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Mandall N, Aleid W, Cousley R, Curran E, Caldwell S, DiBiase A, Dyer F, Littlewood S, Nute S, Campbell SJ, Atkins S, Bayoumi S, Bhatt V, Chambers P, Goodger N, Bates C, Malik O, Waring D, Bassett P. The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial. J Orthod 2024; 51:228-239. [PMID: 38845172 DOI: 10.1177/14653125241255139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group in terms of perceived need for orthognathic surgery, skeletal and dental change, and psychological impact. DESIGN A multicentre two-armed parallel randomised controlled trial. SETTING Six UK hospital orthodontic units. METHODS A total of 57 patients were randomly allocated into either the BAMP group (BAMPG) (n = 28) or a no treatment control group (CG) (n = 29). OUTCOMES Data collection occurred at registration (DC1),18 months (DC2) and 3 years (DC3), where skeletal and dental changes were measured from lateral cephalograms and study models. Oral Aesthetic Subjective Impact Score (OASIS) and Oral Quality of Life (OHQOL) questionnaires were used to assess the psychological impact of treatment. RESULTS The mean age was 12.9 ± 0.7 years and 12.6 ± 0.9 years in the BAMPG and CG, respectively. At DC2, the BAMPG achieved a class III ANB improvement of +0.6° compared with -0.7° in the CG (P = 0.004). The overjet improvement was +1.4 mm for the BAMPG and -0.2 mm for the CG (P = 0.002). There was no evidence of any other group differences for the other skeletal or dental cephalometric outcomes (P > 0.05) or the questionnaire data (OASIS P = 0.10, OHQOL P = 0.75). At DC2, the 18-month follow-up, 22% of the BAMPG achieved a positive overjet. At the 3-year follow-up (DC3), fewer participants in the BAMPG were perceived to need orthognathic surgery (48%) compared with 75% of participants in the CG (P = 0.04), with an odds ratio of 0.31 (95% confidence interval = 0.10-0.95). CONCLUSION The BAMP technique did not show any social or psychological benefits; however, the skeletal class III improvement in ANB and the overjet change were sufficient to reduce the perceived need for orthognathic surgery by 27% compared with the CG.
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Affiliation(s)
- Nicky Mandall
- Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, UK
| | - Wesam Aleid
- North Manchester General Hospital, Manchester, UK
| | | | - Edith Curran
- Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, UK
| | - Susi Caldwell
- South Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Fiona Dyer
- Charles Clifford Dental Hospital, Sheffield, UK
| | | | - Spencer Nute
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | | | - Simon Atkins
- The University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | | | - Vyomesh Bhatt
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Paul Chambers
- Bradford Teaching Hospitals NHS foundation Trust, Bradford, UK
| | | | - Claire Bates
- Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, UK
| | - Ovais Malik
- Salford Royal Hospitals NHS Trust, Salford, Manchester, UK
| | - David Waring
- University Dental Hospital of Manchester, Manchester, UK
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Hu S, Zhong J, Li Y, Liu Z, Gao X, Xiong X, Wang J. Mapping the evolving trend of research on Class III malocclusion: a bibliometric analysis. Clin Oral Investig 2024; 28:420. [PMID: 38976020 DOI: 10.1007/s00784-024-05811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES This study aimed to provide visualized knowledge maps to show the evolving trends and key focal points of Class III malocclusion research through a comprehensive bibliometric analysis. MATERIALS AND METHODS Class III malocclusion research published between 2000 and 2023 was retrieved from the Web of Science Core Collection. VOSviewer was utilized to count the citation and publication number of authors, institutions, countries and journals. Co-occurrence, co-citation, and cluster analyses and burst detection were conducted using CiteSpace. RESULTS A total of 3,682 publications on Class III malocclusion were included in the bibliometric analysis. During 2000-2023, both the annual publication count and citation frequency exhibited a gradual upward trajectory, with a noticeable surge in recent years. In terms of production and citation counts of Class III malocclusion research, the core journal is the American Journal of Orthodontics and Dentofacial Orthopedics. Furthermore, apart from the primary keyword 'Class III malocclusion', 'orthognathic surgery' was identified as keyword with the most frequency. The cluster analysis of cited references reveals that the research focal points have shifted to 'skeletal anchorage' and 'surgery-first approach'. Furthermore, the burst detection identified 'quality of life' as a potential research hotspot since it has recently gained increasing scholarly attention. CONCLUSIONS The current study provides scholars with the knowledge maps of evolving trends and prominent topics of Class III malocclusion research and a summary of research progress on various priorities during different periods. These findings are expected to provide a valuable guidance to facilitate the future research on Class III malocclusion.
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Affiliation(s)
- Shoushan Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jiawei Zhong
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yijun Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zejin Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xinlin Gao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Jun Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, Sichuan, 610041, People's Republic of China.
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Akdemir G, Gorucu-Coskuner H. Comparison of different maxillary advancement protocols in patients with unilateral cleft lip and palate: a finite element analysis. Clin Oral Investig 2024; 28:260. [PMID: 38642152 PMCID: PMC11032273 DOI: 10.1007/s00784-024-05633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/23/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the stress distributions and possible amount of movement in the maxillofacial region resulting from different maxillary advancement protocols in patients with unilateral cleft lip and palate. MATERIALS AND METHODS A unilateral cleft lip and palate model (CLP model) with Goslon score 4 was created for finite element analysis. Three different protocols were compared: Group 1: usage of a face mask with elastics placed at a 30? angle to the occlusal plane over a conventional acrylic plate; Group 2: usage of a face mask with elastics placed at a 30? angle to the occlusal plane over miniplates placed in the infrazygomatic crest region; Group 3: usage of elastic from the menton plate placed in the mandible to the infrazygomatic plates in the maxilla. RESULTS Dental effects were greater in the maxillary protraction protocol with a face mask over a conventional acrylic plate (Von Misses Stress Values; Group 1?=?cleft side:0.076, non-cleft side:0.077; Group 2?=?cleft side:0.004, non-cleft side: 0.003; Group 3?=?cleft side:0.0025; non-cleft side:0.0015), whereas skeletal effects were greater in maxillary protraction protocols with face mask using skeletal anchorage (Von Misses Stress Values; Group 1:0.008; Group 2:0.02; Group 3:0.0025). The maximum amount of counterclockwise rotation of the maxilla as a result of protraction was observed in traditional acrylic plate face mask protocol, and the minimum amount was observed by using elastics between infrazygomatic plates and menton plate. CONCLUSIONS In individuals with unilateral cleft lip and palate with Goslon score 4, it was observed that the skeletally anchored face mask caused more skeletal impact and displacement than both the traditional acrylic plate face mask model and the pure skeletally supported maxillary protraction model. CLINICAL RELEVANCE When planning maxillary protraction treatment in patients with cleft lip and palate, it should be considered that more movement in the sagittal plane might be expected on the cleft side than the non-cleft side, and miniplate and screws on the cleft side are exposed to more stress when using infrazygomatic plates as skeletal anchorage.
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Lee HJ, Jeong H, Park JH, Choi DS, Jang I, Cha BK. A comparison of maxillary posterior changes following facemask therapy: Skeletal anchorage versus tooth-borne anchorage. Orthod Craniofac Res 2024; 27:303-312. [PMID: 37955169 DOI: 10.1111/ocr.12731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To compare changes in the maxillary posterior structure as seen in cone-beam computed tomography (CBCT) images resulting from facemask therapy using skeletal (miniplate/FM) anchorage versus tooth-borne anchorage (RME/FM). MATERIALS AND METHODS A retrospective study was conducted on 20 patients divided into the miniplate/FM group (nine patients aged 9.5 ± 1.4 years) and the RME/FM group (11 patients aged 9.2 ± 1.4 years). CBCT images before and after facemask therapy were evaluated to assess changes in the maxillary posterior structure. RESULTS The miniplate/FM group had greater advancement of the maxilla and midface compared to the RME/FM group (p < .05). Specifically, there was about three times more advancement of the pterygomaxillary suture in the miniplate/FM group than in the RME/FM group (p < .05). Moreover, the advancement of the pterygomaxillary suture was about half the advancement of A point in the miniplate/FM group, while only about 25% in the RME/FM group. Finally, the miniplate/FM group showed an increase in the transverse dimension of the posterior and superior parts of the maxilla (p < .05). CONCLUSION There was greater forward movement of the pterygomaxillary suture with facemask therapy using the skeletal anchorage compared to tooth-borne anchorage, leading to a more significant advancement of the maxilla and midface.
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Affiliation(s)
- Hyeon-Jong Lee
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Hannah Jeong
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Dong-Soon Choi
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Insan Jang
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Bong-Kuen Cha
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
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Dutta S, Batra P, Raghavan S, Sharma K, Talwar A, Arora A, Srivastava A. Comparative assessment of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP): A single-center, prospective randomized clinical trial. SPECIAL CARE IN DENTISTRY 2024; 44:491-501. [PMID: 37084175 DOI: 10.1111/scd.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the maxillary protraction effect of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS Thirty patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective clinical study. The patients were allocated into two groups using computer generated random number table. Group I (facemask therapy along with two I shaped miniplates, FM + MP) and Group II (facemask mask along with tooth-anchored appliance, FM). Skeletal and dental parameters were evaluated on pre- and post-treatment lateral cephalograms and pharyngeal airway on cone-beam computed tomography systems (CBCT) for assessment of the treatment changes. RESULTS Both methods proved to be effective with statistically significant improvements in skeletal and dental parameters (p < .05). Skeletal parameters (e.g., SNA, convexity-point A, ANB) with the FM + MP group showed greater change compared to those with FM group (SNA, 2.56°; convexity-point A, 1.22°; ANB, 0.35°). Significant proclination of maxillary incisors was observed in the FM group as compared to FM + MP group (U1 to NA, 5.4°; 3.37 mm). A statistically significant increase in pharyngeal airway volume was noted in both groups (p < .05). CONCLUSION While both therapies are effective in protracting the maxilla in growing patients with UCLP, the FM + MP allows for a greater skeletal correction, minimizing the dental side effects seen with FM therapy alone. Thus, FM + MP appears to be a promising adjunct in reducing the severity of Class III skeletal correction needed in patients with cleft lip and palate (CLP).
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Affiliation(s)
- Shuvadeep Dutta
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | | | | | - Aditya Talwar
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, Haryana, India
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Pang SL, Wong KF, Lin Y, Leung YY. Self-designed three-dimensional printed skeletal anchorage titanium device for orthopaedic traction in a growing Class III patient. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101571. [PMID: 37499905 DOI: 10.1016/j.jormas.2023.101571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Maxillary retrusion in a growing skeletal class III patient can be treated with growth modification by facemask therapy with skeletal anchorage. A 12-year-old boy presented with Skeletal Class III relationship, retrognathic maxilla and paranasal deficiency. Cone beam computer tomography (CBCT) was taken for the design of the customized skeletal anchorage device with a 3D planning computer software. Two pairs of skeletal anchorage surgical guides and plates were designed with the correct vector and location, and to avoid tooth roots in the fixation. The plates were printed with titanium and fixed onto the patient for the facemask therapy. CAD-CAM technology allows customization and precise execution of the skeletal anchorage for the facemask therapy. Self-designed 3D printed skeletal anchorage device, with the advantages of increased rigidity, ease of placement and accuracy of force application, can be a valid alternative to stock titanium plates.
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Affiliation(s)
- Si Ling Pang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Ka Fai Wong
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yifan Lin
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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Jang JW, Lee MH, Chung DH, Lee JW, Lee SM, Koh SD, Park JH. Long-term effects of lateral nasal wall anchored facemasks compared with tooth-borne facemasks. Am J Orthod Dentofacial Orthop 2023; 164:584-592. [PMID: 37212767 DOI: 10.1016/j.ajodo.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION This study investigated the long-term effect and stability of skeletally anchored facemasks (SAFMs) with lateral nasal wall anchorage compared with conventional tooth-borne facemasks (TBFMs) in growing patients with a Class III relationship. METHODS A total of 180 subjects treated with SAFMs (n = 66) and TBFMs (n = 114) were screened. Thirty-four subjects were qualified and grouped into the SAFM group (n = 17) and TBFM group (n = 17). Lateral cephalograms were taken at the initial observation, after the protraction, and at the final observation. RESULTS Greater advancement of the maxilla was attained with SAFM than with TBFM after protraction (initial observation - after the protraction) (P <0.05). In particular, advancement of the midfacial area (SN-Or) was prominent and maintained after the postpubertal stage (P <0.05). The intermaxillary relationship was also improved (ANB, AB-MP) (P <0.05), and greater counterclockwise rotation of the palatal plane (FH-PP) was observed in the SAFM group compared with the TBFM group (P <0.05). CONCLUSIONS Compared with TBFM, the orthopedic effects of SAFM were greater in the midfacial area. The palatal plane had a greater counterclockwise rotation in the SAFM group than in the TBFM group. Maxilla (SN-Or), intermaxillary relationship (APDI), and palatal plane angle (FH-PP) demonstrated a significant difference between the 2 groups after the postpubertal stage.
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Affiliation(s)
- Ji-Woo Jang
- Postgraduate Student, Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Mo-Hyeon Lee
- Clinical Assistant Professor, Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Dong-Hwa Chung
- Professor, Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea.
| | - Jin-Woo Lee
- Professor, Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Sang-Min Lee
- Professor, Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | | | - Jae Hyun Park
- Professor and Chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
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Kaya D, Kocadereli I, Saatci I. Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study. Dental Press J Orthod 2023; 28:e2321302. [PMID: 37493848 PMCID: PMC10365068 DOI: 10.1590/2177-6709.28.3.e2321302.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/05/2022] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. METHODS Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. RESULTS After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. CONCLUSION Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.
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Affiliation(s)
- Demet Kaya
- Hacettepe University, Gün Hospital, Department of Oral and Dental Health Care, Orthodontics (Ankara, Turkey)
| | - Ilken Kocadereli
- Hacettepe University, Faculty of Dentistry, Department of Orthodontics (Ankara, Turkey)
| | - Isil Saatci
- Hacettepe University, Faculty of Medicine, Department of Radiology (Ankara, Turkey)
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Mossaad AM, Abdelrahman MA, Ghanem WA, Elsayed SA. Soft-Tissue Changes in Unilateral Cleft Lip and Palate Patients after Non-surgical Maxillary Advancement with Face Mask Therapy - A Prospective Cohort Study. Ann Maxillofac Surg 2023; 13:179-183. [PMID: 38405550 PMCID: PMC10883229 DOI: 10.4103/ams.ams_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/30/2023] [Accepted: 09/07/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction The aim of this study was to evaluate soft-tissue changes in Egyptian cleft lip/palate (CLP) patients after conservative non-surgical maxillary advancement using face mask therapy. Methods This prospective cohort study included 20 Egyptian patients with unilateral CLP, six females and 14 males, ranging in age from 10 to 15 years and suffering from moderate maxillary deficiency. These patients had been chosen randomly from the Oro-dental Genetics Clinic at the National Research Centre, Egypt. For lateral cephalometry tracing and superimposition of pre-operative and post-treatment data, this study used Dolphin 11.0 software. Subnasal (Sn), pronasal (Pn), soft tissue pogonion (Pg), labial superior (Ls), stomion superioris (Ss), labiale inferior (Li), stomion inferioris (Si) and soft tissue Menton (Me) were the soft tissue points used in this analysis. Results All of the cases were successful and demonstrated a positive response to the orthodontic traction. All post-operative linear measurements of the measured soft-tissue points showed statistically significant advancement (P = 0.05) except for pronasal linear measurements, which did not show a significant difference post-treatment (P = 0.84). Discussion With the use of the face mask procedure, both upper and lower lip soft-tissue points improved significantly, but nasal points remained unchanged, requiring more management.
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Affiliation(s)
- Aida M. Mossaad
- Department of Oro-dental Genetics, National Research Centre, Cairo, Egypt
| | | | - Wael A Ghanem
- Department of Plastic Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Shadia Abdelhameed Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Adel SM, Abbas BA, Marzouk WW, Zaher AR. Airway dimensional changes following bone anchored maxillary protraction: a systematic review. BMC Oral Health 2023; 23:260. [PMID: 37138306 PMCID: PMC10158221 DOI: 10.1186/s12903-023-02940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The introduction of skeletal anchorage utilized for maxillary protraction with a face mask or class III elastics has been developed for the management of class III malocclusions with minimal dental effect. The objective of the present review was to evaluate the current evidence regarding airway dimensional changes following bone-anchored maxillary protraction. A search was conducted by two authors (S.A & B.A) in the following databases: MEDLINE via PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and Open Grey; besides a hand search in references of selected articles and developing a search alert in electronic databases. Selection criteria comprised randomized as well as prospective clinical trials evaluating airway dimensional changes following bone-anchored maxillary protraction. Relevant data were extracted after studies retrieval and selection. The risk of bias was thereafter evaluated using the revised RoB 2 tool for randomized clinical trials and the ROBINS-I tool was used for non-randomized clinical trials. The quality of studies was assessed using the modified Jadad score. After examining (eligibility) full-text articles, four clinical trials were ultimately included. These studies evaluated the airway dimensional changes, following bone-anchored maxillary protraction in comparison to different control study groups. Based on the available evidence, all the bone-anchored maxillary protraction devices used in the eligible studies in the present systematic review resulted in an improvement in the airway dimensions. However, due to the few numbers of studies available and the guarded evidence due to the low quality of evidence of three out of four included articles, there is no strong evidence to support a significant increase in the airway dimensions following bone-anchored maxillary protraction. Therefore, there is a need for more randomized controlled clinical trials with similar bone-anchored protraction devices and similar assessment methods for more valid comparisons, excluding any confounding factors, on airway dimensional changes.
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Affiliation(s)
- Samar M. Adel
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion Street, Alexandria, El Azarita Egypt
| | - Bassant A. Abbas
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion Street, Alexandria, El Azarita Egypt
- PhD resident, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Wessam W. Marzouk
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champolion Street, Alexandria, El Azarita Egypt
- Professor, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Abbas R. Zaher
- Professor, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Ozbilen EO, Papaefthymiou P, Yilmaz HN, Küçükkeleş N. Does surgically assisted maxillary protraction with skeletal anchorage and Class III elastics affect the pharyngeal airway? A retrospective, long-term study. Korean J Orthod 2023; 53:35-44. [PMID: 36696958 PMCID: PMC9877364 DOI: 10.4041/kjod22.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
Objective Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.
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Affiliation(s)
- Elvan Onem Ozbilen
- Department of Orthodontics, School of Dentistry, Marmara University, Istanbul, Turkey,Corresponding author: Elvan Onem Ozbilen. Assistant Professor, Department of Orthodontics, School of Dentistry, Marmara University, Istanbul 34854, Turkey., Tel +905358783400 e-mail
| | - Petros Papaefthymiou
- Department of Orthodontics, School of Dentistry, Marmara University, Istanbul, Turkey
| | - Hanife Nuray Yilmaz
- Department of Orthodontics, School of Dentistry, Marmara University, Istanbul, Turkey
| | - Nazan Küçükkeleş
- Department of Orthodontics, Bezmialem Vakıf University Faculty of Dentistry, Istanbul, Turkey
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GARG D, RAI P, TRIPATHI T, KANASE A. Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis. Dental Press J Orthod 2023; 27:e2220377. [PMID: 36629626 PMCID: PMC9829108 DOI: 10.1590/2177-6709.27.5.e2220377.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/25/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. OBJECTIVE This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. METHODS A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. RESULTS The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. CONCLUSIONS The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.
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Affiliation(s)
- Dhiraj GARG
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Priyank RAI
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Tulika TRIPATHI
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Anup KANASE
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
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Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: a retrospective follow-up study. Prog Orthod 2022; 23:44. [PMID: 36178519 DOI: 10.1186/s40510-022-00429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regardless of the treatment protocol, stability in Class III patients always represents a major concern. The aim of this study was to assess the short and long-term skeletal and dentoalveolar modifications in a group of class III patients treated with hybrid rapid maxillary expander (RME) and facemask (FM). Indeed, no long-term studies have been conducted yet with the objective of evaluating the effects of this kind of approach when applied to patients who have already gone thought their peak of growth. MATERIAL AND METHODS 27 patients with skeletal Class III malocclusion were treated using hybrid RME according to alternating rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by 4 months of facemask therapy. After the orthopaedic phase, each patient underwent orthodontic treatment with fixed multibracket appliances. A mean follow-up of 7 years, 10 months was performed. Pre-treatment (TO), post-treatment (T1) and follow up (T2) cephalometric tracing were analysed, comparing dental and skeletal measurements. RESULTS Point A advanced by a mean of 3.5 mm with respect to VerT, then relapsed by 0.7 in the post-facemask period, thereby yielding of a mean advancement of 2.7 at T2. The sagittal relationship significantly changed after RME + facemask protraction (3.8° of ANB and 5.189 mm of Wits). Although both Wits and ANB values worsened over time, the improvement from T0 is still appreciable at T2. CONCLUSION Despite the physiological relapse due to mandibular growth, the long-term cephalometric follow-up confirms the maintenance of all positive outcomes of the previous orthopaedic treatment with hybrid RME and facemask.
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Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs. Eur J Orthod 2022; 45:157-168. [PMID: 36074492 DOI: 10.1093/ejo/cjac048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. OBJECTIVE To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. MATERIALS AND METHODS PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. RESULTS Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). LIMITATIONS Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. CONCLUSIONS Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. REGISTRATION PROSPERO register (CRD42020221982).
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Affiliation(s)
- Valentina Rutili
- Postgraduate Program in Orthodontics, The University of Florence, Italy
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Debora Franceschi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Felicita Pierleoni
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA
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Shimada E, Kanetaka H, Yamauchi K, Takahashi T, Nochioka K, Igarashi K. Rationale and design for efficacy and safety evaluation of Bone-Anchored Maxillary Protraction (BAMP) for patients with unilateral cleft lip and palate with skeletal anterior crossbite: a single-arm, open-label, non-randomised prospective study protocol. BMJ Open 2022; 12:e061831. [PMID: 36581967 PMCID: PMC9438208 DOI: 10.1136/bmjopen-2022-061831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Bone-anchored maxillary protraction (BAMP) was devised recently as a method of direct maxillary protraction using anchor plates implanted in the maxilla and mandible without involving the teeth. Although several reports have described orthognathic effects of BAMP on patients with cleft lip and palate (CLP) with skeletal crossbite, none has described a study of Japanese patients with CLP or of BAMP treatment effects on speech in patients with CLP. This study, by performing BAMP treatment, and by evaluating speech function and skeletal and soft tissues, is intended to clarify BAMP efficacy and safety for patients with unilateral CLP (UCLP) who have skeletal crossbite. METHODS AND ANALYSIS This single-arm, open-label, non-randomised prospective study examines 20 patients with UCLP with skeletal crossbite (Wits appraisal ≤-5.0 mm). These 10-15 year-old participants had already undergone cheiloplasty, palatoplasty and bone grafting. The anchor plates are implanted in the zygomatic process in the maxilla and in the anterior part of the mandible. Two weeks after anchor plate implantation, maxillary protraction is started using elastics. Protraction is performed at 150 g per side at the start of protraction, 200 g per side from 1 month after the start of protraction and 250 g per side from 3 months after the start of protraction. The treatment period will be approximately 1½ years. Pretreatment and post-treatment, cephalometric analysis, speech evaluation, nasopharyngeal closure function evaluation and facial soft tissue evaluation will be performed to ascertain the effects of BAMP on patients with UCLP. ETHICS AND DISSEMINATION Ethical approval for this study has been received from Tohoku Certificated Review Board of Tohoku University, Japan, CRB2200003. The approval number is 2021-34-2. The results of this research shall be presented at domestic and international academic conferences, and be published to peer-reviewed journals. TRIAL REGISTRATION NUMBER jRCTs022210007.
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Affiliation(s)
- Eriya Shimada
- Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroyasu Kanetaka
- Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Miyagi, Japan
- Liaison Center for Innovative Dentistry and Division for Interdisciplinary Integration, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kaoru Igarashi
- Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Miyagi, Japan
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Lee YS, Park JH, Kim J, Lee NK, Kim Y, Kook YA. Treatment effects of maxillary protraction with palatal plates vs conventional tooth-borne anchorage in growing patients with Class III malocclusion. Am J Orthod Dentofacial Orthop 2022; 162:520-528. [PMID: 35933257 DOI: 10.1016/j.ajodo.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evaluate the treatment effects of maxillary protraction using palatal plates and compare them to those with conventional tooth-borne anchorage in growing patients with Class III malocclusion. METHODS Forty patients were divided into 2 groups according to the type of anchorage used: group 1 (n = 20; mean age, 10.5 ± 1.6 years; palatal plates) and group 2 (n = 20; mean age, 10.0 ± 1.2 years; tooth-borne appliances). Lateral cephalograms were taken before and after maxillary protraction. Skeletal, dental, and soft-tissue variables were measured. For statistical analysis, paired and independent t tests were performed. RESULTS Group 1 showed maxilla advancement by 2.3 ± 1.0 mm compared with group 2 by 0.9 ± 0.6 mm, and group 2 indicated clockwise rotation of the mandible, but there was no such clockwise rotation in group 1 (P <0.001). Group 1 had a less lingual inclination of the mandibular incisors than group 2 (IMPA, -1.0° ± 3.8° vs -3.8° ± 2.8°; P <0.05). There was no difference in soft-tissue changes between the 2 groups. CONCLUSIONS A facemask with palatal plate induced maxillary advancement with less mandibular clockwise rotation and dental movement than conventional tooth-borne anchorage. This modality can be used efficiently for maxillary protraction in growing patients with Class III malocclusion.
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Affiliation(s)
- You-Sun Lee
- Graduate School of Clinical Dental Science, Catholic University of Korea, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Jaehyun Kim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Nam-Ki Lee
- Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoonji Kim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
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Kamath A, Sudhakar SS, Kannan G, Rai K, SB A. Bone-anchored maxillary protraction (BAMP): A review. J Orthod Sci 2022; 11:8. [PMID: 35754417 PMCID: PMC9214452 DOI: 10.4103/jos.jos_153_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/04/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Protraction therapy for maxillary deficiency in the treatment of skeletal class III malocclusion involves the use of facemask. Conventionally facemask has been anchored to the maxillary dentition, which is responsible for some of the counter-productive effects of facemask therapy including backward and downward rotation of the chin, increase in the lower anterior facial height, proclination of maxillary incisors, retroclination of mandibular incisors apart from mesialization of maxillary molars with extrusion and decreased overbite. AIM The aim of this article is to highlight the nuances of Bone-Anchored Maxillary Protraction (BAMP) including a literature review, which is comprehensive and narrative and comparing the different techniques involved such as type 1 BAMP versus type 2 BAMP and BAMP versus facemask. MATERIALS AND METHODS A computerized search was performed in electronic databases such as PubMed, PubMed Central, Cochrane, Embase, DOAJ, and Google scholar using key words such as "bone-anchored maxillary protraction" and "BAMP." The search was confined to articles in English published till March 2021. Forty-seven case-controlled, cross-sectional, retrospective and prospective studies, as well as systematic reviews and meta-analysis were included in this article, which were limited to human subjects. A hand search of the reference lists of the included articles was also carried out to include missed out articles. CONCLUSION To overcome these drawbacks, BAMP was introduced, which causes both maxillary protraction, restraint of mandibular growth with minimal dentoalveolar changes. BAMP is used widely nowadays in the treatment of skeletal class III malocclusion.
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Affiliation(s)
- Apoorva Kamath
- Department of Orthodontics, Srinivas Institute of Dental Sciences, Mukka, Mangaluru, Karnataka, India
| | - Shetty Suhani Sudhakar
- Department of Orthodontics, Srinivas Institute of Dental Sciences, Mukka, Mangaluru, Karnataka, India
| | - Greeshma Kannan
- Department of Orthodontics, Srinivas Institute of Dental Sciences, Mukka, Mangaluru, Karnataka, India
| | - Kripal Rai
- Public Health Dentistry, Srinivas Institute of Dental Sciences, Mukka, Mangaluru, Karnataka, India
| | - Athul SB
- Department of Orthodontics, Kannur Dental College, Kerala, India
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18
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Lee HJ, Choi DS, Jang I, Cha BK. Comparison of facemask therapy effects using skeletal and tooth-borne anchorage. Angle Orthod 2021; 92:307-314. [PMID: 34964848 DOI: 10.2319/032121-219.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage. MATERIALS AND METHODS This retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated. RESULTS SNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1-T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2-T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1-T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group. CONCLUSIONS Facemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.
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Cornelis MA, Tepedino M, Riis NDV, Niu X, Cattaneo PM. Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis. Eur J Orthod 2021; 43:51-68. [PMID: 32815989 DOI: 10.1093/ejo/cjaa016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this systematic review was to determine which evidence level supports maxillary advancement after bone-anchored maxillary protraction (BAMP) in growing patients compared to controls. SEARCH METHODS PubMed, Cochrane, Embase, Scopus, and Web-of-Science databases were searched with no restrictions on publication status or year. SELECTION CRITERIA Prospective and retrospective human studies about BAMP, in at least three patients, were included. Authors were contacted when necessary, and reference lists of the included studies were screened. DATA COLLECTION AND ANALYSIS Two authors undertook independent data extraction with conflict resolution by a third author. Risks of bias were assessed. A meta-analysis for estimates of changes for ANB angle, Wits appraisal, and incisor to mandibular plane angle (IMPA) angle of BAMP treatment compared to control groups was performed. RESULTS A total of 449 articles were initially retrieved; 28 full-text articles met the inclusion criteria. Sample sizes ranged from 3 to 52 patients. There was heterogeneity in cephalometric outcomes reported, which prevented the comparison of certain outcomes. ANB angle improved more with BAMP in the maxilla combined with facemask (bone-anchored facemask, BAFM) compared to traditional facemask therapy: this was statistically but not clinically significant (0.2 degrees). No data are available for BAMP with skeletal anchorage in both jaws in combination with Class III elastics (bone-anchored Class III elastics, BAC3E). Likewise, no statistically significant differences in Wits appraisal were found (less than 1 mm). Lower incisor retroclination and facial height seemed to be better controlled with BAC3E compared to BAFM. CONCLUSIONS The level of evidence available to support the maxillary advancement effect after BAMP was low. Publications reporting results based on identical samples tended to suggest overly positive results of BAMP. The differences in sagittal correction between BAMP and traditional facemask therapy were small and of questionable clinical significance. Long-term follow-up results are not available and, therefore, much needed. LIMITATIONS Most articles had a low level of evidence and some included a historical control group. REGISTRATION PROSPERO database number CRD42015023366.
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Affiliation(s)
- Marie A Cornelis
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Neel de Vos Riis
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Xiaowen Niu
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Paolo M Cattaneo
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Suresh S, Sundareswaran S, Sathyanadhan S. Effect of microimplant assisted rapid palatal expansion on bone-anchored maxillary protraction: A finite element analysis. Am J Orthod Dentofacial Orthop 2021; 160:523-532. [PMID: 34215468 DOI: 10.1016/j.ajodo.2020.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 02/01/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate the craniofacial effects of microimplant assisted rapid palatal expansion (MARPE) on bone-anchored maxillary protraction (BAMP) through a finite element analysis. METHODS A 3-dimensional finite element model of the skull with associated sutures was created from the computed tomography image of a 12-year-old male patient. Two protraction protocols: BAMP without MARPE (protocol 1) and BAMP with MARPE (protocol 2), were analyzed using Ansys software (Ansys, Canonsburg, Pa). Stress distribution in the sutures and displacement pattern of craniofacial structures were analyzed in the 2 protocols using finite element analysis. RESULTS Both protocols produced changes in craniofacial structures in all the 3 planes. Displacement of the maxilla was more pronounced in protocol 2 in all directions with mild clockwise rotation. Protocol 1 displayed a translatory movement of the maxilla without any rotation and mild constriction in the anterior region. In protocol 2, an expansion of the maxilla, which increased in the superoinferior direction, was also observed. Von Mises stress in circummaxillary sutures was significantly more in protocol 2, indicating an increased displacement of craniomaxillary structures. CONCLUSIONS The use of MARPE during BAMP enhanced maxillary protraction and reduced the counterclockwise rotation tendency of the maxilla. Hence, it may be inferred that incorporation of MARPE during BAMP protocol may prove beneficial in the treatment of patients with skeletal Class III malocclusion with open bite tendency or hyperdivergent growth pattern.
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Affiliation(s)
- Sugitha Suresh
- Department of Orthodontics, Government Dental College, Calicut, Kerala, India
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Kale B, Buyukcavus MH. Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions. Orthod Craniofac Res 2021; 24:543-552. [PMID: 33506632 DOI: 10.1111/ocr.12471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study sought to evaluate the effects of different maxillary protraction methods on the pharyngeal airway in Class III patients with maxillary retrognathia. SETTING AND SAMPLE POPULATION A total of 59 individuals (31 females and 28 males) with a mean age of 11.38 ± 1.24 years were included in this study. MATERIAL AND METHODS Fifty-nine treated maxillary retrognathic patients who underwent different protraction methods were evaluated. Twenty patients treated with RME (Rapid Maxillary Expansion) made up the first group, and 20 patients treated with 5-week Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) protocol comprised the second group. Lastly, 19 patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Sixteen linear and four areal pharyngeal airway measurements were made on lateral cephalograms before and after treatment. Differences between the groups were assessed using analysis of variance (ANOVA) tests. RESULTS The mean maxillary protraction levels were determined as 2.7, 3.69 and 4.01 mm in the RME, Alt-RAMEC and SA groups, respectively. In the nasopharynx, AD1-PNS, AD2-PNS, PNS-Ba and PNS-Ho measurements revealed a significant increase in the SA group compared to the other groups (P < .05). In the oropharynx, PNS-Ep measurement increased significantly in the RME group (P < .05). In the total pharyngeal airway area, an increase was detected in the SA, Alt-RAMEC, and RME groups. CONCLUSION The most effective protraction method in terms of pharyngeal airway dimensions, especially in the nasopharynx, is the application of the face mask with skeletal anchorage. A greater increase in vertical airway length (PNS-Ep) was observed with RME.
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Affiliation(s)
- Burak Kale
- Department of Orthodontics, Faculty of Dentistry, Antalya Bilim University, Antalya, Turkey
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22
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Jang YK, Chung DH, Lee JW, Lee SM, Park JH. A comparative evaluation of midfacial soft tissue and nasal bone changes with two maxillary protraction protocols: Tooth-borne vs skeletal-anchored facemasks. Orthod Craniofac Res 2020; 24 Suppl 1:5-12. [PMID: 33237624 DOI: 10.1111/ocr.12445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Greater advancement of the maxilla can be achieved with skeletal-anchored facemasks (SAFM) using miniplates than with conventional tooth-borne facemasks (TBFM). The purpose of this study was to compare the effects of TBFM and SAFM on midfacial soft tissue and nasal bone up to two years after treatment. SETTINGS AND SAMPLE POPULATION Sixty-seven growing patients with Class III malocclusions were treated with facemasks. They were divided into a SAFM group with 31 subjects (average age 11.1 years) and a TBFM group with 36 subjects (average age 11.0 years). MATERIALS AND METHODS Cephalometric analysis was conducted using linear and angular midfacial measurements. Lateral cephalograms were taken initially (T0), after treatment (T1) and at two years post-treatment (T2). Significance was assessed between the two groups. RESULTS Comparing changes in the midfacial area between the SAFM and TBFM groups during the traction period (T0-T1), angular measurements such as SNOr (1.34°), nasolabial angle (4.20°), nasal angles 1 and 2 (1.23°, 2.14°) and linear measurements such as Prn, Sn, A' distance (approximately 2 mm) increased significantly more in the SAFM group. Over the entire treatment period (T0-T2), the changes in SNOr (1.33°), nasolabial angle (6.54°), nasal angles 1 and 2 (1.45°, 2.99°) and Prn, Sn, A' distance (approximately 2 mm) remained significant (P < .05). CONCLUSIONS In the treatment of growing patients with Class III malocclusions with maxillary deficiency, it was possible to achieve significantly greater advancement in the midfacial area with SAFM treatment than with TBFM treatment. This significant difference was well maintained at two years post-treatment.
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Affiliation(s)
- Young-Kwang Jang
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Dong-Hwa Chung
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Jin-Woo Lee
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Sang-Min Lee
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Korea
| | - Jae Hyun Park
- Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
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23
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Cha BK, Park JH, Choi DS, Jang I. Facemask therapy with skeletal anchorage: A possible alternative to orthognathic surgery. Orthod Craniofac Res 2020; 24 Suppl 1:13-20. [PMID: 33119188 DOI: 10.1111/ocr.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Treatment of skeletal Class III malocclusion in young patients is very challenging. Facemask therapy has been proven to be effective in early correction of Class III malocclusion. With the aid of skeletal anchorage, the orthopaedic effects are expected to be greater than the effects with conventional facemask with tooth-borne anchorage. However, only a few studies have reported on the long-term stability of facemask therapy combined with skeletal anchorage. This report examines two patients with skeletal Class III malocclusion who were treated with facemask and skeletal anchorage followed by orthodontic treatment using fixed orthodontic appliances. The long-term effects of facemask therapy with skeletal anchorage are discussed and compared with the conventional facemask therapy.
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Affiliation(s)
- Bong-Kuen Cha
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Dong-Soon Choi
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Insan Jang
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
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24
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Elabbassy EH, Sabet NE, Hassan IT, Elghoul DH, Elkassaby MA. Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate. Angle Orthod 2020; 90:539-547. [PMID: 33378498 PMCID: PMC8028472 DOI: 10.2319/091919-598.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate (UCLP) and whether it was enhanced when preceded by maxillary expansion. MATERIALS AND METHODS The sample consisted of 28 growing children (9-13 years old) with UCLP and Class III malocclusion. They were divided into two equal groups. In group I, patients were treated with BAMP not preceded by maxillary expansion. In group II, patients were treated with BAMP preceded by maxillary expansion. To assess treatment changes in three dimensions, Cone-beam computed tomography images were taken 1 week after surgical placement of the miniplates (T1) and after 9 months of treatment (T2). RESULTS BAMP produced forward movement of the maxilla in both groups (3.17 mm) and (3.37 mm) respectively, without significant differences between the two groups except for clockwise rotation of the palatal plane in group I (1.60). CONCLUSIONS BAMP is an effective treatment modality for correcting midface deficiency in patients with UCLP whether or not maxillary expansion was carried out.
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25
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de Souza RA, Dourado GB, Farias IMAO, Pithon MM, Neto JR, de Paiva JB. Miniscrews as an alternative for orthopedic traction of the maxilla: A case report. APOS TRENDS IN ORTHODONTICS 2020. [DOI: 10.25259/apos_16_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of this study was to report the case of a Class III prepuberal patient treated by a maxillary protraction using four miniscrews. The screws were installed between maxillary first molars and second premolars and between mandibular canines and first premolars. A 1/4˝ intermaxillary elastics were used in both sides, ligating the upper-lower screws to perform a maxillary protraction and correction of the Class III malocclusion. A bite plate made by resin flow was made on lingual surfaces of the mandibular incisors to eliminate occlusal interference. After 16 months of treatment, it was possible to see a significant improvement of patient’s facial profile, with overcorrection in overjet and preservation of the tissues and integrity of dental roots.
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Affiliation(s)
| | | | | | - Matheus Melo Pithon
- Department of Orthodontics, Universidade Estadual do Sudoeste da Bahia, Jequie, Bahia,
| | - José Rino Neto
- Department of Orthodontics, University of São Paulo, Sao Paulo, Brazil,
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26
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Tripathi T, Kalra S, Rai P. Management of skeletal Class III with facial asymmetry using skeletal anchorage: 4-year follow-up. Dental Press J Orthod 2020; 25:S2176-94512020000210000. [PMID: 32490925 PMCID: PMC7265666 DOI: 10.1590/2177-6709.25.2.24.e1-9.onl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction: Skeletal Class III malocclusion with asymmetry is one of the most difficult problems to correct in orthodontics. A functional shift of the mandible in growing patients may occur accompanying a Class III, due to constricted maxillary arch and occlusal interferences. Studies have indicated that posterior unilateral crossbite develops early and has a low rate of spontaneous correction. It may further lead to development of mandibular and facial asymmetry by growth and displacement of mandible if left untreated in growing patients. Objective: This article reports the clinical case of a thirteen-year-old female patient in CVMI transition stage that had maxillary hypoplasia with a developing facial asymmetry. Results: The case was successfully managed with bone-anchored facemask therapy and with elimination of occlusal interferences with guided occlusion. Reverse twin block in the retention phase maintained the results achieved. Conclusion: A four-year follow-up evaluation revealed successful maintenance of the treatment results.
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Affiliation(s)
- Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shilpa Kalra
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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27
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Liu C, Qiao X, Zhang S, Ma W, Wang W, Ge X, Hu X, Kang W, Lu H. Banded versus modified appliances for anchorage during maxillary protraction. J Orofac Orthop 2020; 81:172-182. [PMID: 32107567 DOI: 10.1007/s00056-019-00214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to compare banded versus modified appliances for anchorage during maxillary protraction in Class III malocclusions. PATIENTS AND METHODS The sample size consisted of 40 growing patients with Class III maxillary deficiency: 20 patients received maxillary protraction with a modified appliance and 20 patients with a banded appliance. Pre- and posttreatment cephalometric radiographs of all subjects were obtained and analyzed. The paired t‑test and Wilcoxon ranks test were used for statistical analysis. RESULTS The patients in the modified appliance group needed fewer appointments and shorter treatment time than those in the banded appliance group. The modified appliance was superior to the banded appliance with respect to simple structure, comfort, retention, and convenience in maintaining oral hygiene. The modified appliance was as effective as the banded appliance in correcting the Class III malocclusion. However, a greater increase was found in mandibular plane angle, anterior facial height, total facial height, mesialization of maxillary molars, and proclination of maxillary incisors in the banded appliance group compared with that in the modified appliance group (P < 0.05). CONCLUSIONS The newly developed modified appliance may be a promising approach in treating growing Class III patients with maxillary deficiency, which could decrease treatment time, increase treatment efficiency, and reduce anchorage loss.
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Affiliation(s)
- Chunyan Liu
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Xing Qiao
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Shilong Zhang
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Wensheng Ma
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Wen Wang
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Xiaolei Ge
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Xiaoying Hu
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Wenjing Kang
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China.,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China
| | - Haiyan Lu
- Department of Orthodontics, College of Stomatology, Hebei Medical University, Shijiazhuang, Hebei, China. .,Hebei Province, The Key Laboratory of Stomatology, Shijiazhuang, Hebei, China. .,, NO. 383, East Zhongshan Road, 050017, Shijiazhuang, Hebei, China.
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28
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Lee SH, Koh SD, Chung DH, Lee JW, Lee SM. Comparison of skeletal anchorage and tooth-borne maxillary protraction followed by fixed appliance in Class III malocclusion. Eur J Orthod 2019; 42:193-199. [DOI: 10.1093/ejo/cjz086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Summary
Objectives
The purpose of this study was to compare the results of skeletal anchorage (SAMP) and tooth- borne (TBMP) maxillary protraction followed by fixed appliance in growing skeletal Class III patients.
Materials and methods
Patients treated with maxillary protraction were selected and classified into two groups (SAMP: n = 19, mean age = 11.19 years; TBMP: n = 27, mean age = 11.21 years). Lateral cephalograms taken before treatment (T0), after the maxillary protraction (T1), and after the fixed appliance treatment (T2) were analysed and all variables were statistically tested to find difference between the two groups.
Results
Compared to the TBMP, the SAMP showed significant forward growth of maxilla (Co-A point and SN-Orbitale) and improvement in intermaxillary relationship (ANB, AB to mandible plane, and APDI) after the overall treatment (T0–T2), with no significant sagittal changes in maxilla or mandible throughout the fixed appliance treatment (T1–T2).
Limitations
In maxillary protraction, effects of skeletal anchorage were retrospectively compared with those of dental anchorage, not with Class I or III control.
Conclusions and implications
After maxillary protraction, skeletal and tooth-borne anchorage did not cause significant differences in the residual growth of maxilla throughout the phase II treatment. Orthopaedic effects with skeletal anchorage showed appropriate stability in maxilla and intermaxillary relationship even after fixed appliance treatment.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Chungnam, South Korea
| | | | - Dong-Hwa Chung
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Chungnam, South Korea
| | - Jin-Woo Lee
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Chungnam, South Korea
| | - Sang-Min Lee
- Department of Orthodontics, College of Dentistry, Dankook University, Cheonan, Chungnam, South Korea
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29
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Fakharian M, Bardideh E, Abtahi M. Skeletal Class III malocclusion treatment using mandibular and maxillary skeletal anchorage and intermaxillary elastics: a case report. Dental Press J Orthod 2019; 24:52-59. [PMID: 31721947 PMCID: PMC6833933 DOI: 10.1590/2177-6709.24.5.052-059.oar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/02/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Skeletal Class III malocclusion is one of the most challenging malocclusions to treat. In around 40% of Class III patients, maxillary retrognathia is the main cause of the problem and in most patients, orthopedic/surgical treatments includes some type of maxillary protraction. Objective: The aim of this case report was to describe a treatment method for a patient with maxillary retrognathia and Class III skeletal discrepancy using mandibular and maxillary skeletal anchorage with intermaxillary elastics. Case report: A 13-year-old boy with maxillary retrognathia and mandibular prognathism was treated using bilateral miniplates. Two miniplates were inserted in the mandibular canine area and two other miniplates were placed in the infrazygomatic crests of the maxilla. Class III intermaxillary elastics were used between the miniplates. Results: After eight months of orthopedic therapy, ANB angle increased by 4.1 degrees and ideal overjet and overbite were achieved. Mandibular plane angle was increased by 2.1 degrees and the palatal plane was rotated counterclockwise by 4.8 degrees. Conclusion: This case showed that the skeletal anchorage treatment method may be a viable option for treating patients with Class III skeletal malocclusion.
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Affiliation(s)
- Mehrnaz Fakharian
- Torbat Heydarieh University of Medical Sciences, Department of Orthodontics (Torbat Heydarieh, Iran)
| | - Erfan Bardideh
- Mashhad University of Medical Sciences, School of Dentistry, Postgraduate Program in Orthodontics (Mashhad, Iran)
| | - Mostafa Abtahi
- Mashhad University of Medical Sciences, Dental Research Center, Department of Orthodontics (Mashhad, Iran)
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30
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Abstract
As orthodontic treatment has advanced in complexity and in frequency, more recent techniques, using temporary skeletal anchorage, were developed to help correct more severe occlusal and dentofacial discrepancies that were treated with orthognathic surgery alone previously. These techniques have allowed the orthodontist to move teeth against a rigid fixation, allowing for more focused movements of teeth and for orthopedic growth modification. These types of treatments using rigid fixation have allowed for greater interaction between the orthodontist and the oral and maxillofacial surgeon, and have vastly enhanced the treatment planning for the orthodontist in today's society.
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Affiliation(s)
- Jason P Jones
- Department of Oral and Maxillofacial Surgery, UT Health San Antonio, 8210 Floyd Curl Drive, MC 8124, San Antonio, TX 78229, USA
| | - Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, M/C 841, Chicago, IL 60612-7211, USA.
| | - Daniel E Perez
- Department of Oral and Maxillofacial Surgery, UT Health San Antonio, 8210 Floyd Curl Drive, MC 8124, San Antonio, TX 78229, USA.
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31
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Castrillón-Marín RA, Barbosa-Liz DM, Ardila CM. Treatment of Class III malocclusion using Hybrid Hyrax, Face Mask and Alt-RAMEC Protocol: A Case Report in a Latin-American patient. J Clin Exp Dent 2019; 11:e665-e669. [PMID: 31516666 PMCID: PMC6731007 DOI: 10.4317/jced.55939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 11/20/2022] Open
Abstract
The management of Class III malocclusion is one of the greatest challenges of orthodontics. Current treatments offer the possibility of using direct skeletal anchorage to improve clinical outcomes. This case shows the results of using a Hyrax hybrid palatal anchorage, Alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction protocol) and a facemask to treat a maxillary hypoplasia Class III malocclusion in a Latin-American patient. The appliance design and the protocol used are widely described. Clinical and cephalometric results suggest that it is a good treatment option for this Latino patient, with moderate malocclusion and limitations in the dental anchorage.
Key words:ALT-RAMEC, Angle Class III, malocclusion, maxillary expansion, mini-screws, orthodontic anchorage, TADs.
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Affiliation(s)
| | - Diana-María Barbosa-Liz
- Orthodontist. Titular Professor. Gionorto Research Group. Department of Orthodontics. School of Dentistry. Universidad de Antioquia. Medellin. Colombia
| | - Carlos-Martin Ardila
- Periodontist. Ph.D in Epidemiology; Biomedical Stomatology Research Group, Universidad de Antioquia, Medellín, Colombia
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32
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de Souza RA, Rino Neto J, de Paiva JB. Maxillary protraction with rapid maxillary expansion and facemask versus skeletal anchorage with mini-implants in class III patients: a non-randomized clinical trial. Prog Orthod 2019; 20:35. [PMID: 31475309 PMCID: PMC6717741 DOI: 10.1186/s40510-019-0288-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background The use of skeletal anchorage devices for maxillary protraction in patients with class III malocclusion due to deficiency in the middle third of the face has been shown to be a promising approach to treatment of these patients. The aim of this study was to evaluate the treatment of class III patients with maxillary retrusion, using orthodontic mini-implants (MI) associated with intermaxillary elastics in comparison with the rapid maxillary expansion and facemask protocol (RME/FM). Methods In this prospective non-randomized clinical trial, the sample of 24 participants between 7 and 12 years of age (median age of 10.0 years and interquartile range = 3.0 years), at the stage prior to the pre-pubertal growth spurt, was divided in two groups. In group facemask (FM) (n = 12), the individuals received orthopedic treatment with RME/FM. In group MI (n = 12), two mini-implants were inserted in the region close to the maxillary first molar roots, and the other two in the region of the mandibular canines. Initial and final lateral teleradiographs were taken for cephalometric evaluation of all the cases. Statistical analysis included the Mann-Whitney, Wilcoxon, and Fisher’s exact tests. The level of significance was 5% (α = 0.05). Results Improvement was verified in the facial profile and occlusion of the participants, showing advancement of the maxilla in the two groups, with significant differences (P ≤ 0.05) between T0 and T1 in the following measurements: SNA, ANB, Wits, Co-A, Co-Gn, NAP, A-Npog, overjet, and molar relationship. There was no statistically significant intergroup difference (P > 0.05) in the cephalometric measurements evaluated, but the time of treatment was significant, and was faster for group MI. Conclusions The protocol with mini-implants may be an option for the correction of Class III due to maxillary deficiency.
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Affiliation(s)
- Ricardo Alves de Souza
- School of Dentistry, University of São Paulo, São Paulo, Brazil. .,Southwest Bahia State University, Jequié, Bahia, Brazil.
| | - José Rino Neto
- School of Dentistry, University of São Paulo, São Paulo, Brazil.,Department of Orthodontics, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Butantã, São Paulo, SP, 05508900, Brazil
| | - João Batista de Paiva
- School of Dentistry, University of São Paulo, São Paulo, Brazil.,Department of Orthodontics, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Butantã, São Paulo, SP, 05508900, Brazil
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33
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Aldaz J, Andrade D, Aguilar E, Bravo M. Maxillary protaction with zygomatic anchorage in a growing class III patient. Int Orthod 2019; 17:395-401. [PMID: 31056418 DOI: 10.1016/j.ortho.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Maxillary protraction headgear with dental anchorage is commonly used in the treatment of class III malocclusion, but this treatment has been shown to have certain undesirable effects such as the loss of dental anchorage. These side effects can be reduced with the use of skeletal anchorage such as miniplates, mini screws and implants. This case report describes an orthopaedic treatment performed on a 10-year-old boy presenting a class III malocclusion with maxillary hypoplasia, for which a 10-month first phase of maxillary protraction was realised with zygomatic miniplates used as a skeletal anchorage. As a result, significant skeletal, dental and facial changes were observed.
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Affiliation(s)
- Johanna Aldaz
- Universidad de Cuenca, Faculty of Dentistry, Av El Paraíso y Av 10 de Agosto, Cuenca, Ecuador.
| | - Daniela Andrade
- Universidad de Cuenca, Faculty of Dentistry, Av El Paraíso y Av 10 de Agosto, Cuenca, Ecuador
| | - Edison Aguilar
- Universidad de Cuenca, Faculty of Dentistry, Av El Paraíso y Av 10 de Agosto, Cuenca, Ecuador
| | - Manuel Bravo
- Universidad de Cuenca, Faculty of Dentistry, Av El Paraíso y Av 10 de Agosto, Cuenca, Ecuador
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34
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Imaging study of midface growth with bone-borne trans-sutural distraction osteogenesis therapy in growing cleft lip and palate patients. Sci Rep 2019; 9:871. [PMID: 30696887 PMCID: PMC6351653 DOI: 10.1038/s41598-018-37326-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Trans-sutural distraction osteogenesis (TSDO) promotes midface growth in growing cleft lip and palate (CLP) patients with midfacial hypoplasia. The superficial skeletal changes after therapy revealed rotation advancement of the midfacial skeleton associated with differential displacement in each segment, but reports rarely focus on the changes of internal structures, including circummaxillary sutures, the maxillary tuberosity and the maxillary sinus, which may play a crucial role during this process. This study evaluated the computed tomographic (CT) images of 26 growing CLP patients who received bone-borne TSDO therapy. The results revealed that the most prominent new bone formation occurred in the pterygomaxillary suture and pushed the P-point forward. The maxillary first molar exhibited significantly greater advancement compared with the P-point due to the growth of the maxillary tuberosity. The contribution ratio values of the advancement of the maxillary tuberosity and P-point to the maxillary first molar were 26% and 74%, respectively, in UCLP and 25% and 75%, respectively, in BCLP. Furthermore, the maxillary sinus volume was also significantly increased. In conclusion, midface growth with bone-borne TSDO therapy depends on both secondary displacement promoted by sutural bone formation mainly in the pterygomaxillary suture and primary displacement by growth of the maxillary tuberosity and maxillary sinus volume.
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35
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Van Hevele J, Nout E, Claeys T, Meyns J, Scheerlinck J, Politis C. Bone-anchored maxillary protraction to correct a class III skeletal relationship: A multicenter retrospective analysis of 218 patients. J Craniomaxillofac Surg 2018; 46:1800-1806. [DOI: 10.1016/j.jcms.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/07/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022] Open
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36
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Eom J, Bayome M, Park JH, Lim HJ, Kook YA, Han SH. Displacement and stress distribution of the maxillofacial complex during maxillary protraction using palatal plates: A three-dimensional finite element analysis. Korean J Orthod 2018; 48:304-315. [PMID: 30206529 PMCID: PMC6123076 DOI: 10.4041/kjod.2018.48.5.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to analyze initial displacement and stress distribution of the maxillofacial complex during dentoskeletal maxillary protraction with various appliance designs placed on the palatal region by using three-dimensional finite element analysis. Methods Six models of maxillary protraction were developed: conventional facemask (Type A), facemask with dentoskeletal hybrid anchorage (Type B), facemask with a palatal plate (Type C), intraoral traction using a Class III palatal plate (Type D), facemask with a palatal plate combined with rapid maxillary expansion (RME; Type E), and Class III palatal plate intraoral traction with RME (Type F). In Types A, B, C, and D, maxillary protraction alone was performed, whereas in Types E and F, transverse expansion was performed simultaneously with maxillary protraction. Results Type C displayed the greatest amount of anterior dentoskeletal displacement in the sagittal plane. Types A and B resulted in similar amounts of anterior displacement of all the maxillofacial landmarks. Type D showed little movement, but Type E with expansion and the palatal plate displayed a larger range of movement of the maxillofacial landmarks in all directions. Conclusions The palatal plate served as an effective skeletal anchor for use with the facemask in maxillary protraction. In contrast, the intraoral use of Class III palatal plates showed minimal skeletal and dental effects in maxillary protraction. In addition, palatal expansion with the protraction force showed minimal effect on the forward movement of the maxillary complex.
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Affiliation(s)
| | - Mohamed Bayome
- Department of Dentistry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Postgraduate Studies, the Universidad Autonóma del Paraguay, Asunción, Paraguay
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hee Jin Lim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Ho Han
- Division of Orthodontics, Department of Dentistry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate. J Craniofac Surg 2018; 29:309-314. [PMID: 29135737 DOI: 10.1097/scs.0000000000004122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement (ΔA-vertical reference plane, 4.8 mm, P < 0.001; ΔSNA, 1.9 degree, P < 0.001; ΔA-N perp, 1.9 mm, P < 0.05), although the mandible exhibited a forward growth (ΔSNB, 1.2 degree, P < 0.05). Despite downward movement of the posterior maxilla with counterclockwise rotation (Δpalatal plane angle, -1.5 degree, P < 0.05), the mandible did not exhibit clockwise rotation but counterclockwise rotation (ΔSN to mandibular plane angle, -1.4 degree, ΔBjork sum, -1.4 degree, Δocclusal plane to SN plane angle, -1.5 degree, ΔFMA, -1.0 degree, all P < 0.05) and showed decrease in Gonial angle (-1.2 degree, P < 0.01). Although there was labioversion of the maxillary incisor (ΔU1 to SN, 4.1 degree, P < 0.05), the mandibular incisor did not exhibit significant linguoversion (ΔIMPA, -1.3 degree, P > 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage.
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Class III Treatment with Skeletal and Dental Anchorage: A Review of Comparative Effects. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7946019. [PMID: 30057910 PMCID: PMC6051274 DOI: 10.1155/2018/7946019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/26/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022]
Abstract
Objectives This review addresses the comparative effects of skeletal anchored maxillary protraction (MP) versus dental anchored MP. Materials and Methods The studies retrieved had to have both test and control groups treated by the use of a facemask with or without the use of skeletal anchorage though either (palatal/buccal) maxillary or mandibular miniscrews/miniplates, respectively. Results Nine articles were included. Dentoalveolar changes were seen in all the studies. In particular, a significant proclination of the upper incisors was documented in the group treated with a dental anchorage facial mask, as compared to that treated with skeletal anchorage. Comparing the two methods, almost all the studies indicated a greater maxillary advancement in the group treated with skeletal anchorage. Conclusions Therapies with skeletal anchorage produce greater maxillary protraction, reducing undesirable dental effects.
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Meyns J, Brasil DM, Mazzi-Chaves JF, Politis C, Jacobs R. The clinical outcome of skeletal anchorage in interceptive treatment (in growing patients) for class III malocclusion. Int J Oral Maxillofac Surg 2018; 47:1003-1010. [PMID: 29709324 DOI: 10.1016/j.ijom.2018.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/01/2018] [Accepted: 04/08/2018] [Indexed: 12/28/2022]
Abstract
A systematic review of the literature was performed regarding the clinical outcome (effectiveness) of bone anchorage devices in interceptive treatment for class III malocclusion. A search of Embase, PubMed and Web of Science databases yielded 285 papers. An additional two articles were retrieved through manual searching of the reference lists. After initial abstract selection, 32 potentially eligible articles were screened in detail, resulting in a final number of eight articles included in this review. Insufficient evidence was found regarding the effects of skeletal anchorage in interceptive class III treatment to support definitive conclusions on long-term skeletal effects and stability. In the short term, it seems that bone anchors can provide more skeletal effect with less dentoalveolar compensations and less unwanted vertical changes. This does not always exclude the use of a face mask. The use of miniscrews as skeletal anchorage device does not seem to provide more skeletal effect, although it could minimize the unwanted dental effects in the upper jaw. No information regarding the need for orthognathic surgery, orthodontic treatment time or patient compliance and complications was found in the selected articles.
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Affiliation(s)
- J Meyns
- Division of Maxillofacial Surgery, General Hospital St-Jan Genk, Genk, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium.
| | - D M Brasil
- Oral Radiology Area, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - J F Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Brazil
| | - C Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium; Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KULeuven, Leuven, Belgium; Oral Facial Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
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40
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Maino G, Turci Y, Arreghini A, Paoletto E, Siciliani G, Lombardo L. Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients. Am J Orthod Dentofacial Orthop 2018; 153:262-268. [DOI: 10.1016/j.ajodo.2017.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 10/18/2022]
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41
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Karamanli BD, Kılıçoğlu H, Karamanli AF. Evaluation of the Effects of the Dental and Skeletal Anchored Face Mask Therapies on the Craniofacial System by Using Nonlinear Finite Element Analysis. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_50_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims
The aim of this study was to evaluate the biomechanical effects on the craniofacial complex of skeletal anchorage and dental anchorage during face mask therapy.
Subjects and Methods
Two nonlinear finite element (FE) simulations were performed using a three-dimensional FE model. Face mask therapy with dental anchorage in the upper canines and face mask therapy with skeletal anchorage in the piriform apertures of the maxilla were simulated. In both simulations, the magnitude of the applied force was 750 g per side, and the force direction was 30° forward and downward relative to the occlusal plane.
Results
The circummaxillary sutures showed greater and more uniform stresses in the skeletal anchorage model than the dental anchorage model. This is the result of the more parallel forward movement of the maxilla in the skeletal anchorage model.
Conclusions
In Class III malocclusions with maxillary deficiency, for improved effects on the maxilla, choosing skeletal anchorage may be more effective in face mask therapies
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Affiliation(s)
| | - Hülya Kılıçoğlu
- Department of Orthodontics, Istanbul University, Istanbul, Turkey
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Lam R, Goonewardene MS, Allan BP, Sugawara J. Success rates of a skeletal anchorage system in orthodontics: A retrospective analysis. Angle Orthod 2017; 88:27-34. [PMID: 29053335 DOI: 10.2319/060617-375.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the premise that skeletal anchorage with SAS miniplates are highly successful and predictable for a range of complex orthodontic movements. MATERIALS AND METHODS This retrospective cross-sectional analysis consisted of 421 bone plates placed by one clinician in 163 patients (95 female, 68 male, mean age 29.4 years ± 12.02). Simple descriptive statistics were performed for a wide range of malocclusions and desired movements to obtain success, complication, and failure rates. RESULTS The success rate of skeletal anchorage system miniplates was 98.6%, where approximately 40% of cases experienced mild complications. The most common complication was soft tissue inflammation, which was amenable to focused oral hygiene and antiseptic rinses. Infection occurred in approximately 15% of patients where there was a statistically significant correlation with poor oral hygiene. The most common movements were distalization and intrusion of teeth. More than a third of the cases involved complex movements in more than one plane of space. CONCLUSIONS The success rate of skeletal anchorage system miniplates is high and predictable for a wide range of complex orthodontic movements.
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Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Kusnoto B, Evans CA. Three-dimensional assessment of soft tissue changes associated with bone-anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop 2017; 152:336-347. [DOI: 10.1016/j.ajodo.2017.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/01/2017] [Accepted: 01/01/2017] [Indexed: 11/29/2022]
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44
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Angelieri F, Ruellas AC, Yatabe MS, Cevidanes LHS, Franchi L, Toyama-Hino C, De Clerck HJ, Nguyen T, McNamara JA. Zygomaticomaxillary suture maturation: Part II-The influence of sutural maturation on the response to maxillary protraction. Orthod Craniofac Res 2017; 20:152-163. [PMID: 28660731 DOI: 10.1111/ocr.12191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the influence of the maturational stages of zygomaticomaxillary sutures (ZMS) on the response to maxillary protraction. SUBJECTS AND METHODS A total of 40 Class III patients were treated retrospectively with either a combination of rapid maxillary expansion and facial mask (RME/FM) or bone-anchored maxillary protraction (BAMP). The RME/FM group consisted of 18 patients (mean age 8.3 years), while the BAMP group was comprised of 22 patients (mean age 11.8 years). The initial CBCT images (T1) of the ZMSs were classified blindly. 3D models from CBCT images at the start and at the end of orthopaedic treatment were registered on the anterior cranial base, and corresponding structures were measured on colour-coded maps and semitransparent overlays. The amounts of protraction of the maxilla, zygoma, orbitale and maxillary first molars for both groups were analysed with two-way ANOVA with Holm-Sidak post hoc test for multiple comparisons. RESULTS A significant association was found between the early maturation stages of the ZMSs and the amount of maxillary protraction, regardless of the protraction method used. Class III patients with ZMS stages A and B showed greater maxillary protraction than patients at stage C. CONCLUSION The maturational stages of ZMS are associated with the response maxillary protraction.
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Affiliation(s)
- F Angelieri
- Department of Orthodontics, Guarulhos University, Guarulhos, Brazil.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - A C Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M S Yatabe
- Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - L H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - L Franchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.,Department of Surgery and Translational Medicine, The University of Florence, Florence, Italy
| | - C Toyama-Hino
- Special Studies in Orthodontics, São Paulo Military Hospital, São Paulo, Brazil
| | - H J De Clerck
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.,Private Practice, Brussels, Belgium
| | - T Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - J A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.,Center of Human Growth and Development, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
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Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Evans CA. Dentoalveolar and arch dimension changes in patients treated with miniplate-anchored maxillary protraction. Am J Orthod Dentofacial Orthop 2017; 151:1092-1106. [PMID: 28554455 DOI: 10.1016/j.ajodo.2016.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate dentoalveolar and arch dimension changes in 2 miniplate-anchored maxillary protraction protocols in relation to an untreated control group using 3-dimensional digital models. METHODS Thirty growing Class III subjects with maxillary deficiency in the late mixed or early permanent dentition phase were randomly divided into 3 groups. In group 1 (n = 10), patients were treated with skeletally anchored facemasks anchored with miniplates placed at the zygomatic buttress. In group 2 (n = 10), patients were treated with Class III elastics extending from infrazygomatic miniplates in the maxilla to symphyseal miniplates in the mandible. Group 3 (n = 10) was an untreated control group. The decision to discontinue orthopedic treatment was made when the patients had 3 to 4 mm of positive anterior overjet. Pretreatment, posttreatment, and observation 3-dimensional digital models were analyzed, superimposed, 3 dimensionally mapped, and sectioned. RESULTS In this study, there were no significant changes in maxillary arch depth and maxillary or mandibular intermolar width before and after maxillary protraction or after the observation period in the control group. The mandibular arch depth decreased by a small but statistically significant amount only in groups 1 and 3. Superimposition of the pretreatment and posttreatment or observation maxillary 3-dimensional digital models showed minimal clinically significant dentoalveolar changes. CONCLUSIONS Miniplate-anchored maxillary protraction protocols can accomplish maxillary advancement by eliminating movements of teeth and dentoalveolar changes. No spontaneous improvement in transverse deficiency was detected after correction of the anteroposterior deficiency at this age. Consequently, patients with transverse maxillary deficiency should have rapid maxillary expansion before or during the miniplate-anchored protraction period to improve the transverse deficiency.
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Affiliation(s)
- Mohammed H Elnagar
- Department of Orthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt; Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Ill.
| | - Eman Elshourbagy
- Department of Orthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Safaa Ghobashy
- Department of Orthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Mohamed Khedr
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Carla A Evans
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Ill
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de Menezes LM, de Oliveira RB, Weissheimer A, Avelar RL. Midfacial Protraction With Skeletal Anchorage After Pterygomaxillary Separation. J Craniofac Surg 2017; 27:1561-4. [PMID: 27428915 DOI: 10.1097/scs.0000000000002840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present article reports the treatment of a 7-year-old girl with maxillary hypoplasia associated with multiple tooth agenesis through maxillary protraction with skeletal anchorage and pterygomaxillary separation. Two titanium mini-plates were placed in the lateral region of the nasal cavity and used as anchorage for maxillary protraction with a reverse-pull facemask. Pterygomaxillary separation was also performed to enhance the effects of maxillary protraction. One week after surgery, 300 g of force was applied on each side to protract the maxilla. Active treatment time was 4 months, with 12 additional months of follow-up. Analysis of the cone beam computed tomography images demonstrated that skeletal anchorage enabled the correction of the maxillomandibular discrepancy, with an improvement in facial appearance and occlusion and with no dental effects. Pterygomaxillary separation was not effective, showing no superior orthopedic response on maxillary advancement or restrictions to maxillary growth in the 12-month post-treatment follow-up.
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Affiliation(s)
- Luciane Macedo de Menezes
- *Department of Orthodontics †Department of Oral and Maxillofacial Surgery ‡Orthodontic Program, Pontificial Catholic University of Rio Grande do Sul (PUCRS), Partenon §Department of Oral and Maxillofacial Surgery, Center University Unichristus, Fortaleza, Brazil
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47
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Seo WG, Han SJ. Comparison of the effects on the pharyngeal airway space of maxillary protraction appliances according to the methods of anchorage. Maxillofac Plast Reconstr Surg 2017; 39:3. [PMID: 28184366 PMCID: PMC5265226 DOI: 10.1186/s40902-017-0101-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the study is to compare the effects on the pharyngeal airway space of skeletal anchored face mask with those of tooth-borne facemask. Methods We used two types of facemask for maxillary protraction, the tooth-borne facemask (TBFM) and the skeletal anchored facemask (SAFM), and evaluated the effects of each facemask on the pharyngeal airway. Twenty-eight patients (mean age 10.3 years) were treated with the TBFM and 24 patients (mean age 11.2 years) were treated with the SAFM. Lateral cephalometric radiographs were taken before treatment (T1) and after treatment (T2) to assess changes in the dimensions of the upper airway. Statistical analysis was performed with independent t tests, matched t tests, Mann-Whitney U tests, and Kruskal-Wallis tests. Results There were marked increases in upper airway dimensions in both groups following treatment, but the SAFM group had a significantly greater increase in airway dimensions than the TBFM group. Also, the SAFM subgroups showed more improved airway measurements than the TBFM subgroups in both the superior and inferior pharyngeal airways. Conclusions SAFM is more effective than TBFM in increasing upper airway dimensions.
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Affiliation(s)
- Won-Gyo Seo
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, South Korea
| | - Se-Jin Han
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, South Korea
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Bozkaya E, Yüksel AS, Bozkaya S. Zygomatic miniplates for skeletal anchorage in orthopedic correction of Class III malocclusion: A controlled clinical trial. Korean J Orthod 2017; 47:118-129. [PMID: 28337421 PMCID: PMC5359630 DOI: 10.4041/kjod.2017.47.2.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effects of facemask therapy, which was anchored from the zygomatic buttresses of the maxilla by using two miniplates, in skeletal Class III patients with maxillary deficiency. METHODS Eighteen skeletal Class III patients (10 girls and 8 boys; mean age, 11.4 ± 1.28 years) with maxillary deficiency were treated using miniplate-anchored facemasks, and their outcomes were compared with those of a Class III control group (9 girls and 9 boys; mean age, 10.6 ± 1.12 years). Two I-shaped miniplates were placed on the right and left zygomatic buttresses of the maxilla, and a facemask was applied with a 400 g force per side. Intragroup comparisons were made using the Wilcoxon test, and intergroup comparisons were made using the Mann-Whitney U-test (p < 0.05). RESULTS In the treatment group, the maxilla moved 3.3 mm forward, the mandible showed posterior rotation by 1.5°, and the lower incisors were retroclined after treatment. These results were significantly different from those in the control group (p < 0.05). No significant anterior rotation of the palatal plane was observed after treatment. Moreover, changes in the sagittal positions of the maxillary incisors and molars were similar between the treatment and control groups. CONCLUSIONS Skeletally anchored facemask therapy is an effective method for correcting Class III malocclusions, which also minimizes the undesired dental side effects of conventional methods in the maxilla.
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Affiliation(s)
- Erdal Bozkaya
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Alime Sema Yüksel
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Süleyman Bozkaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Papadopoulou AK, Dalci O, Petocz P, Darendeliler MA. Effects of hybrid-Hyrax, Alt-RAMEC and miniscrew reinforced heavy Class III elastics in growing maxillary retrusive patients. A four-year follow-up pilot study. AUSTRALASIAN ORTHODONTIC JOURNAL 2017. [DOI: 10.21307/aoj-2020-099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Introduction
The aim of this study was to evaluate the short- and long-term effects of hybrid-Hyrax, Alt-RAMEC and applied, miniscrew reinforced, heavy intermaxillary elastics on a modified lingual arch in growing skeletal Class III patients.
Methods
Fifteen subjects (seven male, eight female) were included, with an average age of 12.52 ± 0.94 years, of cervical vertebrae maturation (CVM) stage CS2-CS4 and skeletal Class III malocclusions due to a retrognathic maxilla. Nine weeks of Alt-RAMEC were followed by eight to nine weeks of maxillary protraction with heavy 400 gm Class III elastics worn 24 h/day. Treatment was finalised with orthodontic fixed appliances. Cone beam computed tomographic (CBCT) scans were taken initially (T1), at the end of maxillary protraction (T2) and four years after active orthopaedic treatment (T3). Cephalometric measurements were performed on reconstructed lateral cephalograms and the differences between time intervals were calculated using an analysis of variance (ANOVA).
Results
A positive overjet was achieved in all but one subject. From T1 to T2, A point advanced 3.12 ± 3.42 mm and from T2 to T3 advanced a further 2.21 ± 3.49 mm. Significant initial increases in SNA of 1.05° ± 1.10° (p = 0.004), ANB of 2.71° ± 1.01° (p = 0.00), Wits of 4.49 ± 2.21 mm (p = 0.00) and overjet of 4.90 ± 1.66 mm (p = 0.00) were accomplished and maintained without significant changes in the vertical dimension. Upper and lower incisor inclinations were not affected by the protraction protocol but significantly increased (U1-PP: 8.39° ± 5.59°) between T2 and T3. SNB decreased initially by 1.67° ± 1.34° (p = 0.00) but relapsed due to residual mandibular growth and a counterclockwise rotation of the mandibular plane.
Conclusion
The hybrid-Hyrax Alt-RAMEC combined with miniscrew reinforced heavy Class III elastics resulted in a favourable and stable Class III correction.
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Affiliation(s)
- Alexandra K. Papadopoulou
- * Discipline of Orthodontics , Faculty of Dentistry , University of Sydney , Sydney Dental Hospital , Sydney South West Area Health Service , Sydney , Australia
- † Department of Oral Surgery, Implantology and Dental Radiology , School of Dentistry , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Oyku Dalci
- * Discipline of Orthodontics , Faculty of Dentistry , University of Sydney , Sydney Dental Hospital , Sydney South West Area Health Service , Sydney , Australia
| | - Peter Petocz
- + Department of Statistics , Macquarie University , Sydney , Australia
| | - M. Ali Darendeliler
- * Discipline of Orthodontics , Faculty of Dentistry , University of Sydney , Sydney Dental Hospital , Sydney South West Area Health Service , Sydney , Australia
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50
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Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Evans CA. Comparative evaluation of 2 skeletally anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop 2016; 150:751-762. [DOI: 10.1016/j.ajodo.2016.04.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 10/20/2022]
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