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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) 25085296 | Yang/2014 | 7 included cohort studies | Meta-Analysis | | Key results | Short 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) 18929269 | Levin/2008 | 32 patients with Class III malocclusion treated with FR-3 | Prospective Cohort Study | | Key results | The 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) 8686678 | Firatli/1996 | 20 patients with Class III malocclusion treated with FR-3 | Case Control Study | | Key results | FR-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: |
11/29/2022 |
| 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
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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