Orthodontic Management for Class III Malocclusion

Abstract

Background: Class III malocclusion influences between 5% and 15% of the population. The 2 most common quandaries encompassing Class III management are the planning of treatment and the type of appliance. Various appliances have been utilized to correct a Class III skeletal discrepancy; however there is little proof accessible on their adequacy in the long term. Additionally, early management of Class III malocclusion has been practiced with expanding interest. Nevertheless, there has been no strong confirmation on the advantages in the long term. Aim of the study: we conducted this systematic review to assess the adequacy of orthodontic techniques utilized in the early treatment of Class III malocclusion in the short and long terms. Methods: A systematic search was performed in the scientific database independently of language, particularly MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and individual orthodontic journals were searched to November 2016. The selection criteria included randomized controlled trials (RCTs) and prospective controlled clinical trials (CCTs) of children between the ages of 7 and 12 years on early treatment with any type of orthodontic/orthopaedic appliance compared with another appliance to correct Class III malocclusion or with an untreated control group. The primary outcome measure was correction of reverse overjet, and the secondary outcomes included skeletal changes, soft tissue changes, quality of life, patient compliance, adverse effect, Peer Assessment Rating score, and treatment time. Results: Ten studies, 6 RCTs and 4 CCTs, are involved in this review. In the RCT group, only 2 of 6 studies were assessed at low risk of bias, and the others were at high or unclear risk of bias. All 4 CCT studies were classified as high risk of bias. Two RCTs involving 109 participants looked at the comparison between protraction facemask and untreated control. The results for ANB angle (mean difference, 3.40; 95% CI, 2.6-3.15; P <0.0001) and reverse overjet (mean difference, 2.5 mm; 95% CI, 1.21-3.79; P< 0.0001) were statistically significant favouring the facemask group. All CCTs validated a statistically significant advantage in favour of the use of each appliance. Nonetheless, the studies had high risk of bias. Conclusions: There is a moderate amount of evidence to show that early treatment with a facemask results in positive improvement for both skeletal and dental effects in the short term. Though, there was absence of evidence on long-term benefits. There is certain evidence regarding the chin cup, removable mandibular retractor, and tandem traction bow appliance; however the studies had a high risk of bias. Additional high-quality, long-term studies are assessing to evaluate the early treatment effects for Class III malocclusion patients.