Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review

Abstract

Objective This systematic review evaluated the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of orthodontic camouflage (OC) versus orthodontic-orthognathic surgical (OOS) treatment in borderline class III malocclusion patients. Methods Eligibility criteria. The included studies were clinical trials and/or follow-up observational studies (retrospective and prospective). Information sources. PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS were searched up to October 2021. Risk of bias. Downs and Black quality assessment checklist was used. Synthesis of results. The outcomes were the skeletal, dentoalveolar, and soft tissue changes obtained from pre- and post-cephalometric measurements. Results Included studies. Out of 2089 retrieved articles, 6 were eligible and thus included in the subsequent analyses. Their overall risk of bias was moderate. Outcome results. The results are presented as pre- and post-treatment values or mean changes in both groups. Two studies reported significant retrusion of the maxillary and mandibular bases in OC, in contrast to significant maxillary protrusion and mandibular retrusion with increased ANB angle in OOS. Regarding the vertical jaw relation, one study reported a significant decrease in mandibular plane inclination in OC and a significant increase in OOS. Most of the included studies reported a significant proclination in the maxillary incisors in both groups. Three studies reported a significant proclination of the mandibular incisors in OOS, while four studies reported retroclination in OC. Conclusion Interpretation. The OSS has a protrusive effect on the maxillary base, retrusive effect on the mandibular base, and thus improvement in the sagittal relationship accompanied with a clockwise rotational effect on the mandibular plane. The OC has more proclination effect on the maxillary incisors and retroclination effect on the mandibular incisors compared to OOS. Limitation. Meta-analysis was not possible due to considerable variations among the included studies. Owing to the fact that some important data in the included studies were missing, conducting further studies with more standardized methodologies is highly urgent. Registration. The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199591). Clinical relevance The common features including skeletal, dental, and soft tissue characteristics of borderline class III malocclusion cases make it more difficult to select the most appropriate treatment modality that can be either OC or OOS. The availability of high-level evidence—systematic reviews—makes the clinical decision much more clear and based on scientific basis rather than personal preference.

Three-dimensional evaluation of orthodontic treatment efficacy in patients with mild skeletal Class III malocclusion using clear aligners: a retrospective study

“…In cases of mild skeletal Class III malocclusion, camouflage therapy primarily focuses on dealing with sagittal misalignment through distal movement of the molars [18,19]. The findings from our PAR index suggest that CAT effectively managed the sagittal movement of the teeth and offers specific benefits for cases requiring distal tooth movement.…”

Clear Aligners Treatment of Class III Subdivision with an Extraction of a Lower Bicuspid

“…When the Class III malocclusion is characterized by dental and/or skeletal asymmetries, the treatment can be even more complex [ 6 ]. In non-growing subjects with Class III subdivision malocclusion and a midline deviation, combined surgical–orthodontic therapy can be a treatment option, especially if the asymmetry is severe [ 7 , 8 ]. An alternative approach for patients who reject surgery is represented by a compensatory orthodontic treatment associated with tooth extractions [ 9 , 10 ].…”

Highlight the major clinical studies on orthognathic surgery in the correction of anomalies in Class III patients: a systematic review

“…In the setting of orthognathic surgery, malocclusion is the third most common oral health problem after caries and periodontal diseases [1][2][3]. The worldwide prevalence of Class III malocclusion in permanent dentition is estimated at 0.7% in Israel and 19.9% in China, being associated with greater facial disfigurement [4].…”

“…Orthodontics stands out due to its strong aesthetic compromise and unfavorable treatment prognosis, especially when there is a hereditary component. It is suggested that most cases of Class III malocclusion have maxillary retrusion or hypoplasia, which may or may not be associated with mandibular prognathism [2]. Treatment of Class III malocclusion before late mixed dentition seems to induce more favorable craniofacial changes, with a significant increase in maxillary sagittal growth.…”

“…Treatment of Class III malocclusion before late mixed dentition seems to induce more favorable craniofacial changes, with a significant increase in maxillary sagittal growth. However, a mandibular restriction effect can be achieved in later treatment [2]. Some studies report that disarticulation of circumaxillary sutures enhances orthopedic effects [3,4], however, the use of a face mask at a young age, even without palatal expansion, is effective for the correction of skeletal Class III.…”