Class III malocclusion is managed with early orthopedic or later orthodontic camouflage treatments to avoid surgery. This review synthesizes evidence on dental and skeletal changes following non-surgical Class III correction assessed through cone-beam computed tomography (CBCT), emphasizing temporomandibular joint (TMJ) adaptations uniquely assessable through three-dimensional imaging. Electronic databases (PubMed and Web of Science) were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included clinical trials and observational studies of ≥10 Class III patients treated with orthopedic or orthodontic non-surgical protocols, with pre- and post-treatment CBCT assessments. Risk of bias (RoB) was evaluated using RoB 2 for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Analysis focused on overjet, incisor inclination, maxillary and mandibular position, and TMJ structures. Of 780 records, 18 studies (494 patients) met the inclusion criteria. Treatment-specific outcomes varied substantially: Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) hybrid with Miniscrew-Assisted Rapid Maxillary Expansion achieved maximum overjet increase (5.62 ± 1.36 mm) and A point-Nasion-B point angle improvement (3.95 ± 0.57°). Maxillary advancement measured by Sella-Nasion-A point angle was most pronounced with Alt-RAMEC/facemask (FM) (2.73 ± 0.99°), RME/FM (2.68 ± 1.10°), and bone-anchored protraction (2.65 ± 1.02°). TMJ adaptations showed three condylar displacement patterns: 44% backward, 40% backward/downward, and 16% backward/upward. Glenoid fossa remodeling included anterior eminence modification (1.38 ± 1.03 mm) and posterior wall resorption (−1.34 ± 0.60 mm). Transverse skeletal expansion with a maxillary skeletal expander achieved 96.58% skeletal effect with minimal dental tipping (3.08%). CBCT assessment reveals substantial treatment modality differences, with TMJ evaluation representing the defining advantage over conventional cephalometry. Future research requires high-quality trials with a minimum 5-year follow-up, ethnicity stratification, and standardized three-dimensional protocols.
Galwas et al. (2026) studied this question.