title: Is Counterclockwise Rotation of the Maxillomandibular Complex Stable Compared With Clockwise Rotation in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To compare postsurgical skeletal stability between counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) and clockwise rotation (CWR) of the MMC for the correction of dentofacial deformities.
  
  
  METHODS
  To address the study purpose, we designed and implemented a systematic review with meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search strategy was developed, and a search of major databases-PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)-was conducted to find all pertinent articles published from inception through March 2016. The inclusion criteria were randomized controlled trials, controlled clinical trials, retrospective studies, and case series with the aim of comparing postsurgical stability of CCWR and CWR of the MMC. The analysis was performed using lateral cephalometric analysis of postsurgical mean values and correlation between the surgical and postsurgical changes of the occlusal plane angle and linear changes at A point and B point. A weighted mean difference analysis using a random-effects model with 95% confidence intervals was performed.
  
  
  RESULTS
  A total of 133 patients were enrolled from 3 studies (CCWR, n = 83; CWR, n = 50). All included studies were at moderate risk of bias. There was a statistically significant difference between CCWR and CWR of the MMC in the postsurgical changes of the occlusal plane angle (P = .034), but no statistically significant difference was found in the correlation between the surgical and postsurgical changes of the occlusal plane angle in the 2 groups. There was no statistically significant difference between CCWR and CWR of the MMC for stability between assessments immediately after surgery and at longest follow-up relative to the vertical and horizontal positions at A point and B point (P > .05).
  
  
  CONCLUSIONS
  CCWR compared with CWR for the correction of dentofacial deformities in the absence of pre-existing temporomandibular joint pathology is skeletally stable relative to the postsurgical changes of the occlusal plane, as well as the vertical and horizontal changes of the maxilla and mandible.
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen. Electronic address: Dressamalmoraissi@gmail.com.
authors.forename: Essam Ahmed
authors.initials: EA
authors.lastname: Al-Moraissi
authors.affiliation: Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Wolford
mesh_terms: D063169:Dentofacial Deformities / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000002:abnormalities* / Q000601:surgery*; D008437:Maxilla / Q000002:abnormalities* / Q000601:surgery*; D056948:Orthognathic Surgical Procedures; D012399:Rotation