This systematic review aims to investigate and summarize the mid-term effects and stability of the treatment with facemask appliance.

Search without restrictions in five databases (Pubmed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials) since inception and hand searching until March 2021 was conducted. Detailed search strategies were based on the PubMed strategy and adapted accordingly. Studies assessing the mid-term effects of facemask appliance, with a follow-up post-treatment period of more than 6 years or after the peak of pubertal growth, were to be included. The risk of bias in individual studies was assessed using the Cochrane guidelines for the RCT and the ROBINS-I tool for the non-RCT studies.

Five studies were finally considered eligible for inclusion (one RCT and four CCTs). According to the reported evidence, the mid-term success rate ranged from 62.7% to 100%. Mid-term success was identified with positive overjet as well as acceptable aesthetic and functional characteristics.

Class III malocclusion treated with facemask presents a high percentage of success in the mid-term follow-up period. The mid-term effects of facemask were stable for the maxilla, in terms of sagittal and anteroposterior dentoskeletal dimensions, and any kind of relapse is attributed to uncontainable residual growth of the mandible. However, considering the high risk of bias and the follow-up period limitations, more high-quality studies are necessary in order to achieve further clarification. Future research should be based also on identifying biomarkers to indicate likely treatment responses.

PROSPERO: CRD42020179402.