Systematic Review Of The Surgery-first Approach Versus Orthodontic-first Approach In Correction The Skeletal Class Ⅲ With Orthognathic Surgery

Objective: In this study,orthodontic-first approach was used for the reference standard,a systematic review is to analyze the stability and efficiency between surgical-first approach and orthodontic-first approach in correction the skeletal class III with orthognathic surgery,to evaluation the strengths and weaknesses of the two treatment approaches,and to provide orthodontic treatment suggestions for clinical guidance.Methods: Formulate search queries,Databases of Cochrane Library、Medline、EMBASE、PUBMED were retrieved and relevant unpublished gray literatures and magazines were manually retrieved,the deadline is December 2015.The studies about the skeletal class III malocclusion treated by surgical-first approach and orthodontic-first approach were comprehensively found.Two researchers independently selected studies based on the selection criteria and quality assessment system,disagreements were solved by discussion.The new risk of bias assessment tools recommend by Cochrane Collaboration was used for quality evaluation of randomized controlled trials,"non-randomized controlled trial quality evaluation criteria and scorecard" of Chinese Evidence Journal was used for quality evaluation of non-randomized controlled clinical trial.Low-quality literatures were excluded based on the level of quality literature.Use the dimension and angle of the changes of hard tissue landmarks between after surgery and after removal of brackets as the amount of relapse,A point,B point,Pog point were chosen as the landmarks,△SNA、△SNB 、△ANB、△A(x)、△B(x)、△Pog(x)were the amounts of sagittal relapse,△A(y)、△B(y)、△Pog(y)were the amounts of vertical relapse;transverse dimensional changes;effectiveness of treatment time: Postsurgical-Duration,total-Duration.The outcome measurements combined and evaluated in the Meta-analysis by RevMan5.2.Qualitative description was performed for diverged documents.Results: Totally seven non-randomized controlled trails of foreign articles,292 cases were included,quality evaluation of included trials were medium.1.The results of meta-analysis showed that:△SNB、△A(x)、△B(x)、△Pog(x)of non-presurgical orthodontics 、 Postsurgical-Duration of non-extraction 、Total-Duration of extraction have no significant statistical difference(P>0.05);△ANB、△Pog(x)of minimal presurgical orthodontics、△Pog(y)、Postsurgical-Duration of extraction 、 Total-Duration of non-extraction have significant statistical difference(P<0.05),2.△SNA、△A(y)、△B(y)、Transverse Dimensional Changes,qualitative description,△SNA、△A(y)、Transverse Dimensional Changes have no significant statistical difference(P>0.05),△B(y)has significant statistical difference(P<0.05).Conclusions:1.The transverse change of bimaxillary and the sagittal and vertical stability of maxillary of SFA and OFA were similar.2.For simple cases,the sagittal and vertical stability of mandible of SFA and OFA were similar;for complex cases,the sagittal andvertical stability of mandible of SFA was poor than OFA,it revealed a forward and counter-clockwise rotation relapse,proper cases should be selected strictly.3.The total-duration of non-extraction cases,SFA was shorter than OFA,the total duration of extraction cases,SFA and OFA were similar.4.The postsurgical-duration of non-extraction cases,SFA and OFA were similar,the postsurgical-duration of extraction cases,OFA was shorter than SFA.5.The study was a non-randomized controlled trial of systematic review,the results should be treated carefully.