When considering that a second, comprehensive stage of orthodontic treatment will be needed, it may not provide enough additional benefit to the patient considering the increased treatment time.
Specialty/Discipline (Orthodontics)
Keywords FR-3 Frankel-3
ID# 3509
Date of submission: 11/29/2022spacer
E-mail arndtc@livemail.uthscsa.edu
Author Charlie Arndt, DDS
Co-author(s) Ben Bartlett, DDS
Co-author(s) e-mail bartlettb@uthscsa.edu
Faculty mentor/Co-author Maria Karakousoglou BDS, MS
Faculty mentor/Co-author e-mail karakousoglo@uthscsa.edu
Basic Science Rationale
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