Comparative Analysis of Early Class III Malocclusion Treatments-A Systematic Review and Meta-Analysis

Several therapeutic methods have been proposed for early class III malocclusion treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and meta-analysis was to summarize the clinical evidence on the efficacy of each method. The PRISMA recommendations were followed. Four databases were searched for articles published up to February 2024. Controlled trials, randomized or non-randomized clinical trials, and prospective or retrospective studies with a control group and a minimum follow-up of 6 months were included. The risk of bias was assessed using the Cochrane collaboration tool. Inconsistency was assessed using the Q test, with a significance level of p < 0.05 and a forest plot. A total of 61 articles were identified, and eight were included in the meta-analysis, which examined three parameters: Sella-Nasion-A (SNA), Sella-Nasion-B (SNB), and A Point-Nasion-B (ANB) values. The meta-analysis was carried out using the random effects model and the inverse variance method. The effect size was determined as the difference between the means of the SNA, SNB, and ANB values in the initial and final intervention groups or between the intervention group and control group. Statistical significance was assessed using the z-test and was declared when p-value < 0.05. The heterogeneity of the meta-analysis was analyzed using the Q test and the I² statistical index. Publication bias was analyzed using the trim-and-fill method to adjust the skewness of the funnel plot. The risk of bias in the selected studies was assessed using the Cochrane collaboration tool to analyze the methodological quality assessment of the clinical trials. There were statistically significant differences between traditional maxillary disjunction and traction and the different types of Alt-RAMEC protocols, with the latter allowing greater skeletal corrections.