Background The introduction of skeletal anchorage utilized for maxillary protraction with a face mask or class III elastics has been developed for the management of class III malocclusions with minimal dental effect. The objective of the present review was to evaluate the current evidence regarding airway dimensional changes following bone-anchored maxillary protraction. A search was conducted by two authors (S.A & B.A) in the following databases: MEDLINE via PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and Open Grey; besides a hand search in references of selected articles and developing a search alert in electronic databases. Selection criteria comprised randomized as well as prospective clinical trials evaluating airway dimensional changes following bone-anchored maxillary protraction. Relevant data were extracted after studies retrieval and selection. The risk of bias was thereafter evaluated using the revised RoB 2 tool for randomized clinical trials and the ROBINS-I tool was used for non-randomized clinical trials. The quality of studies was assessed using the modified Jadad score. After examining (eligibility) full-text articles, four clinical trials were ultimately included. These studies evaluated the airway dimensional changes, following bone-anchored maxillary protraction in comparison to different control study groups. Based on the available evidence, all the bone-anchored maxillary protraction devices used in the eligible studies in the present systematic review resulted in an improvement in the airway dimensions. However, due to the few numbers of studies available and the guarded evidence due to the low quality of evidence of three out of four included articles, there is no strong evidence to support a significant increase in the airway dimensions following bone-anchored maxillary protraction. Therefore, there is a need for more randomized controlled clinical trials with similar bone-anchored protraction devices and similar assessment methods for more valid comparisons, excluding any confounding factors, on airway dimensional changes.

Objective Study was conducted to 3D evaluate skeletal effects of two different intraoral force application systems for treating skeletally growing ClassIII patients(RCT). Material and Methods 33 patients recruited and randomly allocated between three groups: GroupI(n = 11)treated with CS2000(CSgroup/ pulling force), GroupII(n = 11)treated with reversed Forsus Fatigue Resistant(RFgroup/ pushing force) and GroupIII(n = 11)untreated control(negative control). A CBCT taken before treatment(T0) and after gaining a 2mm overjet or after observation period of 6months(T1). Skeletal measurements were assessed and compared between groups. Within group comparisons were done using Wilcoxon Sign Rank test. Results Sagittaly in RFgroup, OLp-Apt increased by3.60mm, OLp-Bpt decreased by-2.50mm and OLp-Pg decreased as well by-2.00mm(P < 0.0001). In the same sagittal dimension for CSgroup, OLp-Apt increased by3.10mm, OLp-Bpt decreased by-1.10mm and OLp-Pg decreased as well by-1.00mm. Wits appraisal was increased by5.00mm and5.50mm in RF and CSgroup accordingly(P < 0.0001). There was an increase in OLs-Apt in treatment groups by3.80mm in RFgroup and5.00mm in CSgroup(P < 0.0001). Vertically there was a statistical significant difference between two groups. The ANS-Me decreased in RFgroup by-0.70mm and increased in CSgroup by2.00mm. Both treatment groups demonstrated an increase in SNAangle(2.6°in RFgroup and2.5° in CSgroup), decrease in SNBangle − 1.00°in RFgroup and-2.00°in CSgroup, hence increase in ANBangle.(P < 0.0001) Conclusions CS2000 spring and reversed Forsus Fatigue Resistance device promoted forward maxillary advancement in average of 5months. Both appliances gave close effects to bone anchored maxillary protraction devices and functional appliances, removing compliance factor out of the equation. Clinical relevance: Short term correction of growing skeletal class III using either one of novel techniques give positive skeletal results. Trial registration: Registered in clinicaltrial.gov (NCT04825951) in 01/04/2019, taking the approval of institutional review board at the Faculty of Dentistry, Alexandria University protocol record 070320212.