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VOLUME 13 , ISSUE S2 ( Supplementary Issue 2, 2022 ) > List of Articles


Treatment Efficacy and Patient Acceptance of Removable Mandibular Retractor Appliance and Bone-anchored Maxillary Protraction in Growing Skeletal Class III Patients: A Systematic Review

Sowmithra Devi, Aravind Kumar Subramaniyan

Keywords : Class III functional appliance, Growing skeletal class III patients, Removable mandibular appliance

Citation Information :

DOI: 10.5005/jp-journals-10015-2152

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: There are various treatment modalities in correcting the developing class III, of which the efficacy of removable mandibular retractor (RMR) in class III correction has not been discussed much in the literature. Available literature has compared various fixed and removable appliances for class III correction, which did not take RMR into inclusion. Hence, this systematic review focuses on the efficacy of the RMR appliance in bringing about favorable skeletal, dentoalveolar, and soft tissue changes in growing skeletal class III patients and patient acceptance of the appliance. Objective: To assess the skeletal, dentoalveolar, and soft tissue effects of RMR appliance and acceptability of the appliance in growing skeletal class III patients. Search methods: A systematic review of articles was performed using different electronic databases (PubMed, Cochrane Library, MEDLINE, Embase, Google Scholar, LILACS, and Web of Science) along with a manual search of orthodontic journals from 2011 to the year 2021. Selection criteria: Search items consisted of “removable appliances” and “skeletal class III.” The selection criteria were set to include only randomized controlled trials (RCTs). Four RCTs were included in the systematic review that evaluated dental, skeletal, and soft tissue effects and patient acceptance of RMR appliances. Data collection and analysis: Data regarding patient acceptance, skeletal, dentoalveolar, and soft tissue outcomes were extracted to collect study characteristics. Two separate authors independently extracted the data. Review manager (RevMan) version 5.1, Denmark, was the software used to analyze the data. After evaluating the risk of bias, standardized mean differences and 95% confidence intervals were calculated. Results: Of the four RCTs included, two RCTs evaluated the dentoalveolar, skeletal, and soft tissue changes with bone-anchored mandibular protraction (BAMP) and RMR appliance, and two RCTs evaluated the patient compliance and acceptability of the appliance. The results of the study by Majanni and Hajeer in 2016 revealed that skeletal and soft tissue changes were more pronounced with BAMP and dental changes were more pronounced with RMR appliance. However, a study by Saleh et al. concluded that hard and soft tissue changes were pronounced with RMR appliances when compared with no treatment controls. Two RCTs that evaluated patient compliance revealed that compared to RMR, bone-anchored intermaxillary traction (BAIMT) produced more pain, pressure, and tension of soft tissues that gradually reduced over time, and speech difficulty and social avoidance were noted in patients wearing RMR, which decreased gradually in time. Conclusion: Studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of MR appliances. The available evidence suggests that the use of MR produces predominant dental changes and causes speech difficulty and social avoidance for the patients. More trials are needed to produce stable results on the use of RMR appliances.

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