Watkinson, S., Harrison, J. E., Furness, S., and Worthington, H. V. (2013). Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database of Systematic Reviews Issue 9, Art. No.: CD003451. DOI: 10.1002/14651858.CD003451.pub2 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003451.pub2/full

This review included seven randomized controlled trials and indicated that there was some evidence that the use of a face mask to correct a Class III incisor relationship was effective on a short-term basis. There was no evidence to show whether the short-term benefits will be maintained when the child is fully matured and the use of rapid maxillary expansion solely as an adjunct to improve the efficacy of face-mask treatment cannot be recommended. The studies were generally of poor quality with further research required.


Baccetti T., Rey, D., Oberti, G., Stahl, F., and McNamara, J. A. (2009). Long-term outcomes of Class III treatment with mandibular cervical headgear followed by fixed appliances. Angle Orthodontist, 79, 828–34. [DOI: 10.2319/111408-580.1] [PubMed: 19705951].

The patients in the treatment group were followed up over 5 years. The favourable dento-skeletal changes seen were maintained.


Battagel, J. M. (1993). The aetiological factors in Class III malocclusion. European Journal of Orthodontics, 15, 347–70. [DOI: 10.1093/ejo/15.5.347] [PubMed: 8223970].


Bryant, P. M. F. (1981). Mandibular rotation and Class III malocclusion. British Journal of Orthodontics, 8, 61–75. [DOI: 10.1179/bjo.8.2.61] [PubMed: 6942886].

This paper is worth reading for the introduction alone, which contains a very good discussion of growth rotations. The study itself looks at the effect of growth rotations and treatment upon Class III malocclusions.


Cevidanes, L., Baccetti, T., Franchi, L., McNamara, J.A., and De Clerk, H. (2010). Comparison of two protocols for maxillary expansion: bone anchors versus face mask with rapid maxillary expansion. Angle Orthodontist, 80, 799–806. [DOI: 10.2319/111709-651.1] [PubMed: 20578848]

An interesting paper.


De Toffol, L., Pavoni, C. Baccetti, T., Franchi, L., and Cozza, P. (2008). Orthopedic treatment outcomes in Class III malocclusion. Angle Orthodontist, 78, 561–73. [DOI: 10.2319/030207-108.1] [PubMed: 18416617]

Unfortunately, like many systematic reviews the available evidence on this topic at the time of this review was not strong.


Fareen, N., Alam, M. K., Khamis, M. F., and Mokhtar, N. (2017). Treatment effects of reverse twin-block and reverse pull fask mask on craniofacial morphology in early and late mixed dentition. Orthodontics & Craniofacial Research, 20, 134–9. [DOI: 10.1111/ocr.12179] [PubMed: 28440029]

This study indicated that reverse pull fask-mask treatment produced more favourable craniofacial changes than reverse twin-block therapy, especially in the late mixed dentition phase.


Gravely, J. F. (1984). A study of the mandibular closure path in Angle Class III relationship. British Journal of Orthodontics, 11, 85–91. [DOI: 10.1179/bjo.11.2.85] [PubMed: 6587912].

A very readable and clever article which examines the displacement element of Class III malocclusions.


Kerr, W. J. S., Miller, S., and Dawber, J. E. (1992). Class III malocclusion: surgery or orthodontics? British Journal of Orthodontics, 19, 21–4. [DOI: 10.1179/bjo.19.1.21] [PubMed: 1562575].

An interesting study which compares the pre-treatment lateral cephalometric radiographs of two groups of Class III cases treated by either surgery or orthodontics alone. The authors report the thresholds for three cephalometric values which would indicate when surgery is required.


Kim, J. H., Viana, M. A., Graber, T. M., Omerza, F. F., and BeGole, E. A. (1999). The effectiveness of protraction face mask therapy: a meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 115, 675–85. [DOI: 10.1016/S0889-5406(99)70294-5] [PubMed: 10358251]


Mandall, N., DiBiase, A., Littlewood, S., Nute, S., Stivaros, N., McDowall, R., et al. (2010). Is early Class III protraction facemask treatment effective? A randomized, controlled trial: 15-month follow-up. Journal of Orthodontics, 37, 149–61. [DOI: 10.1179/14653121043056] [PubMed: 20805344]

A well-designed multicentre randomized controlled trial. One of the few studies in this area to look at patient-related outcomes, but interestingly found that early treatment did not result in a clinically significant psychosocial benefit.


Mandall, N., Cousley, R., DiBiase, A., Dyer, F., Littlewood, S., Mattick, R., et al. (2016). Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two arm parallel randomized controlled trial. Journal of Orthodontics, 43, 164–75. [DOI: 10.1080/14653125.2016.1201302] [PubMed: 27564126]

An excellent multicentre randomized controlled trial which indicates the potential medium- to long-term benefits of interceptive treatment of Class III malocclusions with protraction facemask to reduce the need for orthognathic surgery in the future.


Vaughan, G. A., Mason, B., Moon, H. B., and Turley, P. K. (2005). The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective randomized clinical trial. American Journal of Orthodontic and Dentofacial Orthopedics, 132, 467–74. [DOI: 10.1016/j.ajodo.2005.04.030] [PubMed: 16168327]


Wiedel, A. and Bondemark, L. (2015). Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition – a randomised controlled trial. European Journal of Orthodontics, 32, 123–7. [DOI: 10.1093/ejo/cju005] [PubMed: 25114123]


Woon, S. C. and Thiruvenkatachari, B (2017). Early orthodontic treatment for CIII malocclusion: a systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 151, 28–52. [DOI: 10.1016/j.ajodo.2016.07.017] [PubMed: 28024779]

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