Stability factors after double-jaw surgery in Class III malocclusion

Objective: To identify the stability factors of skeletal Class III malocclusion after double-jaw surgery by a systematic review of the literature. Materials and Methods: The survey covered the period from September 1959 to October 2007 and used the MeSH, Medical Subject Headings. The inclusion criteria were stability of bimaxillary surgery of the permanent dentition, adult patients with skeletal Class III malocclusion, a follow-up of at least 12 months, randomized and nonrandomized controlled clinical trials (RCCTs; CCTs), prospective and retrospective studies with and without concurrent untreated as well as normal controls, and clinical trials (CTs) comparing at least two treatment strategies without any untreated or normal control group. Results: The search strategy resulted in 1783 articles. After selection according to the inclusion/ exclusion criteria, 15 articles qualified for the final review analysis. Quality was low in two studies, medium in twelve, and medium/high in one article, which was represented by a RCT (randomized clinical trial). Most of the studies had sufficient sample size, method error analysis, and adequate statistical methods. Thus, the quality level of the studies was sufficient to draw evidence-based conclusions. Conclusions: Surgical correction of skeletal Class III malocclusion after combined maxillary and mandibular procedures appears to be stable for maxillary advancements up to 5 mm and for the correction of presurgical sagittal intermaxillary discrepancies smaller than 7 mm.