Skip to main content Skip to main navigation menu Skip to site footer
Review
Published: 01-06-2023

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

UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
Orthognathic surgery Malocclusion Class III malocclusion Clinical studies

Abstract

Introduction: In the setting of orthognathic surgery, malocclusion is the third most common oral health problem after caries and periodontal diseases. Malocclusion is found in ages between 7 and 15 years with a prevalence of 6% in Brazil. Objective:  The present study aimed to highlight the main considerations and findings of clinical studies on the importance of orthognathic surgery in the correction of anomalies in class III patients. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles with different dates up to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found, 70 articles were evaluated and 56 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 20 studies that did not meet GRADE. Based on the results, the treatment of Class III must be fundamentally based on the diagnosis so that the treatment can be installed in order to correct the compromised structures instead of being compensated in places not affected by this malocclusion. In other words, the degree of involvement of the maxilla and mandible must be evaluated so that the treatment is directed to that bone base and really achieves its goals and impacts of facial improvement. Redirection of growth in Class III cases is indicated as soon as the anomaly is diagnosed, as the displacement processes that occur in the middle face can only be affected with treatment while the growth zones are able to respond to the biomechanical stimulus. Therefore, the younger the Class III patient is treated, the better the facial correction effects.

Metrics

Metrics Loading ...

References

  1. Bai Y, Tang Y, Ren M, Wang M, Zhao W, Zeng T, Liu F, Zhu S. Orofacial myofunctional changes in skeletal Class III patients after bimaxillary orthognathic surgery. J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3526-3533. doi: 10.1016/j.bjps.2022.04.102.
  2. Alhammadi MS, Almashraqi AA, Khadhi AH, Arishi KA, Alamir AA, Beleges EM, Halboub E. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review. Clin Oral Investig. 2022 Nov;26(11):6443-6455. doi: 10.1007/s00784-022-04685-6.
  3. Park SY, Choi YK, Lee SH, Kang HJ, Kim SS, Kim SH, Kim YI. Long-term condylar remodelling after bimaxillary orthognathic surgery in skeletal Class III patients. Br J Oral Maxillofac Surg. 2022 Oct;60(8):1056-1061. doi: 10.1016/j.bjoms.2021.06.004.
  4. Lee YH, Tsai CY, Wang LC, Lai UK, Lai JP, Lin SS, Chang YJ. Comparison of the PostSurgical Position of the Temporomandibular Joint after Orthognathic Surgery in Skeletal Class III Patients and Patients with Cleft Lip and Palate. J Pers Med. 2022 Aug 31;12(9):1437. doi: 10.3390/jpm12091437.
  5. Boeck EM, Lunardi N, Pinto Ados S, Pizzol KE, Boeck Neto RJ. Occurrence of skeletal malocclusions in Brazilian patients with dentofacial deformities. Braz Dent J. 2011;22(4):340-5. doi: 10.1590/s0103-64402011000400014.
  6. Saleh M, Hajeer MY, Al-Jundi A. Assessment of pain and discomfort during early orthodontic treatment of skeletal Class III malocclusion using the Removable Mandibular Retractor Appliance. Eur J Paediatr Dent 2013;14:119-24.
  7. Angle EH. Classification of malocclusion. Dent. Cosmos. 1899;41:248-64.
  8. Sanborn RT. Differences between the facial skeletal patterns of Class III malocclusion and normal occlusion. Angle Orthod. 1955;25:208-22.
  9. Guyer EC, Ellis EE, McNamara JA, Behrents RG. Components of Class III malocclusion in juveniles and adolescents. Angle Orthod. 1986;56:7-30.
  10. Ellis E 3rd, McNamara JA Jr. Components of adult Class III open-bite malocclusion. Am J Orthod. 1984;86:277-90.
  11. Showkatbakhsh R, Jamilian A, Behnaz M, Ghassemi M, Ghassemi A. The short-term effects of Face mask and Fixed Tongue Appliance on Maxillary Deficiency in Growing Patients – A Randomized Clinical Trial. Int J Orthod. 2015;26(1)29-34.
  12. Proffit WR. Contemporary Orthodontics. 4th ed. St Louis: CV Mosby; 2007.
  13. Haynes S. The prevalence of malocclusion in English children aged 11–12 years. Rep Congr Eur Orthod Soc. 1970:89-98.
  14. Cobourne M. Early treatment for class III malocclusion. J Orthod. 2016;43(3):159-160. doi:10.1080/14653125.2016.1215860.
  15. Agostino P, Ugolini A, Signori A, Silvestrini-Biavati A, Harrison JE, Riley P. 2014. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev. 8: CD000979.
  16. Mandall N, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R, et al. Early class III protraction facemask treatment reduces the need for orthognathic surgery. A multicentre, two-arm parallel randomised, controlled trial. J Orthod. 2016, 43: 164–175.
  17. Mandall N, DiBiase A, Littlewood S, Nute S, Stivaros N, McDowall R, et al. Is early class III protraction facemask treatment effective? A multicentre, randomised, controlled trial: 15-month follow-up. J Orthod. 2010, 37: 149–161.
  18. Thiruvenkatachari B, Harrison JE, Worthington HV, O’Brien KD. 2013. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database Syst Rev. 11: CD003452.
  19. Irie M, Nakamura S. Orthopedic approach to severe skeletal Class III malocclusion. Am J Orthod. 1975;67:377-92.
  20. Woon SC, Thiruvenkatachari B. Early orthodontic treatment for Class III malocclusion: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2017;151(1):2852. doi:10.1016/j.ajodo.2016.07.017].
  21. Baik HS, Han HK, Kim DJ, Proffit WR. Cephalometric characteristics of Korean Class III surgical patients and their relationship to plans for surgical treatment. Int J Adult Orthodon Orthognath Surg. 2000;15:119-28.
  22. Abbasi S, Rahpeyma A, Shooshtari Z, Rezaeetalab F, Vaezi T, Samieirad S. Bimaxillary Orthognathic Surgery Does Not Induce Obstructive Sleep Apnea in Skeletal Class III Patients. J Oral Maxillofac Surg. 2022 Aug;80(8):1340-1353. doi: 10.1016/j.joms.2022.04.010.
  23. De Toffol L, Pavoni C, Baccetti T, Franchi L, Cozza P. Orthopedic Treatment Outcomes in Class III Malocclusion A Systematic Review. Angle Orthod. 2008;78:561-73.
  24. Turchetta BJ, Fishman LS, Subtelny JD. Facial growth prediction: a comparison of methodologies. Am J Orthod Dentofacial Orthop. 2007; 132:439-49.
  25. Yoshida I, Yamaguchi N, Mizoguchi I. Predction of post-treatment outcome after combined treatment with maxillary protraction and chincup appliances. Eur J Orthod. 2006;28:89-96.
  26. Vaughn GA, Mason B, Moon HB, Turley PK. The effects of maxillary protraction therapy with or without rapid palatal expansion: A prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop. 2005;128:299-309.
  27. Ge YS, Liu J, Chen L, Han JL, Guo X. Dentofacial effects of two facemask therapies for maxillary protraction: Miniscrew implants versus rapid maxillary expanders. Angle Orthod. 2012;82:1083-91.
  28. Jamilian A, Haraji A, Showkatbakhsh R, Valaee N. The Effects of Miniscrew with Class III Traction in Growing Patients with Maxillary Deficiency. Int Journal Orthod. 2011;22:25-30.
  29. Showkatbakhsh R, Jamilian A, Ghassemi M, Ghassemi A, Taban T, Imani Z. The Effects of facemask and reverse chin cup on maxillary deficient patients. Journal of Orthod. 2012;39:95-101.
  30. Abdelnaby YL, Nassar EA. Chin cup effects using two different force magnitudes in the management of Class III malocclusions. Angle Orthod. 2010;80:957-62.
  31. Showkatbakhsh R, Toumarian L, Jamilian A, Sheibaninia A, Mirkarimi M, Taban T. The effects of facemask and tongue plate on maxillary deficiency in growing patients: a randomized clinical trial. Journal of Orthod. 2013;40:130- 36.
  32. Hamdy Mahmoud M, Ismail Elfaramawi T. Maxillary stability in patients with skeletal class III malocclusion treated by bimaxillary orthognathic surgery: comparison of mandible-first and maxilla-first approaches in a randomised controlled study. Br J Oral Maxillofac Surg. 2022 Jul;60(6):761-766. doi: 10.1016/j.bjoms.2021.10.001.
  33. Atalay Z, Tortop T. Dentofacial effects of a modified tandem traction bow appliance. Eur J Orthod. 2010;32:655-61.
  34. Arman A, Toygar, TU, Abuhijleh, E. Evaluation of maxillary protraction and fixed appliance therapy in Class III patients. Eur J Orthod. 2006;28:383-92.
  35. Mandal NA, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R. et al. Is early class protraction facemask treatment effective? A multicentre, randomized, controlled trial: 3-year follow-up. Journal of Orthod. 2012;39:176- 85.
  36. Liu W, Zhou Y, Wang X, Liu D, Zhou S. Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: A single-center, randomized controlled trial. Am J Orthod Dentofacial Orthop. 2015;148:641-51.
  37. Showkatbakhsh R, Jamilian A, Taban T,Golrokh M. The effects of Face mask and Tongue Appliance on Maxillary Deficiency in growing patients: A randomized clinical trial. Progress in orthodontics. 2012;13:266-72.
  38. Seehra J, Fleming PS, Mandall N, DiBiase AT. A comparison of two different techniques for early correction of Class III malocclusion. Angle Orthod. 2012;82:96–101.
  39. Kurt Demirsoy K, Türker G, Amuk M, Kurt G. How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class double-jaw orthognathic surgery patients. J Stomatol Oral Maxillofac Surg. 2022 Sep;123(4):e133-e139. doi: 10.1016/j.jormas.2022.03.009.
  40. Watkinson S, Harrison JE, Furness S, Worthington HV. Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database of Systematic Reviews 2013, Issue 9.
  41. Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer SJ et al. Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res. 2014;17:133-43.
  42. Foersch M, Jacobs C, Wriedt S, Hechtner M, Wehrbein H. Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis. Clin Oral Invest. 2015;19:1181-92.
  43. Morales-Fernández M, Iglesias-Linares A, Yañez-Vico RM, MendozaMendoza A, Solano-Reina E. Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: New approaches, similar objectives? A systematic review. Angle Orthod. 2013;83:540-52.
  44. Ye C, Zhihe Z, Zhao Q, Ye J. Treatment Effects of Distal Movement of Lower Arch With Miniscrews in the Retromolar Area Compared With Miniscrews in the Posterior Area of the Maxillary. J Craniofac Surg. 2013;24:1974-79.
  45. Chatzoudi MI, Ioannidou-Marathiotou I, Papadopoulos MA. Clinical effectiveness of chin cup treatment for the management of Class III malocclusion in pre-pubertal patients: a systematic review and meta-analysis. Progress in Orthodontics. 2014;15:62.
  46. Yang X, Li C, Bai D, Su N, Chen T, Xu Y, et al. Treatment effectiveness of Fränkel function regulator on the Class III malocclusion: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2014;146:143-54.
  47. Saleh M, Hajeer Y, Al-Jundi A. Short-term soft- and hard-tissue changes following Class III treatment using a removable mandibular retractor: a randomized controlled trial. Orthod Craniofac Res. 2013;16:75-86.
  48. Keim RG, Gottlieb EL, Nelson AH. Vogels DS 3rd. 2008 JCO study of orthodontic diagnosis and treatment procedures. Part 3: more breakdowns of selected variables. J Clin Orthod. 2009;43:22-33.
  49. McNamara JA JR, Brudon WL. Orth odontics and dentofacial orthopedics. Ann Arbor, Mich: Needham Press; 2001.
  50. Hong M, Kim I, Cho JH, Kang KH, Kim M, Kim SJ, Kim YJ, Sung SJ, Kim YH, Lim SH, Kim N, Baek SH. Accuracy of artificial intelligence-assisted landmark identification in serial lateral cephalograms of Class III patients who underwent orthodontic treatment and two-jaw orthognathic surgery. Korean J Orthod. 2022 Jul 25;52(4):287-297. doi: 10.4041/kjod21.248.
  51. Tuncer BB, Kaygisiz E, Tuncer C, Yuksel S. Pharyngeal airway dimensions after chin cup treatment in Class III malocclusion subjects. J Oral Rehab. 2009;36:110-17.
  52. Liu C, Hou M, Liang L, Huang X, Zhang T, Zhang H, et al. Sutural distraction osteogenesis (SDO) versus osteotomy distraction osteogenesis (ODO) for midfacial advancement: A new technique and primary clinical report. J Craniofac Surg. 2005;16:537-48.
  53. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results. Am J Orthod Dentofacial Orthop. 2008; 133:440-49.
  54. De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC, Tulloch CJ. Orthopedic traction of the maxilla with mini- plates: a new perspective for treatment of midface deficiency. J Oral Maxillofac Surg. 2009; 67:2123-29.
  55. Gulcek BN, Ozbilen EO, Biren S. Changes in the condylar head after orthognathic surgery in Class III patients: a retrospective three-dimensional study. Angle Orthod. 2022 Nov 21;93(2):168–75. doi: 10.2319/052922-394.1.
  56. Eshghpour M, Sharifian Attar AR, Labafchi A, Shooshtari Z, Bahramijoo F, Samieirad S. Emergence from Anesthesia: A Comparison between Isolated Mandibular Setback and Bimaxillary Orthognathic Surgeries in Skeletal Class III Patients. World J Plast Surg. 2022 Jul;11(2):144-149. doi: 10.52547/wjps.11.2.144.

How to Cite

Augusto, E. Z. R., Viudes, J. H., Rezende, E. B., & Scriboni, A. B. (2023). Highlight the major clinical studies on orthognathic surgery in the correction of anomalies in Class III patients: a systematic review. MedNEXT Journal of Medical and Health Sciences, 4(S2). https://doi.org/10.54448/mdnt23S212