{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T19:13:27Z","timestamp":1791659607655,"version":"4.3.4"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,31]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = \u22125.91 favouring skeletal anchorage, 95% CI from \u22127.64 to \u22124.27, P &amp;lt; 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low).<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration<\/jats:title><jats:p>PROSPERO register (CRD42020221982).<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejo\/cjac048","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T15:28:47Z","timestamp":1662650927000},"page":"157-168","source":"Crossref","is-referenced-by-count":20,"title":["Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs"],"prefix":"10.1093","volume":"45","author":[{"given":"Valentina","family":"Rutili","sequence":"first","affiliation":[{"name":"Postgraduate Program in Orthodontics, The University of Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Nieri","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, The University of Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, The University of Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicita","family":"Pierleoni","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, The University of Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Giuntini","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, The University of Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2072-460X","authenticated-orcid":false,"given":"Lorenzo","family":"Franchi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, The University of Florence , Italy"},{"name":"Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan , Ann Arbor , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1067\/mod.2000.109840","article-title":"Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy","volume":"118","author":"Baccetti","year":"2000","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/ejo\/19.3.289","article-title":"Maxillary development revisited: relevance to the orthopaedic treatment of Class III malocclusions","volume":"19","author":"Delaire","year":"1997","journal-title":"European Journal of Orthodontics"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S1073-8746(97)80059-X","article-title":"Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study","volume":"3","author":"Williams","year":"1997","journal-title":"Seminars in Orthodontics"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1093\/ejo\/17.6.467","article-title":"A comparative study of the effects of customized facemask therapy or headgear to the lower arch on the developing Class III face","volume":"17","author":"Battagel","year":"1995","journal-title":"European Journal of Orthodontics"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ortho.2021.07.003","article-title":"Mid-term follow up effectiveness of facemask treatment in class III malocclusion: a systematic review","volume":"19","author":"Kakali","year":"2021","journal-title":"International Orthodontics"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/ocr.12040","article-title":"Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis","volume":"17","author":"Cordasco","year":"2014","journal-title":"Orthodontics & Craniofacial Research"},{"key":"2023033115535169300_","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1179\/14653121043056","article-title":"Is early Class III protraction facemask treatment effective? 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