Non-Cochrane · intervention · PM42256817
Effectiveness of Intra-oral Non-skeletally Anchored Appliances in the Correction of Skeletal Class III Malocclusion in Growing Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Kourbaj Yazan M, Hajeer Mohammad Y, Kara-Boulad Jehad M, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.110262
Findings
8 findings
| Population | ||||
|---|---|---|---|---|
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Point A-TV change (mm) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD 1.92 [0.87, 2.98] Low Downgraded: risk of bias, imprecision 2 studies · 106 participants |
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Nasolabial angle change (degrees) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD -5.18 [-7.54, -2.83] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 106 participants |
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Facial convexity angle (gla.sn.pog) change (degrees) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD 4.92 [3.51, 6.32] Low Downgraded: risk of bias, imprecision 2 studies · 106 participants |
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Point B-TV change (mm) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD 0.13 [-0.98, 1.25] Low Downgraded: risk of bias, imprecision 2 studies · 106 participants |
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Point Id-TV change (mm) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD 0.16 [-0.85, 1.17] Low Downgraded: risk of bias, imprecision 2 studies · 106 participants |
| Growing patients aged 6 to 12 years with skeletal Class III malocclusion | Removable mandibular retractor (RMR) | Before treatment (pre-post change after active treatment) | Point Pr-TV change (mm) End of active treatment (change from before to after treatment) · Orthodontic clinics | MD 1.97 [0.87, 3.07] Low Downgraded: risk of bias, imprecision 2 studies · 106 participants |
| Growing patients with skeletal Class III malocclusion | Bionator III appliance | Any comparator | Early correction of Class III malocclusion | no estimate extracted No studies found 0 studies |
| Growing patients with skeletal Class III malocclusion | Activator III appliance | Any comparator | Early correction of Class III malocclusion | no estimate extracted No studies found 0 studies |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Khwanda 2022 Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class… PMID:35720777 | 2022 | 1 other review | not stated | not extracted yet |
| Al-Hammadi 2023 matched by author and year (probable) | NR | this review only | Point A-TV change (mm); Point B-TV change (mm); Point Pr-TV change (mm); Point Id-TV change (mm); Facial convexity angle (gla.sn.pog) change (degrees); Nasolabial angle change (degrees) | not extracted yet |
| Alzabibi 2021 Short-term effects of the orthodontic removable traction appliance in the treatment of skeletal Class III malocclusion: A randomized… DOI:10.17219/dmp/126304 | 2021 | this review only | not stated | not extracted yet |
| Husson 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Husson 2016 NCT:02144324 | NR | this review only | not stated | not extracted yet |
| Majanni 2016 The Removable Mandibular Retractor vs the Boneanchored Intermaxillary Traction in the Correction of Skeletal Class III Malocclusion in… DOI:10.5005/jp-journals-10024-1856 | 2016 | this review only | not stated | not extracted yet |
| Minase 2019 Effectiveness of reverse twin block with lip pads-RME and face mask with RME in the early treatment of class III malocclusion DOI:10.1186/s40510-019-0266-0 | 2019 | this review only | not stated | not extracted yet |
| Saleh 2013 Short‐term soft‐ and hard‐tissue changes following Class <scp>III</scp> treatment using a removable mandibular retractor: a randomized… DOI:10.1111/ocr.12007 | 2012 | this review only | Point A-TV change (mm); Point B-TV change (mm); Point Pr-TV change (mm); Point Id-TV change (mm); Facial convexity angle (gla.sn.pog) change (degrees); Nasolabial angle change (degrees) | not extracted yet |
| Ulgen 1994 The effects of the Fränkel's function regulator on the Class III malocclusion DOI:10.1016/s0889-5406(94)70140-7 | 1994 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Effectiveness of Treatment Modalities for the Correction of Anterior Crossbite in Children: A Systematic Review and Meta-Analysis of… (2026) | 1 | 0.03 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Growing patients 6 to 12 years with skeletal Class III malocclusion | Growing patients with skeletal Class III malocclusion, mean ages 7 to 11.5 years (n=336) |
| Intervention | Intra-oral non-skeletally anchored Class III appliances | RMR (3 studies), modified RMR (1), BAIMT (1), reverse twin block (2), modified tandem appliance (1), Frankel III (1), LCP-IMT/ORTA (1); no trials of Bionator III or Activator III |
| Comparison | No orthodontic treatment or a different appliance | Untreated control, face mask, or another appliance (RMR vs BAIMT, RMR vs modified RMR, RTB vs RTB+PBMT) |
| Outcomes | Increase in ANB angle (SNA improvement, SNB decrease); mandibular length (Go-Me); Wits appraisal | Skeletal (SNA, SNB, ANB, Co-Gn, Wits, points A and B), dentoalveolar (overjet, overbite, U1-SN, L1-GoMe, Pr, Id) and soft-tissue (facial convexity, nasolabial and mentolabial angles, lip to E-line) changes; 6 outcomes pooled |
| Study designs | RCTs | 8 RCTs (n=336); 2 RCTs pooled (n=106) |
| Timing | Not specified | Active treatment 4.3 months to 1.9 years |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | No | Yes | no |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |