Non-Cochrane · intervention · PM42801521
Comparison Between Skeletally-Anchored and Conventional Maxillary Protraction in Growing Class ΙΙΙ Patients: A Systematic Review and Meta-Analysis.
Papadopoulou Christianna Iris, Paschaei Nusha, Brunello Giulia, et al. · Clinical and experimental dental research · 2026 · PubMed · doi:10.1002/cre2.70466
Findings
15 findings
| Population | ||||
|---|---|---|---|---|
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | Upper first molar mesialization (mm) End of active treatment | MD -1.14 [-2.12, -0.17] Low Downgraded: risk of bias, imprecision 4 studies · 160 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Upper first molar extrusion (vertical anchorage loss) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis A: RCTs only (all available RCT data, including Alzoubi 2023) | MD -0.85 [-1.96, 0.26] GRADE not reported 2 studies · 80 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Mandibular plane angle (SN-MnPl) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis A: RCTs only (all available RCT data, including Alzoubi 2023) | MD -0.41 [-6.62, 5.79] GRADE not reported 2 studies · 80 participants |
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | Mandibular plane angle SN-MnPl (degrees) End of active treatment | MD -0.38 [-1.67, 0.91] Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 160 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Maxillary incisor proclination (U1-PP) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis A: RCTs only (all available RCT data, including Alzoubi 2023) | MD -1.00 [-3.40, 1.40] GRADE not reported 2 studies · 75 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | SNA angle Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis B: RCTs only, excluding Alzoubi 2023 (reconstructed data) | MD 0.94 [-0.96, 2.84] GRADE not reported 2 studies · 80 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Mandibular plane angle (SN-MnPl) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis B: RCTs only, excluding Alzoubi 2023 (reconstructed data) | MD -0.41 [-6.62, 5.79] GRADE not reported 2 studies · 80 participants |
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | SNA angle (degrees) End of active treatment | MD 0.65 [0.18, 1.13] Moderate Downgraded: risk of bias 5 studies · 194 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Upper first molar mesialization (horizontal anchorage loss) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis B: RCTs only, excluding Alzoubi 2023 (reconstructed data) | MD -0.67 [-6.14, 4.80] GRADE not reported 2 studies · 80 participants |
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | Maxillary incisor proclination U1-PP (degrees) End of active treatment | MD -2.47 [-4.14, -0.8] Low Downgraded: risk of bias, imprecision 4 studies · 155 participants |
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | Upper first molar extrusion (mm) End of active treatment | MD -0.74 [-1.07, -0.4] Moderate Downgraded: risk of bias 4 studies · 160 participants |
| Growing patients with skeletal Class III malocclusion | Skeletally anchored maxillary protraction | Conventional tooth-borne facemask maxillary protraction | WITS appraisal (mm) End of active treatment | MD -0.88 [-2.49, 0.73] Low Downgraded: risk of bias, imprecision 3 studies · 114 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | SNA angle Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis A: RCTs only (all available RCT data, including Alzoubi 2023) | MD 0.86 [-0.10, 1.82] GRADE not reported 3 studies · 114 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Upper first molar extrusion (vertical anchorage loss) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis B: RCTs only, excluding Alzoubi 2023 (reconstructed data) | MD -0.85 [-1.96, 0.26] GRADE not reported 2 studies · 80 participants |
| Growing patients (about 8-12 years) with skeletal Class III malocclusion (maxillary deficiency) | Skeletally anchored maxillary protraction (miniplates or orthodontic mini-implants with facemask or Class III elastics) | Conventional tooth-borne facemask maxillary protraction (same RME/Alt-RAMEC protocol in both groups) | Upper first molar mesialization (horizontal anchorage loss) Short-term: start to end of active maxillary protraction (T1-T0, about 6-12 months) · Orthodontic clinical trials · Sensitivity analysis A: RCTs only (all available RCT data, including Alzoubi 2023) | MD -0.67 [-6.14, 4.80] GRADE not reported 2 studies · 80 participants |
Included primary studies 5
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 | 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 | not stated | not extracted yet |
| Ağlarcı 2016 Comparison of short-term effects between face mask and skeletal anchorage therapy with intermaxillary elastics in patients with maxillary… PMID:26219549 | 2016 | this review only | not stated | not extracted yet |
| Şar 2011 Comparative evaluation of maxillary protraction with or without skeletal anchorage. PMID:21536207 | 2011 | this review only | not stated | not extracted yet |
| Seiryu 2020 A comparative assessment of orthodontic treatment outcomes of mild skeletal Class III malocclusion between facemask and facemask in… PMID:31398066 | 2020 | 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) | 2 | 0.08 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Growing patients requiring early Class III treatment (15 years or younger, all ethnicities); excluding previous orthodontic treatment, systemic or periodontal disease, craniofacial syndromes, studies with fewer than five patients | Growing Class III patients aged about 8-12 years (n=194 participants; 5 studies) |
| Intervention | Skeletally anchored (bone-anchored) maxillary protraction with miniplates or orthodontic mini-implants; RME/Alt-RAMEC applied uniformly across groups | Skeletal anchorage: miniplates or mini-implants with facemask (n=4 studies) or maxillary mini-implants plus mandibular miniplates with Class III elastics (n=1); RME in both groups in 3 studies (Alt-RAMEC in 1) |
| Comparison | Conventional maxillary protraction with dental anchorage (tooth-borne facemask) | Conventional tooth-borne facemask (n=5 studies), with the same RME/Alt-RAMEC protocol as the intervention group in 3 |
| Outcomes | Skeletal changes (SNA, WITS, SN-MnPl); anchorage loss (upper first molar mesialization and extrusion, upper incisor proclination); treatment duration; associated risks | Upper molar mesialization (n=4), upper molar extrusion (n=4), maxillary incisor proclination (n=4), SNA (n=5), SN-MnPl (n=4), WITS appraisal (n=3); treatment duration and associated risks not pooled |
| Study designs | Prospective CCTs or RCTs | 3 RCTs and 2 prospective CCTs (n=5) |
| Timing | Not specified | Short-term, from start to end of active maxillary protraction (about 6-12 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 | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 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 | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | RCT: Yes · NRSI: Yes | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | RCT: Yes · NRSI: No | yes |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |