Table 3. Data extraction.
|
aArticle- Authors- Y.o.p |
Study design | Participants (number-age- gender) | Intervention | Treatment’s duration | Observational period | Outcomes | Method of Outcome Assessment | Results | Conclusions |
|---|---|---|---|---|---|---|---|---|---|
| Ritucci-Nanda[8], 1986 | retrospective | 10 F treated; 7F untreated (age not reported) |
10 CC; 7 untreated | Not reported | From age of 5y until the beginning of pubertal growth spurt. | Effects on growth and development of the cranial base and midface produced by the CC. | Lateral cephalometric radiographs (semiannually for treated patients; annually for controls) and menarche data (to assess the skeletal maturity stage). | Significantly decreased N-S-Ba angle, imposed downward vertical growth of the midface and Mx incisors’ eruption rate. More horizontal displacement of Mx 1st molars. | Closure of cranial flexure angle, inhibition of the downward vertical growth of the midface (posteriorly more evident). No effect on anteroposterior dimension. Increased mesial Mx molars’ movement. No soft-tissue changes reported. |
| Alacrόn et al.[25], 2011 | retrospective | 50 (25M,25F) treated, (8.5 ± 0.5 y); 40 (20M,20F) untreated (8.6 ± 0.4 y) |
50 CC; 40 untreated | 36m | Until the end of the treatment. | Mandibular shape changes in prognathic children treated with CC. | Lateral cephalometric radiographs + geometric morphometric analysis. | More rectangular corpus-ramus relationship, anteroposterior compression of the distance between the condyle and the coronoid process- relative vertical posterior ramus and gonial area compression, decreased gonial angle, increased symphysis height and narrowing. | Wide modification of the mandibular shape (more rectangular Mn configuration, forward condyle orientation, gonial area compression and symphysis narrowing. |
| Arman et al.[17], 2004 | retrospective | group 1: 31 (9M; 22F), 11.0 ± 0.24 y; group 2: 14 (8M; 6F), 11.1 ± 0.49 y, group 3: 14 (3M; 11F), 11.6 ± 0.61 y and 20 untreated controls (gender not reported), 10.5 ± 0.24 y. |
group 1: CC, group 2: CC+OBP, group 3: RHG; 20 controls. | group 1: 1.0 ± 0.15 y, group 2: 1.2 ± 0.15 y, group 3: 0.9 ± 0.09 y | Until the end of treatment for the treated groups; 1.0 ± 0.09 y for controls. | Skeletal, dentoalveolar and soft-tissue changes of CC, CC+OBP, RHG. Comparison of the treated groups with untreated controls and with each other. | Lateral cephalometric and hand-wrist radiographs. | Significant changes: decreased SNB, increased ANB, Wits appraisal, facial convexity angle (NAPg) and anteroposterior facial heights, increased overjet and decreased overbite, Mx incisors’ protrusion (U1i-HR) and proclination (U1- HR), Mn incisors’ retrusion (L1I-VR) and retroclination (L1-HR) and vertical movement (L1i-HR). Significant A(S)+upper lip’s forward movement (A(S)-VR, UL-VR), lower lip’s retraction (LL-VR, LL- E Ricketts, backward movement of B(S) (B(S)-VR) and backward position of soft chin (Pg(S)-VR). | Significant dentoskeletal improvements of skeletal Class III growing patients. More evident soft-tissue changes in the CC group. Long-term evaluation of stability is required. |
| Wendell et al.[27], 1985. | retrospective | 10F (age range: 5y 4m - 15y 6m; 7F (age range: 6y – 15y. | 10 CC; 7 untreated. | mean time: 3y 1m (until the correction of Class III Malocclusion). | Variable for treated patients (not specified). 6y 2m for the controls. | Effects of CC therapy on mandibular growth and dentition studied in young Japanese females. | Lateral cephalometric radiographs (semi-annually for the treated patients, annually for the controls. | 60-68% significant reduction of the ramal length (Ar-Go), body length (Go-Pg), and total Mn length (Ar-Pg). Continued reduction after the end of active treatment (55-61%). Significant closure of the N-S-Ba angle and significant decreases in anterior facial height (N-Me) during treatment. 50% further sign. anterior displacement of the 1st molars (M6x) during and 90% after the active treatment. | Significant reduction of the absolute Mn length during and after the end of the active treatment. Less downward Mn displacement relative to the cranial base. Significant dental changes declaring a favourable migratory dental displacement into Class I occlusion. |
| Alacrόn et al.[28], 2015 | retrospective | 42 (21M,21F), 8.5 ± 0.5 y; 25 (12M,13F), 8.5 ± 0.5 y. |
42 CC; 25 untreated. | 36 ± 6 m. | Until the age of 11 ± 0.6 y on average for the treated patients; Until the age of 11 ± 0.5 y on average for controls. | Soft-tissue changes in association to any skeletal and dentoalveolar changes induced by CC. | Lateral cephalometric radiographs. | Significant changes: inhibition of the sagittal growth of the mandible and the Mn incisors’ alveolus (B-GD, Pg-GD, Id-GD), inhibition of the total Mn length (Co-Pg), decreased facial convexity angle, lower lip’s inclination (Linf-E Ricketts), upper lip thickness, upper lip protrusion (Lsup-E Ricketts). Similar correlations of changes both in the hard+soft tissues apart from that one between the Pg retrusion and the reduction in the facial convexity angle. | Short-term soft facial profile improvement by favourable soft-tissue alterations following the underlying skeletal and dentoalveolar changes except for a significant correlation of Pogonion retrusion and reduction in the facial convexity angle. |
| Tuncer et al.[18], 2009 | retrospective | 20 (10M, 10F) 10.31 ± 1.15 y; 18 (10M, 8F) 9.89 ± 1.55 y. |
20 CC + OBP; 18 untreated |
9.78 ± 0.93 y. | Until the end of the treatment for the treated patients; 11.14 ± 0.24 y for the untreated controls. | Examination of the sagittal pharyngeal dimensions after CCtherapy. | Lateral cephalometric and hand-wrist radiographs. | Significant changes: decreased SNB and increased Sn-GoGn angles, increased total (N-Me) and upper heights. increased nasopharyngeal area and downward movement of the hyoid bone (H-SN). | Short-term downward and backward rotation of the mandible, increased vertical height, increased nasopharyngeal airway area. |
| Gökalp and Kurt [29], 2005. | prospective | 13 (3M,10F), 9.06y; 7 (1M,6F) 8.90y. |
13 CC; 7 untreated |
1y 7m. | Until the end of the treatment. | Investigation of skeletal Class III improvement after CC therapy. | Lateral cephalometric radiographs and Magnetic resonance imaging. | Significantly increased Mn body length and overjet. | CC alters the condylar growth pattern by producing morphological changes of the TMJ components and remodelling of the mandible towards an improved skeletal Class III malocclusion. |
| Sakamoto et al.[23], 1984. | retrospective | 26F, (age range: 6-9 y). 1F from the treated group was cross-sectionally contrasted to 423F (age range: 3-30y) to illustrate the reported skeletal changes induced by CC. |
26 CC (+additional double spring lingual arch in some cases). 423 untreated. |
Not reported. | More than 2 y after the end of CC therapy. | Skeletal changes and post-treatment stability after CC therapy. | Lateral cephalometric radiographs. | During treatment: decreased SNPg, increased ANB, FMA angles, restraint of growth (Mn body, ramus, Mn length, facial length), decreased gonial angle. 1y after the removal of CC: Forward Mn displacement (increased SNPg, decreased ANPg angles). 2 y after the removal of CC: no changes not maintained. | Restraint of growth was noted during CC therapy, but relapsed after the end of the treatment. No obvious changes in the cranium and the maxilla. Similar growth in Mn increments before and after the removal of CC. |
| Deguchi and McNamara [26], 1999. | retrospective | 22F, 9y 4m; 20F, 9y 7m. |
22 CC (+ additional lingual arch to flare the upper incisors); 20 untreated. | 1y 9m. | 28 ± 7.9 m for the treated patients; 30 ± 12m for the controls. | Investigation of the orthopedic effect of CC in the posterior displacement of the mandible and the glenoid fossa. | Lateral cephalometric and hand-wrist radiographs. | Significantly decreased gonial angle, less incremental increase in Mn length (Gn-Cd), posterior movement of points B and Pg, not increased anterior facial height. | Reduction in Mn growth increments. |
| Akin et al.[19], 2015. | retrospective | 25 (9M,16F), 9.8 ± 1.6 y, 25 (10M,15F), 10.3 ± 1.5 y; 17 (8M,9F), 10.1 ± 1.3 y. |
25 CC + OBP (flat surface Essix plate); 25 facemask; 17 untreated. |
Not reported. | Until the end of the treatment for the treated patients; 6m for the untreated. | Orofacial airway dimensional effects of facemask or CC compared to untreated controls. | Lateral cephalometric and hand-wrist radiographs. | Significant changes: decreased SNB, increased ANB and Sn-GoGn angles, forward movement and proclination of Mx incisors (increased U1-NA), backward movement and retroclination of Mn incisors (L1-NB), increased UL-E Ricketts, indicating protrusion of the upper lip. Changes in the perpendicular distance from hyoid (H) to the C3-Me line compared to controls. | CC therapy is found to induce clockwise Mn rotation. Although it does not significantly affect the pharyngeal airway dimensions, it moves the hyoid bone to a more inferior position in comparison with both the facemask and the untreated patients groups. |
| Lin et al.[20], 2007. | retrospective | 20 (10M,10F), 9y 11m; 20 (10M,10F) 9y 6m. |
20 OMA; 20 untreated. |
1y 4m. | Until the end of the treatment for the treated patients; 1y 5m for the untreated. | Skeletal and dental changes induced by an orthopedic OMA. | Lateral cephalometric radiographs. | Significant changes: Forward movement of point A, increase in Mx length, increased SNA, horizontal change of point B, increase in the Mn plane (Sn-MP) and the ramus plane angles, decreased SNB and gonial angles, labial tipping of Mx incisors, horizontal change in the Mn incisors’ tip, increased overjet. | OMA induces short-term favourable skeletal (forward growth of the Mx complex, backward and downward rotation of the Mn, restraint in forward Mn advancement) and dentoalveolar effects (labial tipping of Mx incisors). |
| Barrett et al.[21], 2010. | retrospective | 26 (11M,15F), 8.5 y treated patients divided in: group 1: 12 patients; group 2: 14 patients; 20 (6M,14F), 7.3y untreated. |
group 1: 12 CC + QH; group 2: 14 CC only; 20 untreated. |
2.6 y for the CC, 2..4 y for controls. | Until the end of treatment. | Skeletal and dentoalveolar changes induced by CC. | Lateral cephalometric radiographs. | Significant changes: a) skeletal: decreased SNB, increased ANB, decrease in palatal plane angle (FH-PP), b) dentoalveolar: uprighting of Mn incisors (decreased IMPA), decreased L1-APg and L1 horizontal movement, increased overjet, c) soft-tissue: decreased LL-E Ricketts and increased nasolabial angle. | Limited Class III correction with light force CC (fewer than 50% of the patients) mostly by dentoalveolar (uprighting of Mn incisors) rather than orthopedic changes. |
| Abu Alhaija and Richardson [24], 1999. | retrospective | 23 (14M,9F), 8.11 ± 0.96 y; 23 matched (age not reported). |
23 CC+URA; 23 untreated. |
3.01 ± 1.61 y | 3.34 ± 1.80 y after the end of treatment; 4.12 ± 1.86 y for the untreated. |
Short-and long-term effects of CC therapy combined with an URA in Class III patients. | Lateral cephalometric radiographs. | Significant changes: a) at the end of the active treatment: increased Mn length and facial height, retroclination of lower and proclination of upper incisors, increased overjet, nasolabial angle and improvement of soft-tissue profile, b) post-treatment: further Mn growth (increased SNB, Wits appraisal), increased facial height, maintained overjet, forward movement of the upper- and the lower lip, forward inferior movement of the chin. | Long-term proclination of the upper incisors, retroclination of the lower incisors, downward redirection of Mn growth and soft-tissue profile improvement. |
| Abdelanby and Nassar [22], 2010. | retrospective | group 1: 20 (10M,10F), 9.6y; group 2: 20 (9M,11F), 10.1 y; group 3: 10 (5M,5F), 9.2y. |
20 CC+OBP (600 gr per side); 20 CC+OBP (300 gr per side); 10 untreated. |
1 y. | 1 y for the untreated patients. | Skeletal and dental effects of CC using 2 force magnitude (300,600 gr per side) in Class III growing patients. | Lateral cephalometric and hand-wrist radiographs. | Significantly decreased SNB, Mn ramus height (Ar-Go), increased ANB, Wits appraisal, anterior, facial height (N-Me) Mn plane angle (SN-MP) and retroclination of Mn incisors. | Limited skeletal changes irrespective of utilization of force magnitude per side except for the reduction of the ramus height. |
*The cited references of the articles in the first column of the table correspond to the numbered references in the text.
Y.o.P: indicates year of publication, M: males, F: females, y: years, m: months, Mx: maxillary, Mn: mandibular, CC: chin-cup, OBP: occlusal bite plate, RHG: reversed headgear, OMA: occipitomental anchorage appliance of maxillary protraction combined with chin-cup traction, QH: quad-helix, URA: upper removable appliance, U1i: upper incisor’s tip, L1I: lower incisor’s tip, A(S), B(S), Pg(S): soft tissue points A,B,Pg respectively, Id: infradentale.