Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis
Abstract Introduction Achieving a harmonious soft tissue profile and enhancing facial appearance are key goals of early treatment for skeletal class III malocclusion. Aim To summarize the current evidence regarding the effects of Class III orthodontic treatment on facial soft tissues, and to compare...
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SpringerOpen
2025-03-01
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| Series: | Progress in Orthodontics |
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| Online Access: | https://doi.org/10.1186/s40510-025-00558-2 |
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| author | Ahmad Marwan Alhamwi Ahmad Sharafeddin Burhan Fehmieh Rafik Nawaya Kinda Sultan |
| author_facet | Ahmad Marwan Alhamwi Ahmad Sharafeddin Burhan Fehmieh Rafik Nawaya Kinda Sultan |
| author_sort | Ahmad Marwan Alhamwi |
| collection | DOAJ |
| description | Abstract Introduction Achieving a harmonious soft tissue profile and enhancing facial appearance are key goals of early treatment for skeletal class III malocclusion. Aim To summarize the current evidence regarding the effects of Class III orthodontic treatment on facial soft tissues, and to compare various Class III orthodontic appliances. Methods A comprehensive search was conducted up to July 2024, using seven databases, with no language restrictions. RCTs and controlled non-randomized studies were included in this systematic review. The GRADE framework was applied to evaluate the quality of evidence. Results Thirty studies were included in this review, of which sixteen were appropriate for quantitative synthesis. The age range fell between 6.6 and 12.3 years. The FM/RME protocol resulted in a 1.58 mm increase in upper lip protrusion and a 4.73-degree decrease in the nasolabial angle compared to the control group. Chincup treatment led to a 2.13 mm increase in upper lip protrusion and a 2.63 mm decrease in lower lip protrusion compared to the control group. The pooled estimate demonstrated a significant increase of 1.82 mm in upper lip protrusion, a significant retrusion of 3.14 mm in the lower lip, and a backward movement of the chin by 4.8 mm in patients treated with miniplate-anchored orthopaedic facemask (FM/MP) compared to the untreated group. However, no significant difference was found between FM/RME and FM/MP, except for a noticeable decrease in the nasolabial angle in the FM/RME group. The analysis of FM/Alt-RAMEC versus FM/RME did not reveal any difference in soft tissue outcomes, except for the upper lip protrusion. The Alt-RAMEC group showed a more pronounced anterior movement of the upper lip by 0.67 mm compared to the RME group. The quality of evidence supporting these findings ranged from low to moderate. Conclusions There is low to moderate evidence suggesting that early treatment positively influences the soft tissues in Class III patients. However, these conclusions are based on a two-dimensional analysis of cephalometric images, which may not provide complete or accurate information. Therefore, more RCTs using comprehensive 3D analysis are needed to confirm these results. Registration PROSPERO ( CRD42024517924 ). |
| format | Article |
| id | doaj-art-9d18d73d6e5a49b695f61c0a01731a34 |
| institution | DOAJ |
| issn | 2196-1042 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Progress in Orthodontics |
| spelling | doaj-art-9d18d73d6e5a49b695f61c0a01731a342025-08-20T02:41:33ZengSpringerOpenProgress in Orthodontics2196-10422025-03-0126112910.1186/s40510-025-00558-2Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysisAhmad Marwan Alhamwi0Ahmad Sharafeddin Burhan1Fehmieh Rafik Nawaya2Kinda Sultan3Department of Orthodontics, University of Damascus Dental SchoolDepartment of Orthodontics, University of Damascus Dental SchoolDepartment of Pediatric Dentistry, Faculty of Dentistry, Syrian Private University.Department of Orthodontics, University of Damascus Dental SchoolAbstract Introduction Achieving a harmonious soft tissue profile and enhancing facial appearance are key goals of early treatment for skeletal class III malocclusion. Aim To summarize the current evidence regarding the effects of Class III orthodontic treatment on facial soft tissues, and to compare various Class III orthodontic appliances. Methods A comprehensive search was conducted up to July 2024, using seven databases, with no language restrictions. RCTs and controlled non-randomized studies were included in this systematic review. The GRADE framework was applied to evaluate the quality of evidence. Results Thirty studies were included in this review, of which sixteen were appropriate for quantitative synthesis. The age range fell between 6.6 and 12.3 years. The FM/RME protocol resulted in a 1.58 mm increase in upper lip protrusion and a 4.73-degree decrease in the nasolabial angle compared to the control group. Chincup treatment led to a 2.13 mm increase in upper lip protrusion and a 2.63 mm decrease in lower lip protrusion compared to the control group. The pooled estimate demonstrated a significant increase of 1.82 mm in upper lip protrusion, a significant retrusion of 3.14 mm in the lower lip, and a backward movement of the chin by 4.8 mm in patients treated with miniplate-anchored orthopaedic facemask (FM/MP) compared to the untreated group. However, no significant difference was found between FM/RME and FM/MP, except for a noticeable decrease in the nasolabial angle in the FM/RME group. The analysis of FM/Alt-RAMEC versus FM/RME did not reveal any difference in soft tissue outcomes, except for the upper lip protrusion. The Alt-RAMEC group showed a more pronounced anterior movement of the upper lip by 0.67 mm compared to the RME group. The quality of evidence supporting these findings ranged from low to moderate. Conclusions There is low to moderate evidence suggesting that early treatment positively influences the soft tissues in Class III patients. However, these conclusions are based on a two-dimensional analysis of cephalometric images, which may not provide complete or accurate information. Therefore, more RCTs using comprehensive 3D analysis are needed to confirm these results. Registration PROSPERO ( CRD42024517924 ).https://doi.org/10.1186/s40510-025-00558-2Skeletal class IIISystematic review |
| spellingShingle | Ahmad Marwan Alhamwi Ahmad Sharafeddin Burhan Fehmieh Rafik Nawaya Kinda Sultan Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis Progress in Orthodontics Skeletal class III Systematic review |
| title | Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis |
| title_full | Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis |
| title_fullStr | Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis |
| title_full_unstemmed | Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis |
| title_short | Soft tissue changes associated with Class III orthopaedic treatment in growing patients: a systematic review and meta-analysis |
| title_sort | soft tissue changes associated with class iii orthopaedic treatment in growing patients a systematic review and meta analysis |
| topic | Skeletal class III Systematic review |
| url | https://doi.org/10.1186/s40510-025-00558-2 |
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