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Title In Growing Class III Skeletal Patients, There Is No Clear Evidence That Bone-Anchored Maxillary Protraction Yields Greater Skeletal Changes Than Reverse-Pull Headgear
Clinical Question In growing class III skeletal patients, does bone-anchored maxillary protraction yield greater skeletal changes than reverse-pull headgear?
Clinical Bottom Line Systematic review and meta-analysis indicate no clear evidence that bone-anchored maxillary protraction yields greater skeletal changes than reverse-pull headgear. Although treatment of skeletal class III patients with bone-anchored maxillary protraction is an effective treatment option, there is no sufficient evidence of greater effect when compared to patients treated with reverse-pull headgear.
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) 28328995Rodríguez de Guzmán-Barrera / 2017410 patients in 9 studiesMeta-Analysis
Key resultsWhen comparing the skeletal anchorage (bone-anchored maxillary protraction) and facemask (reverse-pull headgear) groups, no significant difference was found in regards to overjet, ANB, or SNB between the two treatment groups. Wits and SNA showed greater results in the skeletal anchorage group than in the facemask group. Overall, there is insufficient evidence to say that one treatment modality is better than the other. Wits 1.28 mm (95%CI= 0.28 to 2.28 mm) (p=0.012) SNB 0.06° (95% CI= -0.32° to 0.44°) (p=0.764) SNA 0.60° (95%CI= 0.13° to 1.07°) (P=0.013) ANB 0.29° (95%CI= -0.28° to 0.87°) (p=0.314) Overjet -0.03 mm (95%CI= -0.70 to 0.64 mm) (p=0.923)
Evidence Search Search on PubMed: ("class"[All Fields] OR "classe"[All Fields] OR "classed"[All Fields] OR "classes"[All Fields]) AND "iii"[All Fields]
Comments on
The Evidence
The authors conducted the systematic review in accordance with the PRISMA criteria, but reported a lack of randomized controlled trials. It was also stated that “the heterogeneity of the studies does not provide the best conditions for meta-analysis.”
Applicability This data is relevant in growing patients with skeletal class III presentation. However, bone-anchored maxillary protraction would not be indicated for patients with syndromes or craniofacial abnormalities. It is also important to consider the higher cost associated with this treatment modality. Bone-anchored maxillary protraction should be considered in patients 11 years and older and patients who struggle with compliance.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics)
Keywords Class III, bone-anchored maxillary protraction, reverse-pull headgear
ID# 3512
Date of submission: 11/29/2022spacer
E-mail irimia@livemail.uthscsa.edu
Author Marco Irimia
Co-author(s) Jessica Koster
Co-author(s) e-mail Kosterj@uthscsa.edu
Faculty mentor/Co-author Maria Karakousoglou
Faculty mentor/Co-author e-mail karakousoglo@uthscsa.edu
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