Orthodontic and Maxillofacial Surgery Treatment inAchondroplasia for Orofacial Alterations: A SystematicReview and Preliminary Age-Stratified Guidelines

This systematic review aimed to collect and appraise the clinical outcomes of all orthopaedic, orthodontic and surgical inter-ventions in ACH patients. Following PROSPERO protocol, multiple database sources were searched to December 2024 with nolanguage restrictions for (i) genetically confirmed ACH; (ii) any orthodontic/orthopaedic/orthognathic treatment. Two reviewersindependently screened, extracted data and applied Joanna Briggs Institute appraisal tools. Results were synthesised to collectthe evidence and provide available guidelines. Thirteen studies met the criteria (11 case reports, 2 case series) comprising 16treated individuals (3–23 y.o). Five patients aged 10–16 years achieved stable correction with orthopaedic treatment followed byfixed appliances, without extractions or surgery at ≥ 24-month follow-up. Eight post-growth patients (> 16 years) required eitherextractions (n = 4) or maxillofacial surgery (n = 5) to attain satisfactory occlusion; long-term stability was documented in onlytwo. Two preschool children underwent mid-face distraction and were successfully decannulated. Risk-of-bias was generallymoderate. Early orthopaedic-orthodontic protocols (≤ 16 years) corrected transverse and sagittal discrepancies in ACH, whereascombined orthodontic–surgical approaches were usually indispensable after growth completion. Future prospective are essentialto strengthen the evidence base age-stratified guidelines.