Bone-anchored maxillary protraction versus conventional orthopedic treatment for Class III malocclusion in children...

Class III malocclusion in mixed dentition often involves maxillary retrusion. Conventional orthopedic treatments, such as facemask or chin cup therapy, aim to redirect craniofacial growth but frequently cause dentoalveolar compensation and unfavorable vertical changes. Bone-anchored maxillary protraction (BAMP) provides skeletal traction to enhance maxillary advancement while limiting vertical side effects. This review compares the skeletal, dentoalveolar, and soft-tissue outcomes of BAMP versus conventional orthopedic treatment or natural growth in children under 12 years. The protocol was prospectively registered in PROSPERO (CRD420251042103). A systematic search of PubMed, Scopus, Embase, Web of Science, and the Cochrane Library was conducted up to April 2025 following PRISMA 2020 guidelines. Studies evaluating BAMP against conventional Class III therapies or untreated controls in children younger than 12 years were included. Four quantitative and four qualitative studies were synthesized. Risk of bias was assessed using RoB 2.0 and ROBINS-I. Across 116 patients in the quantitative studies, BAMP consistently improved SNA (+1.9° to +6.17°) and ANB (+1.4° to +6.83°), enhanced Wits appraisal, and demonstrated minimal increases in SN-MP angles, indicating superior vertical control. Overjet gains (+5.97 mm) and stable upper incisor inclination suggested reduced dental compensation. Soft-tissue improvements included enhanced midface projection. The qualitative studies supported these trends. Current evidence indicates that BAMP achieves greater skeletal correction and vertical control with fewer dentoalveolar side effects compared with conventional Class III therapies or observation. Further long-term studies are required.