Int J Stomatol

Int J Stomatol ›› 2022, Vol. 49 ›› Issue (5): 548-555.doi: 10.7518/gjkq.2022053

• Original Articles • Previous Articles     Next Articles

Meta-analysis of the long-term effect of maxillary protraction on jaw growth and development

Zhang Shan(),Ge Xiaolei,Li Jie,Xie Xinyu,Chang Weiwei,Ma Wensheng.()   

  1. Dept. of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, China
  • Received:2021-08-20 Revised:2022-02-24 Online:2022-09-01 Published:2022-09-16
  • Contact: Wensheng. Ma E-mail:245244212@qq.com;798311029@qq.com
  • Supported by:
    Hebei Provincial Government Funded Clinical Medicine Talents Training Project(MXZB00263);The Medical Applicable Technology Following Project of Hebei Province(GZ2021038)

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Abstract:

Objective To evaluate the long-term stability of maxillary protraction in the treatment of Angle Class Ⅲ malocclusion in children with mixed dentition. Methods A comprehensive search of Cochrane Library, PubMed, Ovid, ScienceDirect, Wiley, China Academic Journal Full-text Database, China Biology Medicine Disc, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wan Fang database and other foreign and Chinese databases was conducted until 18 August 2021. Literature screening, quality evaluation and data extraction were carried out by two scholars. Meta-analysis was carried out by RevMan5.3 software, and the evidence quality of the outcome index was evaluated using the Grading of Recommendations Assessment, Development and Evaluation evidence grading system. The results consist of active treatment changes and posttreatment changes, as well as the overall changes in SNA, SNB, ANB, Co-A, Co-Gn, SN-GoGn. Results Ten articles that met the requirements were included. The treated group, which comprised patients with Angle Class Ⅲ malocclusion treated by maxillary protraction, was compared with the untreated Class Ⅲ control group. The results of the meta-analysis showed statistical differences in the increase in SNA, SNB, ANB, Co-A and Co-Gn during the T1-T2 period (P<0.05) and no statistical difference in SN-GoGn (P>0.05). During the T2-T3 period, SNA, SNB, ANB and Co-Gn significantly decreased (P<0.05), but Co-A and SN-GoGn had no significant change (P>0.05). During T1-T3, SNA, SNB, ANB, Co-A and Co-Gn was significantly changed (P<0.05), whereas SN-GoGn had no significant change (P>0.05). Conclusion The analysis of patients with Angle Class Ⅲ malocclusion who were treated by maxillary protraction revealed that the maxillary and mandibular effects come from the active treatment period. Although the Class Ⅲ growth pattern had a tendency to be re-established during the posttreatment period, facemask therapy remarkably improved the maxillary and mandibular sagittal positions and maxilla-mandible relationship, promoted midface growth and inhibited mandibular growth during the long-term observation. More large samples and high-quality clinical studies are needed to verify this conclusion.

Key words: maxillary protraction, Angle Class Ⅲ, growth and development, stability, Meta-analysis

CLC Number: 

  • R 783.5

TrendMD: 

Fig 1

Flow chart of literatures screening"

Tab 1

Characteristics of included studies"

纳入研究研究类型例数试验组特征干预措施随访时间/年对照组特征

Ngan等[16]

（1998）

病例对照试验：试验组（前瞻性）；对照组（回顾性）30/20中国人，骨性Ⅲ类，安氏Ⅲ类，前牙反??，（8.4±1.8）岁扩弓前牵，扩弓每天2次380 g，30°，≥12 h2未经治疗安氏Ⅲ类患者，按照种族、年龄、性别、骨性特征、随访时间与试验组匹配

Macdonald等[17]

（1999）

病例对照试验（回顾性）24/27骨性Ⅲ类，安氏Ⅲ类，前牙反??或对刃??，ANB<1°，wits值≤0 mm，7.4 岁扩弓前牵，扩弓每天2次200~450 g，15°~30°，前3~4月18~22 h，后3~4月仅夜间佩戴≥0.5未经治疗安氏Ⅲ类患者，按照年龄、性别、随访时间与试验组匹配

Chong等[18]

（1996）

病例对照试验：试验组（前瞻性）；对照组（回顾性）16/13前牙反??，（6.80±1.13）岁前牵，230~285 g，30°~40°，12~16 h≥1未经治疗安氏Ⅲ类患者，按照年龄、随访时间与试验组匹配

Anne Mandall等[19]

（2012）

前瞻性随机对照试验13/10北美人，混合牙列晚期，安氏Ⅲ类，前牙反??，wits值≤-2 mm，（8.6±0.08）岁扩弓前牵，扩弓每天1次400 g，≥14 h1.25±0.58未经治疗安氏Ⅲ类患者，按种族、牙齿阶段、错??类型、性别与试验组匹配

Westwood等[20]

（2003）

病例对照试验（回顾性）34/22欧美白人，安氏Ⅲ类，前牙反??或对刃??，wits值≤-1.5 mm, CS1~CS2，（8.25±1.83）岁扩弓前牵，扩弓每天1~2次300~500 g，≥14 h，全部患者二期固定矫治5.58±2.25未经治疗安氏Ⅲ类患者，按照性别、年龄、随访时间与试验组匹配

Pavoni等[21]

（2019）

病例对照试验（回顾性）32/20白人，骨性Ⅲ类，安氏Ⅲ类，前牙反??或对刃??，wits值≤-2 mm，CS1~ CS3，（8.4±1.2）岁

扩弓前牵+下颌??垫

扩弓每天1~2次，400~500 g，30°，≥14 h，??垫全天佩戴，26名患者二期固定矫治

5.2±2.1未经治疗安氏Ⅲ类患者，按照年龄、骨龄、随访时间与试验组匹配

Masucci等[22]

（2011)

病例对照试验：试验组（前瞻性）；对照组（回顾性）30/13欧洲人，安氏Ⅲ类，前牙反??或对刃??，wits值≤-2 mm，CS1~CS3，（9.2±1.6）岁扩弓前牵，扩弓每天1~2次400~500 g，≥14 h，19名患者进行二期固定矫治

8.4±0.9

未经治疗安氏Ⅲ类患者，按照种族、年龄、骨龄、性别、错??畸形程度、随访时间与试验组匹配

Baccetti等[23]

（2000)

病例对照试验（回顾性）16/11北美人，混合牙列早期，安氏Ⅲ类，前牙反??，wits值≤-2 mm，（7±0.58）岁扩弓前牵，扩弓每天1次400 g，≥14 h1.52±0.58未经治疗安氏Ⅲ类患者，按种族、牙齿阶段、错??类型、性别与试验组匹配

Cozza等[24]

（2010)

病例对照试验：试验组（前瞻性）；对照组（回顾性）22/12

白人，安氏Ⅲ类，前牙反??或对刃??，wits值≤-2 mm，CS1~CS2，（8.9±

1.5）岁

前牵+下颌??垫，600 g，30°~40°，≥14 h，

??垫全天佩戴

2.1±1.3未经治疗安氏Ⅲ类患者，按照牙性和骨性特征、骨龄、随访时间与试验组匹配

Baccetti等[25]

（2010）

病例对照试验：试验组（前瞻性）；对照组（回顾性）22/14安氏Ⅲ类，前牙反??或对刃??，wits值≤-2 mm，CS1，（8.9±1.5）岁前牵+下颌??垫，600 g，≥14 h，??垫全天佩戴2未经治疗安氏Ⅲ类患者，按照骨龄、随访时间与试验组匹配

Tab 2

Risk of bias of included studies using Robins-Ⅰ tools"

纳入研究干预前干预时干预后整体偏倚
混杂偏倚选择受试者偏倚干预分类偏倚意向干预偏离偏倚丢失数据偏倚结局测量偏倚选择性报告偏倚
Baccetti等[23]（2000）低低低低低低低低
Baccetti等[25]（2010）低低低低低低低低
Chong等[18]（1996）中低低低低低低中
Macdonald等[17]（1999）中中低低低低低中
Masucci等[22]（2011）低低低低低低低低
Ngan等[16]（1998）低低低低低低低低
Cozza等[24]（2010）低低低低低低低低
Westwood等[20]（2003）低低低低低低低低
Pavoni等[21]（2019低低低低低低低低

Tab 3

Results of sensitive analysis"

结局指标异质性检验结果效应模型Meta分析结果
P值I2/%WMD（95%CI）P值
T1-T2SNA0.750固定1.74 （1.31，2.17）<0.000 01
SNB0.540固定-1.87 （-2.19，-1.55）<0.000 01
ANB0.385固定3.32 （2.88，3.77）<0.000 01
Co-A0.1740固定1.07 （0.36，1.77）0.003
Co-Gn0.780固定-2.47 （-3.25，-1.69）<0.000 01
SN-GoGn0.2426固定-0.21 （-1.07，0.66）0.64
T2-T3SNA0.610固定-0.92 （-1.35，-0.49）<0.000 1
SNB0.450固定-0.40 （-0.79，-0.01）0.05
ANB0.411固定-0.40 （-0.76，-0.04）0.03
Co-A0.430固定-0.49 （-1.17，0.18）0.15
Co-Gn0.990固定-1.33 （-2.38，-0.28）0.01
SN-GoGn0.480固定-0.52 （-1.36，0.32）0.22
T1-T3SNA0.2130固定0. 60 （0.06，1.15）0.03
SNB0.000 378固定-0.78 （-1.04，-0.52）<0.000 01
ANB0.0848固定2.19 （1.73，2.65）<0.000 01
Co-A0.780固定1.36 （0.10，2.61）0.03
Co-Gn0.980固定-3.18 （-4.89，-1.46）0.000 3
SN-GoGn0.2038固定-0. 98 （-2.27，0.31）0.14
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