Title Surgical-Orthodontic Treatment is More Effective for Improving Specific Skeletal Measurements and Soft Tissue Profile Including the Nose When Compared to Orthodontic Camouflage Treatment in Non-Growing Patients with Skeletal Class II Malocclusion.
Clinical Question For adult orthodontic patients with a skeletal class II malocclusion, how does surgical-orthodontic treatment, when compared to orthodontic camouflage treatment, affect the patient’s dental, skeletal, and esthetic measurements?
Clinical Bottom Line Surgical-orthodontic treatment is more effective for improving specific skeletal measurements and soft tissue profile including the nose when compared to orthodontic camouflage treatment in non-growing patients with skeletal class II malocclusion. This is supported by a meta-analysis in which surgical-orthodontic treatment outperformed orthodontic camouflage treatment by a statistically significant margin regarding the SNB angle, the ANB angle, and the soft tissue profile including the nose. However, no difference was found with respect to SNA angle, convexity of the skeletal profile, lower lip to Ricketts Esthetic Line, and soft tissue profile excluding the nose. Additional clinical evidence is needed using a larger sample size, comparing groups with similar pre-treatment conditions, and following a standardized recall protocol.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
28966066Raposo 2017Nine studies, which included 352 patients who received surgical-orthodontic treatment and 258 patients who received orthodontic camouflage treatment. Meta-Analysis
Key resultsThroughout the seven studies included in the meta-analysis, surgical-orthodontic treatment was found to outperform orthodontic camouflage treatment for the SNB angle (SMD -0.51, 95% CI -0.86 to -0.16), ANB angle (SMD -1.04, 95% CI -1.38 to -0.70), and soft tissue profile including the nose (SMD -0.48, 95% CI -0.87 to -0.10). However, no statistically significant difference was observed for SNA angle (SMD 0.04, 95% CI -0.37 to 0.44), convexity of the skeletal profile (SMD -0.30, 95% CI -0.67 to 0.06), linear measurement of LL to the Ricketts Esthetic Line (SMD -0.04, 95% CI -0.45 to 0.37), and soft tissue profile excluding the nose (SMD -0.36, 95% CI -0.73 to 0.01).
Evidence Search (Surgical orthodontic) AND (orthodontic camouflage) AND (class II)
Comments on
The Evidence
Validity: This systematic review and meta-analysis of non-randomized clinical trials was conducted according to the PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Investigators searched for qualifying papers using electronic databases of both published and non-published literature. Two reviewers independently conducted the study selection in an unblended standardized manner according to explicit criteria, with disputes settled by a third author when necessary. The two investigators used a modification of the Downs and Black Checklist for assessment of the methodological quality of non-randomized studies, which included 27 items related to quality of reporting, external validity, internal validity in terms of bias, internal validity in terms of confounding, and statistical power. Of the 9 studies included in the systematic review, three were excluded from the meta-analysis due to a lack of necessary information. Meta-analysis was conducted to calculate summary estimates of standardized mean difference and their 95% confidence intervals. Heterogeneity between studies and publication bias were assessed and reported. Perspective: To improve the strength of evidence from this study, the review would preferentially involve the analysis of randomized controlled clinical trials; however, due to the ethical considerations of consent, as well as the patients’ active involvement in the orthodontic treatment planning process, such an approach is not realistic.
Applicability While this study suggests that surgical-orthodontic treatment is more effective for improving certain skeletal and soft tissue measurements, these are still only a few of the several dental, skeletal, and esthetic characteristics used for orthodontic diagnosis and comprehensive treatment planning. One must consider the complete diagnosis with respect to specific treatment objectives in order to determine the most appropriate treatment modality. With no difference found between treatment types for the various other measurements evaluated in this study, and in consideration of the physical and financial investment involved with surgical-orthodontic treatment, orthodontic camouflage may be an acceptable alternative depending on the case and its specific treatment objectives.
Specialty (Oral Surgery) (Orthodontics)
Keywords Surgical-orthodontic treatment; Orthodontic camouflage treatment; Class II malocclusion
ID# 3420
Date of submission 11/26/2019
E-mail touloupas@livemail.uthscsa.edu
Author Michael Touloupas, DDS
Co-author(s) Jordan Cavayero DMD
Co-author(s) e-mail cavayero@livemail.uthscsa.edu
Faculty mentor Ravikumar Anthony, BDS, MDS, MS
Faculty mentor e-mail anthonyr@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available