Comparative Evaluation of the Effects of Miniscrew and Miniplate Skeletal Anchorage in the Orthopedic Treatment of Growing Class III Malocclusion: A Systematic Review and Meta-Analysis

Background/Objectives: Skeletal Class III malocclusion in growing patients presents therapeutic challenges. While traditional tooth-anchored facemask (FM) therapy is widely used, it may induce undesired dental effects. Bone-anchored maxillary protraction (BAMP), using either miniscrews (MSs) or miniplates (MPs), has been proposed to enhance skeletal outcomes and minimize dental compensation. The objective is to compare the efficacy of MS and MP as skeletal anchorage in the orthopedic treatment of the Class III growing patients. Methods: This systematic review and meta-analysis followed PRISMA guidelines. Five databases and manual searches were conducted without restrictions. Inclusion criteria encompassed randomized and non-randomized controlled trials assessing cephalometric outcomes in growing patients treated with MS or MP. Risk of bias was assessed with RoB 2 and ROBINS-I tools, and evidence certainty was evaluated using GRADE. A meta-analysis was performed, collecting all the statistically significant results that emerged in the 11 articles between skeletal anchorage and controls, comparing the values of the MP group with the MS group. Results: Eleven studies (seven MP, four MS) met the inclusion criteria. Both MS and MP groups showed significant maxillary advancement and improved maxillo–mandibular relationships compared to controls. Regarding vertical values, studies have reported contrasting outcomes. Soft tissue improvements were consistent in both MS and MP devices. Statistical analysis has highlighted how MP devices demonstrated more pronounced skeletal effects, while MS systems were associated with more dental effects. Conclusions: MP may be preferable when the aim is to maximize skeletal correction with fewer dental side effects, while MS can be considered in cases favoring less invasive approaches; long-term follow-up and high-quality clinical studies are needed to confirm these clinical assessments.