JOURNAL ARTICLE
REVIEW

A Bayesian network meta-analysis of orthopedic treatment in Class III malocclusions: Maxillary protraction with skeletal anchorage or a rapid maxillary expander

Zuping Wu, Xin Zhang, Zixuan Li, Yuyao Liu, Hairu Jin, Qian Chen, Jie Guo
Orthodontics & Craniofacial Research 2019 August 27
31452316

OBJECTIVE: To evaluate and compare the effectiveness of orthopedic treatment for Class III malocclusions using skeletal anchorage or a rapid maxillary expander for maxillary protraction.

MATERIALS AND METHODS: Electronic databases, including PubMed, EMBASE, Cochrane Library and Web of Science, were searched for randomized controlled trials (RCTs) and non-randomized clinical trials (CCTs) for orthopedic treatment of Class III malocclusions. Five interventions were studied: a facemask with a maxillary temporary anchorage device (MTAD), a bone-anchored rapid maxillary expansion (BARME), a rapid maxillary expansion (RME), an alternate rapid maxillary expansion and contraction (Alt-RAMEC), and a bone-anchored intermaxillary traction (BAIMT). Eight outcomes (SNA, SNB, ANB, Overjet, SN-GoGn, ANS-Me, IMPA (L1-MP), and U1-PP) were statistically polled. We conducted network meta-analysis using R statistical software with the GeMTC package.

RESULTS: Twenty-five studies met the inclusion criteria. Compared with the RME group, the Alt-RAMEC group (mean difference (MD): 1.3; 95% credibility interval (CrI): 0.26, 2.3) and MTAD group (MD: 0.85; 95% CrI: 0.065, 1.6) showed a better effect on ANB in CCTs. Regarding the vertical relationship, the BAIMT group (MD: -2.2; 95% CrI: -5.2,0.73) showed a smaller effect regarding increasing the vertical dimension of ANS-Me. The RME, MTAD and Alt-RAMEC group showed a higher ability to decrease the angle of L1-MP.

CONCLUSION: The Alt-RAMEC and MTAD protocol have a higher possibility to obtain a skeletal and tooth effect in sagittal relationships. The BAIMT protocol can acquire a better skeletal effect in sagittal relationships with less vertical and dental changes. More well-designed RCTs are needed to ensure that the conclusion is reliable. This article is protected by copyright. All rights reserved.

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