Non-Cochrane · intervention · PM42256824
Effectiveness of Treatment Modalities for the Correction of Anterior Crossbite in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Kourbaj Yazan M, Hajeer Mohammad Y, Burhan Ahmad S, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.110226
Findings
Population Growing children aged 6 to 12 years with skeletal anterior crossbite (Class III)
9 findings
| Facemask therapy combined with rapid maxillary expansion (FM-RME) | Untreated control group | SNB angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD -2.14 [-2.93, -1.35] Low Downgraded: risk of bias, inconsistency 4 studies · 152 participants |
| Facemask therapy combined with rapid maxillary expansion (FM-RME) | Untreated control group | SNA angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD 1.37 [0.57, 2.16] Low Downgraded: risk of bias, inconsistency 4 studies · 152 participants |
| Facemask therapy combined with rapid maxillary expansion (FM-RME) | Untreated control group | ANB angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD 3.54 [2.46, 4.63] Low Downgraded: risk of bias, inconsistency 4 studies · 152 participants |
| Facemask therapy combined with rapid maxillary expansion (FM-RME) | Untreated control group | SNA angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics · Sensitivity analysis excluding Yavan 2023 | MD 1.02 [0.42, 1.62] GRADE not reported 3 studies · 129 participants |
| Facemask therapy combined with rapid maxillary expansion (FM-RME) | Untreated control group | SNB angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics · Sensitivity analysis excluding Xu and Lin 2001 | MD -1.72 [-2.24, -1.20] GRADE not reported 3 studies · 112 participants |
| Skeletally anchored facemask (miniplate or miniscrew supported) | Tooth-anchored facemask | ANB angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD 0.07 [-0.57, 0.72] Moderate Downgraded: risk of bias 3 studies · 118 participants |
| Skeletally anchored facemask (miniplate or miniscrew supported) | Tooth-anchored facemask | SNB angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD 0.24 [-0.31, 0.79] Moderate Downgraded: risk of bias 3 studies · 118 participants |
| Skeletally anchored facemask (miniplate or miniscrew supported) | Tooth-anchored facemask | SNA angle change (degrees) End of treatment (change from baseline) · Orthodontic clinics | MD 0.59 [0.02, 1.16] Moderate Downgraded: risk of bias 3 studies · 118 participants |
| Skeletally anchored facemask (miniplate or miniscrew supported) | Tooth-anchored facemask | Overjet change (mm) End of treatment (change from baseline) · Orthodontic clinics | MD -0.19 [-1.46, 1.08] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 77 participants |
Included primary studies 21
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alzoubi 2023 The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre… PMID:37167546 | 2023 | 1 other review | ANB angle change (degrees) | not extracted yet |
| 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 |
| Liang 2021 Three-dimensional comparative evaluation of customized bone-anchored vs tooth-borne maxillary protraction in patients with skeletal Class… PMID:34172344 | 2021 | 1 other review | ANB angle change (degrees) | not extracted yet |
| Abdelnaby 2010 Chin cup effects using two different force magnitudes in the management of Class III malocclusions. PMID:20578869 | 2010 | this review only | not stated | not extracted yet |
| Alzabibi 2021 Short-term effects of the orthodontic removable traction appliance in the treatment of skeletal Class III malocclusion: A randomized… PMID:34048643 | 2021 | this review only | not stated | not extracted yet |
| Atalay 2010 Dentofacial effects of a modified tandem traction bow appliance. PMID:20348164 | 2010 | this review only | not stated | not extracted yet |
| Canturk 2015 Comparison of the effects of face mask treatment started simultaneously and after the completion of the alternate rapid maxillary… PMID:25017013 | 2015 | this review only | not stated | not extracted yet |
| Ge 2012 Dentofacial effects of two facemask therapies for maxillary protraction. PMID:22639823 | 2012 | this review only | ANB angle change (degrees) | not extracted yet |
| Husson 2016 Dentoskeletal Effects of the Modified Tandem Appliance vs the Facemask Appliance in the Treatment of Skeletal Class III Malocclusion: A… PMID:27595716 | 2016 | this review only | not stated | not extracted yet |
| James 2020 Effect of adding daytime Class III Elastics to the alternate rapid maxillary expansion-constriction and reverse headgear therapy - A… PMID:33354539 | 2020 | this review only | not stated | not extracted yet |
| Kilicoglu 1998 Profile changes in patients with class III malocclusions after Delaire mask therapy. PMID:9563362 | 1998 | this review only | not stated | not extracted yet |
| Majanni 2016 The Removable Mandibular Retractor vs the Bone-anchored Intermaxillary Traction in the Correction of skeletal class III Malocclusion in… PMID:27443361 | 2016 | this review only | not stated | not extracted yet |
| Mandall 2010 Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15-month follow-up. PMID:20805344 | 2010 | this review only | ANB angle change (degrees) | not extracted yet |
| Meyns 2025 Long-term comparison of maxillary protraction with hybrid hyrax-facemask vs. hybrid hyrax-mentoplate protocols using Alt-RAMEC: a 5-year… PMID:40105065 | 2025 | this review only | not stated | not extracted yet |
| Miamoto 2018 Comparison of two early treatment protocols for anterior dental crossbite in the mixed dentition: A randomized trial. PMID:29106299 | 2018 | 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. PMID:30957212 | 2019 | this review only | ANB angle change (degrees) | not extracted yet |
| Salem 2025 Effectiveness of clear aligner versus removable inclined plane in treatment of anterior crossbite in mixed dentition: A randomized… PMID:39706691 | 2025 | this review only | not stated | not extracted yet |
| Showkatbakhsh 2012 The effects of facemask and reverse chin cup on maxillary deficient patients. PMID:22773672 | 2012 | this review only | not stated | not extracted yet |
| Wiedel 2015 Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition--a randomized controlled trial. PMID:25114123 | 2015 | this review only | not stated | not extracted yet |
| Xu 2001 [The orthopedic treatment of skeletal class III malocclusion with maxillary protraction therapy]. PMID:11930708 | 2001 | this review only | ANB angle change (degrees) | not extracted yet |
| Yavan 2023 Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions : A randomized… PMID:34269826 | 2023 | this review only | ANB angle change (degrees) | 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 question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Growing children aged 6 to 12 years with anterior crossbite (skeletal, functional or dental) | Children aged 6 to 12 years (n=854): skeletal crossbite (n=738), functional (n=86), dental (n=30); 21 RCTs |
| Intervention | Any orthodontic approach used to correct anterior crossbite | Intraoral non-skeletally anchored appliances (9 studies); extraoral non-skeletally anchored appliances (7); extraoral skeletally anchored (3); intraoral skeletally anchored (2); FM-RME pooled (4 studies, n=152); skeletally anchored vs tooth-anchored facemask pooled (3 studies, n=118) |
| Comparison | No orthodontic treatment, or a different appliance | Untreated control group; tooth-anchored facemask; other appliances |
| Outcomes | Skeletal relationships (SNA, SNB, ANB), overjet, overbite | ANB, SNA, SNB pooled; overjet pooled for skeletal versus tooth-anchored facemask (2 studies, n=77); overbite not pooled |
| Study designs | Randomized controlled trials only | Randomized controlled trials (n=21), 7 in meta-analysis |
| Timing | Not specified | Treatment durations about 4 to 12 months |
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 | Yes | No | no |
| 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 | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 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: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | 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 | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |