Further high-quality studies are necessary to confirm the effectiveness of the Fränkel function regulator III (FR-3) on maxillary growth over the short term.

Dr Turley raised the question, “Does the FR-3 affect maxillary growth in the short term or not,” about our article, which was a systematic review and meta-analysis regarding the treatment effectiveness of the FR-3 on Class III malocclusions in the August 2014 issue. We appreciate his interest in our study, and it seems that the discussion of SNA changes over the short term in the article may be confusing. We stated in the Conclusion that evidence suggests that the FR-3 might restrict mandibular growth but not stimulate forward movement of the maxilla. Further high-quality studies are necessary to confirm the effectiveness of the FR-3. Moreover, in the Results, as shown in Figure 2, there was no statistical significance of SNA changes in the short term in the 5 studies included.

However, considering the possible clinical heterogeneity of 1 included study, we adopted a sensitive analysis with only 4 studies, and the results in Figure 3 showed that there was a statistical difference of SNA changes in the short term. It was described in the Discussion, which might be a little confusing; therefore, it’s necessary to acquire more high-quality studies to make the results stable in the future. With the development of evidence-based orthodontics, sensitive analysis can be applied to deal with possible heterogeneity more frequently. As a matter of fact, when drawing the conclusions, we considered both the unavoidable clinical heterogeneity and the limitations of systematic review and meta-analysis; this was presented at the last paragraph of the Discussion in our article.