Comparative efficacy of the bone-anchored maxillary protraction protocols for orthopaedic treatment in skeletal Class III malocclusion: A Bayesian network meta-analysis.

ABSTRACT

OBJECTIVE: To compare the treatment effects of five bone-anchored maxillary protraction protocols (BAC3E, BAMP, BARME-FM, BARME-ME, SAFM) for skeletal Class III malocclusion. METHODS: We conducted a systematic literature search through CENTRAL, EBSCO, PubMed and Web of Science and included the randomized controlled trials and clinical controlled trials, which met the criteria. A Bayesian network meta-analysis (NMA) for SNA, SNB, ANB, SN-MP and Wits appraisal was performed in R software using a random consistency model. The additional analyses included node-splitting analysis, statistical heterogeneity analysis, sensitivity analysis and ranking probability by SUCRA. RESULTS: A total of 598 articles were initially obtained; 13 articles involving 482 individuals were eventually included. Among the five bone-anchored maxillary protraction protocols, the largest increment in SNA and Wits appraisal was observed in the BAMP group and BAC3E group, respectively; the SAFM, BAC3E and BAMP groups showed similar capability in terms of changes of ANB; least clockwise rotation of the mandible was found in the BARME-ME group, followed by the BAMP group; dental compensation appears to be most pronounced in the BAC3E group; and intermaxillary traction seems to reduce the lingual inclination of lower incisors and even cause labial inclination. CONCLUSIONS: The SAFM, BAMP and BAC3E groups seem to be advantageous in the improvement of the maxillo-mandibular relationship, followed by the BARME-FM and BARME-ME groups. The findings of this study should be interpreted with caution as only short-term effects were compared and the quality of evidence ranged from very low to moderate. More RCTs with high-quality and long-term investigation are needed.