Ultrasonic-assisted minimally invasive sarpe and mandibular skeletal anchorage for treatment of class III dentofacial anomalies: a non-endoscopic, minimally invasive approach — systematic review and case series of 10 patients

Purpose: The aim of this study was to assess the effectiveness and safety of a minimally invasive, non-endoscopic surgical technique for treating Class III dentofacial anomalies. Specifically, it evaluated a combined approach of surgically assisted rapid palatal expansion (SARPE) and mandibular symphyseal skeletal anchorage. Additionally, a systematic review was conducted to contextualize the findings within the existing literature. Methods: This study comprised a systematic review conducted in accordance with PRISMA-ScR guidelines and a retrospective case series of 10 patients aged 14 to 18 years with skeletal Class III and maxillary compression. All patients previously received unsuccessful interceptive treatment. A triple-incision, ultrasonic-assisted SARPE technique was performed along with mandibular skeletal anchorage via symphyseal mini-plates. Postoperative follow-up included clinical and radiographic evaluations. Results: Nine relevant studies were included in the systematic review, encompassing 435 patients and various minimally invasive SARPE protocols. Most reported favorable outcomes with low complication rates. In the case series, nine of ten patients showed successful outcomes without complications. One patient experienced late detachment of the anchorage plate, which was corrected surgically. Overall, the procedure demonstrated favorable maxillary expansion and patient tolerance. Conclusion: The minimally invasive, non-endoscopic SARPE technique combined with mandibular skeletal anchorage appears to be a safe and effective alternative for adolescent patients with Class III anomalies who have not responded to conventional treatments. The proposed triple-incision approach provides enhanced visualization and reduces postoperative morbidity. Future prospective studies are warranted to validate these findings and establish standardized protocols.