Korean J Orthod.  2022 Sep;52(5):313-323. 10.4041/kjod21.264.

Clinical effectiveness of different types of boneanchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis

• Wang J
• Yang Y
• Wang Y
• Zhang L
• Ji W
• Hong Z
• Zhang L

• KMID: 2533256
• DOI: http://doi.org/10.4041/kjod21.264

Abstract

Objective
This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis.
Methods
We searched seven databases for randomized 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 scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework.
Results
Six interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-NasionSupramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups.
Conclusions
Bone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing 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 a facemask.

Keyword

Class III treatment; Evidence-based orthodontics; Bone implant contact; Early treatment

Figure

• 

  Figure 1 Descriptions of the indicators. 1. SNA, the angle composed by the points sella-nasion-subspinale. 2. SNB, the angle composed by the points sella-nasionsupramentale. 3. ANB, the angle composed by the points subspinale-nasion-supramentale. 4. SNOr, the angle composed by the points sella-nasion-orbitale. 5. SN/MP, the angle composed by the sella-nasion plane and the mandibular plane. 6. U1/PP, the angle composed by the axis of the upper incisors and the palatal plane. 7. IMPA, the angle composed by the axis of lower incisors and the mandibular plane. a. Wits, the distance between the perpendicular of the subspinale and supramentale points to the occlusal plane. b. ANS-Me, the distance between the perpendicular of the anterior nasal spine and menton to the Frankel plane.

• 

  Figure 2 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

• 

  Figure 3 Network plot. A, SNA. B, SNB. C, Wits. D, IMPA. FM, facemask; BAFM, bone anchorage with facemask appliance; MAFM, mixed anchorage with a facemask; BAIP, bone anchorage with intermaxillary protraction; MAIP, mixed anchorage with intermaxillary protraction. See Figure 1 for descriptions of the indicators.

• 

  Figure 4 Forest plot. Network meta-analysis of comparisons with group FM. A, SNA; B, SNB; C, ANB; D, Wits; E, ANS-Me; F, SN/MP; G, U1/PP. Network meta-analysis of comparisons with group CONTROL. H, SNB; I, overbite; J, overjet; K, SNOr; L, IMPA. FM, facemask; BAFM, bone anchorage with facemask appliance; MAFM, mixed anchorage with a facemask; BAIP, bone anchorage with intermaxillary protraction; MAIP, mixed anchorage with intermaxillary protraction; CI, confidence interval. See Figure 1 for descriptions of the indicators.

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