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KJO Korean Journal of Orthodontics

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eISSN 2005-372X
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Korean J Orthod

Published online March 14, 2022

Copyright © The Korean Association of Orthodontists.

Clinical Effectiveness of Different Types of Bone-anchored Maxillary Protraction for Skeletal Class III Malocclusion: Systematic Review and Network Meta-analysis

Jiangwei Wang, MDS1,2,3 (the 1st author); Yingying Yang, MDS1,2,3; Yingxue Wang, MDS1,2,3; Lu Zhang, MDS2,3,4; Wei Ji, MDS2,3,4; Zheng Hong, MDS2,3,4; Linkun Zhang, PhD2,3 (the corresponding author)

1.School of Clinical Stomatology, Tianjin Medical University, Tianjin 300070, China
2.Department of orthodontic, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China
3.Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041
4.School of Medicine, Nankai University, Tianjin 300071, China

Correspondence to:*Correspondence to: Dr. Linkun Zhang, Department of Orthodontics, Tianjin Stomatological Hospital. 75 Dagu Road, Tianjin China. Telephone and fax numbers: 022-59080683. E-mail: linkunzhang@nankai.edu.cn.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective
This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices using network meta-analysis.
Methods
We searched seven databases for random and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction and quality assessment, we calculated the mean differences, 95% confidence intervals and Surface Under the Cumulative Ranking (SUCRA) scores of eleven indicators (SNA, SNB, ANB, Wits, SNOr, SN/MP, ANS-Me, overjet, overbite, U1/PP, and IMPA). Statistical analysis was carried out using R statistical software through the GeMTC package based on the Bayesian framework.
Results
Six interventions and six hundred and sixty-seven patients were involved in eighteen studies. Compared to tooth-anchored groups, results showed more increases of SNA, ANB, Wits, SNOr and fewer increases of SN/MP, ANS-Me, and U1/PP in bone-anchored groups with a statistical difference. Compared to the control group, SNB decreased in all treated groups without any statistical difference. IMPA decreased in groups with facemasks and increased in other groups. SUCRA indicated that bone-anchorage with intermaxillary protraction (BAIP) caused the best effect in ANB, Wits, overjet and U1/PP.
Conclusions
Bone-anchored maxillary protraction can promote more forward movement of maxillary and correct the Class III intermaxillary relationship better, accompanied by less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of facemask.

Keywords: Class III treatment, Evidence-based orthodontics, Bone implant contact, Early treatment

Article

ahead

Korean J Orthod

Published online March 14, 2022

Copyright © The Korean Association of Orthodontists.

Clinical Effectiveness of Different Types of Bone-anchored Maxillary Protraction for Skeletal Class III Malocclusion: Systematic Review and Network Meta-analysis

Jiangwei Wang, MDS1,2,3 (the 1st author); Yingying Yang, MDS1,2,3; Yingxue Wang, MDS1,2,3; Lu Zhang, MDS2,3,4; Wei Ji, MDS2,3,4; Zheng Hong, MDS2,3,4; Linkun Zhang, PhD2,3 (the corresponding author)

1.School of Clinical Stomatology, Tianjin Medical University, Tianjin 300070, China
2.Department of orthodontic, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, China
3.Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin 300041
4.School of Medicine, Nankai University, Tianjin 300071, China

Correspondence to:*Correspondence to: Dr. Linkun Zhang, Department of Orthodontics, Tianjin Stomatological Hospital. 75 Dagu Road, Tianjin China. Telephone and fax numbers: 022-59080683. E-mail: linkunzhang@nankai.edu.cn.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective
This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices using network meta-analysis.
Methods
We searched seven databases for random and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction and quality assessment, we calculated the mean differences, 95% confidence intervals and Surface Under the Cumulative Ranking (SUCRA) scores of eleven indicators (SNA, SNB, ANB, Wits, SNOr, SN/MP, ANS-Me, overjet, overbite, U1/PP, and IMPA). Statistical analysis was carried out using R statistical software through the GeMTC package based on the Bayesian framework.
Results
Six interventions and six hundred and sixty-seven patients were involved in eighteen studies. Compared to tooth-anchored groups, results showed more increases of SNA, ANB, Wits, SNOr and fewer increases of SN/MP, ANS-Me, and U1/PP in bone-anchored groups with a statistical difference. Compared to the control group, SNB decreased in all treated groups without any statistical difference. IMPA decreased in groups with facemasks and increased in other groups. SUCRA indicated that bone-anchorage with intermaxillary protraction (BAIP) caused the best effect in ANB, Wits, overjet and U1/PP.
Conclusions
Bone-anchored maxillary protraction can promote more forward movement of maxillary and correct the Class III intermaxillary relationship better, accompanied by less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of facemask.

Keywords: Class III treatment, Evidence-based orthodontics, Bone implant contact, Early treatment