Method

Participants

Age (y)

Inclusion criteria

Exclusion criteria

Interventions

Total treatment duration (y)

Class III diagnosis

Outcomes

Lew (1990)

Retrospective, cohort.

Cephalometric analysis.

Setting: not specified.

N=38 (10 male, 28 female)

24.3 (SD=3.2)

True Class III dental malocclusion (without mandibular displacement).

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Extraction of mandibular first premolars. Edgewise technique without the use of extraoral appliances or Class III elastics. Anchorage control during space closure mechanics in the mandibular arch was boosted by a lingual arch in all cases.

1.7 (SD=3.2)

Molar relationship of half to full-unit Class III; ANB= -2.3° (SD=2.2); overjet= -4.2 mm (SD=2.8);

Cephalometric changes:

Increase in:

NU1-HP, GLs-HP.

Decrease in:

NL1-HP, NL6-HP, CmSnLs, GLi-HP.

Faerovig and Zachrisson (1999)

Retrospective, cohort.

Cephalometric and model analysis.

Setting: private practice and Department of Orthodontics, University of Oslo.

N=36 (15 male, 21 female)

27.8 (SD=11.1)

Nongrowing adult; occlusion with tendency toward or established mild-to-moderate Class III malocclusion with reduced or no overbite; mild-to-moderate anterior mandibular crowding.

-

Extraction of one mandibular incisor.

Edgewise technique. Nineteen patients received orthodontic treatment in both maxilla and mandible and 17 were treated only in the mandibular arch.

1.5 (SD=0.6)

Tendency toward or established mild-to- moderate Class III malocclusion.

Retrusion and retroinclination of mandibular incisors.

Ning et al. (2009)

Retrospective, cohort.

Cephalometric analysis.

Setting: Department of Orthodontics,

School of stomatology, Fourth Military Medical

University, China.

N=13 (5 male, 8 female)

22.0 (SD=4.5)

Molar relationship between half- to full-unit Class III; anterior crossbite; concave facial profile; -3°<ANB<0; no mandibular shift due to occlusal interference or premature contact of teeth; no congenitally missing teeth (excluding third molars); severe crowding in the maxillary arches (arch length discrepancy < -8 mm); patients and their families intensely rejected surgery; adult patients (ages ≥ 17 years); no subjects had undergone orthodontic therapy of any type prior to this treatment.

-

Extraction of 4 premolars.

Standard edgewise technique.

Class III elastics were used in some cases where required.

2.1 (SD=0.4)

Molar relationship of half to full-unit Class III; ANB= -2° (SD=0.7)

Cephalometric changes: Increase in: Cm.Sn.Ls.

Decrease in:  U1.SN, L1.MP, U1.L1, L1.NB, L1-NB, Li-E, Li-H, Ls-RL2, Li-RL2

Ning and Duan (2010)

Retrospective, cohort.

Cephalometric analysis.

Setting: Department

of Orthodontics at the Fourth Military Medical University.

N=28 (15 male, 13 female).

18.8

Anterior crossbite; Class III molar relationship, no mandibular shift due to occlusal interference or premature contact of teeth; concave facial profile; −4.0° ≤ ANB ＜ 0°; over the adolescent growth spurt; originally classified as surgical cases by other orthodontists but the patients and their families rejected surgical treatment.

-

Extraction of 2 mandibular premolars.

Standard edgewise technique.

Class III elastics were used in some cases when required.

2.0 (SD=0.6)

Molar relationship of half-unit Class III or superior; ANB= -2.4° (SD=2.5).

Cephalometric changes: Increase in: U1.SN, U1.L1, Ls-E, overjet.

Decrease in: L1.MP, L1.NB, L1-NB, Li-E, Li-H, Cm.Sn.Ls, Li-RL2.

Kuroda et al. (2010)

Retrospective, cohort.

Cephalometric and plaster cast analysis.

Setting: private practice.

N=14 (4 male, 10 female)

21.1 (SD=4.4)

ANB angle ≤ 1.0° (range -2.0° to 1.0°), Angle Class III molar relationship, and no congenital deformity in the craniofacial area.

-

No extraction.

Association between edgewise appliance (The Alexander Discipline) and high-pull J-hook headgear applied directly to the mandibular archwire with 200 g of force on each side at night only. Short Class III elastics were used for 7.9 months to maintain the occlusion. The mandibular third molars were extracted in all subjects before treatment.

2.2 (SD=0.5)

Angle Class III molar relationship; ANB= 0.2° (SD=1.0); Wits= -6.0 mm (SD= 2.8); overjet= 0 mm (SD=1.2).

Cephalometric changes: Increase in: U1.FH, Wits, U1-NA, L1e-MP, overjet, overbite.

Decrease in: FH.Occ, L1.MP, L6.MP, L1-NB, L1-A-Po, L1e-PTV, L1a-PTV, L6c-PTV, L6a-PTV, E line- mandibular lip.

Model analysis change: intermolar width increased.

He et al. (2013)

Retrospective, case control.

Cephalometric analysis.

Setting: Department of Orthodontics,

West China Hospital of Stomatology, Chengdu, China.

N=44

Divided in two groups:

Experimental group: 20 patients (10 male, 10 female)

Control group: 24 patients (10 male, 14 female)

Experimental group: 20.6 (SD=4.0)

Control group: 21.3 (SD=1.9)

(1) mild to moderate skeletal Class III relationship (-4° ≤ ANB ≤ 0); Angle Class III molar relationship

bilaterally; no or mild crowding (<4 mm); lack of

a functional mandibular shift and inability of the

mandible to move back spontaneously; and lack of temporomandibular disorder symptoms.

-

Experimental group: 20 patients treated with MEAW and modified Class III elastics from the maxillary mini-implants.

Control group: 24 patients treated with MEAW and long Class III elastics.

Mini-implants

were placed in the buccal interradicular

spaces between the maxillary second premolars and the

first molars in the experimental group. Symmetric or

asymmetric light Class III elastics (5/16 inch and weight 3.5 ounces) were used from the implants in the experimental group and from the maxillary second molars

in the control group to the first loops on the MEAW (mesial to the canines).

-

Angle Class III molar relationship bilaterally.

Experimental group: ANB= -1.9° (SD= 1.3); Wits= -9.8 mm (SD= 1.9); overjet= -0.9 mm (SD= 1.3).

Control group: ANB= -2.1° (SD= 1.5); Wits=-8.8 mm (SD= 2.1); overjet= -1.3 mm (SD= 2.3).

Changes in experimental group:

Increase in: ODI, U1-L1°, U1-SN°, L1-MP (mm), Wits, Overjet, Overbite.

Decrease in: OP-SN, Pog-McNa line, APDI, L1.MP, L6.MP, L6-MP, U6-FHV, L1-FHV, L6-FHV, LL-EP.

Changes in control group:

Increase in: S-Go/N-Me, ODI, U1-PP, U6-PP, L1-MP, L6-MP, U1-FHV, Wits, Overjet, Overbite, UL-EP, LL-EP.

Decrease in: OP-SN, SN-MP, Pog-McNa line, APDI, U1.SN, L1.MP, L6.MP, L1-FHV, L6-FHV.

Janson et al. (2014)

Retrospective, cohort.

Cephalometric analysis and occlusal evaluation (TPI).

Setting: private office file.

N=23 (10 male, 13 female)

25.2 (SD= 6.7)

Dental and skeletal

Class III malocclusion (ANB, NAP and Wits) with at least an end-to-end bilateral Class III molar relationship, anterior and posterior crossbites, and concave facial profile.

-

Fourteen patients were treated with two mandibular premolar and 6 with two mandibular first molar extractions. Three patients were treated without extractions.

3.1 (SD= 0.9)

At least an end-to-end bilateral Class III molar relationship; ANB= -2.91° (SD= 2.99); Wits= -9.40 mm (SD= 4.63); overjet= -1.26 mm (SD= 1.99).

Cephalometric changes:

Increase in: A-NPerp, Co-A, Co-Go, Co-Gn, ANB, Wits, NAP, LAFH, Mx1.NA, IS.PP, Mx6-PP, Md1-MP, Md6-MP.

Decrease in: SNB, Md1.NB, Md1-NB, Md1.MP, overjet, overbite.

Occlusal changes: TPI change: 9.85

Percent TPI reduction: 82.17%

Yu et al. (2016)

Retrospective, cohort (not clear).

Cephalometric analysis.

Setting: Department of Orthodontics, Seoul St. Mary’s Hospital,

The Catholic University of Korea.

N=22 (11 male; 11 female)

23.9 (SD=5.5)

Patients older than 18 years at the start of treatment, with dental Class III malocclusion with more than a one-half cusp discrepancy at the molars, missing or extracted third molars, and no syndrome or systemic disease.

-

Patients received ramal plates for mandibular molar distalization, placed in the retromolar fossa between the anterior border of the mandibular ramus and the temporal crest. Power chain elastics were connected from the plate hooks to the first molar bracket hooks to deliver a force of 300 g per side.

-

Angle Class III molar relationship with more than ½ cusp discrepancy; ANB= 0.61° (SD= 3,04); Wits= -6.02 mm (SD=3.35).

Cephalometric changes:

Increase in: 6R-FH, 6C-MP, ANB, Wits.

Decrease in: 1C-FH, 1R-FH, 6C-VFH, 6R-VFH, 1C-VFH, 6.FH, 1.FH, 1C-MP, 1R-MP, 6C-VMP, 6R-VMP, 1C-VMP, 1.MP, SNB, Pog-Nperp, TVL-LL, TVL-Pog’.

Nakamura et al. (2017)

Retrospective, cohort.

Cephalometric analysis.

Setting: Department of Orthodontics,

Okayama University Hospital, Japan.

N=23

Divided in two groups according to treatment modality:

TADs: 11 patients (2 male, 9 female).

Elastic: 12 patient (5 male, 7 female).

TADs: 25.1 (SD=12.9)

Elastic: 18 (SD=2.7)

Angle Class III molar relationship, mild or moderate skeletal Class III discrepancy, nongrowing patients with nonextraction orthodontic treatment, and comprehensive orthodontic treatment with a multibracket edgewise appliance (0.018 3 0.025-in slot).

Congenital deformity in the craniofacial area and retreatment patient.

TADs: Distalization was performed with miniscrews, miniplates, or titanium screws, placed on the retromolar pad (3 patients) or on the buccal sides. After 4 weeks of TADs placement, a distal force (estimated at either 150 or 200 g) was directly applied on the hook between the canine and first premolar with closing coils.

Elastic: patients were treated with Class III elastics

from the maxillary first molar to the mandibular

canine.

TADs: 3.0 (SD= 1.0).

Elastic: 2.7 (SD= 1.0).

Angle Class III molar relationship.

TADs: ANB= -1.0° (SD= 2.0); overjet= -0.5 mm (SD= 2.6).

Elatic: ANB= 0.4° (SD= 1.0); overjet= 0.6 mm (SD= 2.3).

Changes in TADs:

Increase in: U1.SN, L6.MP, overjet, U6-PP.

Decrease in: Occ plane.

Changes in Elastic:

Increase in: ANB, SN.MP, y-axis, U1.SN, L1.MP, L6.MP, U6-PP, overjet.

Decrease in: Occ plane.