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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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Kathem SJ, Matras RC, Abbas SOM. Class III malocclusion treated with a 3D-printed hybrid hyrax distalizer combined with mentoplate using Alt-RAMEC protocol: A case report. J Orthod 2024; 51:183-191. [PMID: 37392009 DOI: 10.1177/14653125231184910] [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: 07/02/2023]
Abstract
INTRODUCTION The aim of this report was to assess the skeletal, dental and soft tissue changes in a juvenile patient with a severe class III malocclusion. This case report describes a novel method of class III treatment using skeletal anchorage for maxillary protraction and Alt-RAMEC protocol. PATIENT CONCERNS The patient did not have any subjective complaints before treatment and there was no family history of class III malocclusion. CLINICAL FINDINGS AND PRIMARY DIAGNOSES Extra-orally, the patient had a concave profile with a retrusive mid-face and prominent lower lip. The intra-oral examination revealed angle class III malocclusion with a -3-mm overjet. There was no anterior displacement on closure when the patient was assessed clinically. According to the cephalometric analysis, the sagittal jaw relation and Wits appraisal were reduced due to a retrognathic maxilla and prognathic mandible. INTERVENTIONS The treatment plan involved maxillary protraction, Alt-RAMEC protocol for 10 weeks and upper molar distalisation with a hybrid hyrax distalizer in combination with a mentoplate. The active treatment time was estimated to 18 months followed by 6 months retention with the appliance. OUTCOMES The sagittal jaw relationship was increased by approximately 9°, mainly due to maxillary advancement of 8 mm and a positional change of the mandible anteroposteriorly. Natural decompensation of the lower incisors was also observed. In addition, both the facial profile and the smile became more harmonious after treatment. The treatment analysis revealed that the changes achieved were mainly skeletal and it was possible to avoid adverse effects on the dentition. CONCLUSION In conclusion, treatment with a hybrid hyrax distalizer combined with mentoplate using the Alt-RAMEC protocol is effective in correcting the anteroposterior discrepancy in a juvenile class III patient and it is possible to achieve maxillary advancement of 8 mm.
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Affiliation(s)
- Sarah Joda Kathem
- Department of Oral and Maxillofacial Surgery, University Hospital of Zealand, Køge Sygehus, Denmark
| | - Rannvá Caroline Matras
- Department of Oral and Maxillofacial Surgery, University Hospital of Zealand, Køge Sygehus, Denmark
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Steegman RM, Klein Meulekamp AF, Renkema AM, Janssen KI, Kuijpers-Jagtman AM, Ren Y. Three-Dimensional Cone Beam Computed Tomography (CBCT)-Derived Soft Tissue Changes in Patients with Unilateral Cleft Lip, Alveolus, and Palate with Midfacial Deficiency after 1.5 Years of Bone-Anchored Maxillary Protraction. J Clin Med 2024; 13:2890. [PMID: 38792430 PMCID: PMC11122183 DOI: 10.3390/jcm13102890] [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: 04/01/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Bone-anchored maxillary protraction (BAMP) aims to correct midfacial deficiencies, with proven positive skeletal changes without potential unwanted side effects. However, the influence of BAMP treatment on facial soft tissues, particularly in subjects with complete unilateral cleft lip, alveolus, and palate (CUCLAP), remains unclear. Methods: This single-center longitudinal cohort study examined the effects of 1.5 years of BAMP treatment on facial soft tissues in growing subjects with complete unilateral cleft lip, alveolus, and palate. The sample consisted of 25 patients, age range 9.7 to 12.6 years. Three-dimensional surface models derived from CBCT scans were superimposed on stable structures of the anterior cranial base and on the occipital area posterior of the foramen magnum to assess three-dimensional changes due to growth and BAMP therapy. Results: The results revealed a moderate positive correlation (Pearson's correlation coefficient from 0.203 to 0.560) between changes in hard tissue and soft tissue; some correlations were found to be weak (<0.300). Linear changes in soft tissue following BAMP were in the same direction as skeletal changes, showing downward, forward, and outward displacement. The only exception was in the vertical dimension. The lower facial third showed a slight but significant reduction, mainly in lip length (-1.2 mm), whereas the middle facial third showed a small increase (1.1 mm). Conclusions: It was concluded that during BAMP, soft tissue changes occur in the same direction as skeletal changes, although with a larger variability and less pronounced effects.
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Affiliation(s)
- Ralph M. Steegman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
- Zijlweg Orthodontie, Orthodontic Private Practice, Zijlweg 148B2, 2015 BJ Haarlem, The Netherlands
| | - Annemarlien F. Klein Meulekamp
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
| | - Anne-Marie Renkema
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
| | - Krista I. Janssen
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta 10430, Indonesia
| | - Yijin Ren
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (R.M.S.); (A.F.K.M.); (A.-M.R.); (K.I.J.); (Y.R.)
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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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Owens D, Watkinson S, Harrison JE, Turner S, Worthington HV. Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database Syst Rev 2024; 4:CD003451. [PMID: 38597341 PMCID: PMC11005087 DOI: 10.1002/14651858.cd003451.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013. OBJECTIVES To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents. SEARCH METHODS An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists. SELECTION CRITERIA We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible). MAIN RESULTS We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.
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Affiliation(s)
- Darren Owens
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Simon Watkinson
- Orthodontic Department, East Lancashire Hospitals Trust, Blackburn, UK
| | - Jayne E Harrison
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Sarah Turner
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Uzunçıbuk H, Marrapodi MM, Meto A, Ronsivalle V, Cicciù M, Minervini G. Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross-sectional study. J Oral Rehabil 2024; 51:500-509. [PMID: 38041596 DOI: 10.1111/joor.13614] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The objective of this investigation is to assess the relationship between the utilisation of orthodontic intermaxillary elastics and temporomandibular disorder (TMD) symptoms in clear aligner patients and to examine the correlation between the elastic usage time with the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)-Axis II Evaluation Forms. METHODS This study was carried out on a total of 40 clear aligner patients using intermaxillary elastics in the experimental group and 30 clear aligner patients who did not use any intermaxillary elastics in the control group. The data were evaluated using the Mann-Whitney U, chi-square, Fisher's exact chi-square, and Fisher Freeman Halton exact chi-square tests. RESULTS The characteristic pain intensity, mastication, mobility, communication, global and PHQ-9 scores of the experimental group were significantly higher than those of the control group (p < .05). The characteristic pain intensity score, interference score and chronic pain grade score of patients using Class III elastics were statistically significantly higher than those of patients using Class II elastics (p < .05). Patients who used elastics for less than 6 months had statistically significantly higher PHQ-9 scores than those who used elastics for more than 6 months (p < .05). CONCLUSIONS Orthodontic treatment may affect occlusion, bite force and jaw movement, which may cause or worsen TMD symptoms, and the DC/TMD questionnaires can determine if orthodontic patients acquire TMD by assessing their psychosocial state and pain-related problems.
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Affiliation(s)
- Hande Uzunçıbuk
- Department of Orthodontics, Dentistry Faculty, Trakya University, Edirne, Turkey
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Aida Meto
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, Tirana, Albania
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College & Hospitals, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Vichare S, Vichare G. Treatment of maxillary hypoplasia with bone anchored maxillary protraction (BAMP) - A case report. J Orthod Sci 2024; 13:12. [PMID: 38516114 PMCID: PMC10953726 DOI: 10.4103/jos.jos_30_22] [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: 04/06/2022] [Revised: 07/30/2023] [Accepted: 09/13/2023] [Indexed: 03/23/2024] Open
Abstract
Early diagnosis and treatment is known to be beneficial in Class III malocclusions secondary to maxillary hypoplasia. However, success of treatment largely depends on the patient's compliance and thus, appropriate choice of treatment, appliance and the age for interception plays an important role. Bone anchored maxillary protraction is one such approach presented in this case report for a 13 years old boy who reported with the chief complaint of lower front teeth visibility during speech and smiling. On examination his molars were in Angle's Class III relation, anterior crossbite and deep bite with unerupted maxillary canines. Orthodontic treatment was begun for deep bite correction and for creating space for the maxillary canines, followed by surgical intervention for placement of bone anchored miniplates. Protraction was done for 14 months and the total treatment time was 20 months. Improvement in the patient's profile, aesthetics and function was achieved with well aligned arches.
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Affiliation(s)
- Sharvari Vichare
- Department of Orthodontics and Dentofacial Orthopedics, Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS) Bathinda, Punjab, India
| | - Gauri Vichare
- Department of Orthodontics and Dentofacial Orthopedics, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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Hassan Alzahrani F, Devanna R, Althomali Y, Hassan Felemban N, Manjunath Battepati P, Holenarasipur AV. Impact of digital orthodontics on maxillary protraction with implants in children with skeletal class III: A systematic review and meta-analysis. Saudi Dent J 2024; 36:240-248. [PMID: 38420003 PMCID: PMC10897631 DOI: 10.1016/j.sdentj.2023.11.013] [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: 07/12/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024] Open
Abstract
Objective The objective of this systematic review is to assess the effectiveness of digital orthodontics in utilizing implants for maxillary protraction as a treatment for skeletal class III malocclusion in children. Materials and Methods The study was registered with PROSPERO with the number CRD42023407406 on 23/03/2023. We conducted an extensive comprehensive literature search in nine electronic databases, including PubMed, PubMed Central, Scopus, Cochrane databases, Google Scholar, MEDLINE, EMBASE, LILACS, and the Web of Sciences databases. The studies were evaluated for their methodology, the intervention technology used, the outcomes, and their quality. Publication bias assessment was conducted using the Jadad scale and the ROBINS-I assessment tool. Results We included a total of 17 studies that comprised a total of 376 patients in this analysis. The number of patients and participants fluctuated between 1 and 71, with > 60 % being female. The patients were aged between 1.1 and 19.2 years. We included only nine studies in the meta-analysis, in which we observed a success rate between 71.4 % and 100 % with a 95 % CI of 17.4 ± 2.988 (±17.2 %) [14.412-20.388]. The failure rates, although minimal, ranged from 5.9 % to 28.6 %, with a 95 % CI of 2.3 ± 1.480 (±64.3 %) [0.820-3.780]. Conclusion The evidence suggests that digital orthodontics is a promising approach for treating children with skeletal class III malocclusion using implants for maxillary protraction. However, further high-quality studies are required for validating our current observations and regulating the stability of treatment outcomes on a long-term basis.
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Affiliation(s)
| | - Raghu Devanna
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Yousef Althomali
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Nayef Hassan Felemban
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Prashant Manjunath Battepati
- Pediatric Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Amith V. Holenarasipur
- Community Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
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Phusantisampan P, Chaiworawitkul M. Cortical Bone Thickness and Morphology at the Infrazygomatic Crest Area in Growing Thai Patients with UCLP: A CBCT Study. Cleft Palate Craniofac J 2024:10556656241228738. [PMID: 38291624 DOI: 10.1177/10556656241228738] [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: 02/01/2024] Open
Abstract
OBJECTIVES To determine and compare buccal cortical bone thickness and morphology (in terms of shape and height) at the infrazygomatic (IZ) crest in growing Thai patients with unilateral cleft lip and palate (UCLP) using cone-beam computed tomography (CBCT) with the ultimate goal of identifying potential sites that are suitable for the placement of miniplates. DESIGN Prospective study. SETTLING Institutional research. PATIENTS Twenty-four Thai patients with non-syndromic complete UCLP with Class III skeletal discrepancy aged 10-14 years. INTERVENTIONS A total of 48 CBCT images captured the IZ crest. Five horizontal and six vertical reference planes were established in the IZ crest area. MAIN OUTCOME MEASURE The mean buccal cortical bone thickness of the cleft and non-cleft sides were 1.13 ± 0.45 mm and 1.15 ± 0.46 mm, respectively. The most frequently observed shape for the IZ crest was the external concave contour. There were no statistically significant differences in cortical bone thickness and shape distribution between the cleft and non-cleft sides. (P > .05). RESULTS The thickness of the buccal cortical bone increased anteriorly and superiorly from V + 0 and H + 0. The average height of IZ crest on the cleft side was 16.20 ± 1.59 mm and 16.78 ± 1.84 mm on the non-cleft side. Notably, significant differences were detected in terms of height between the cleft and non-cleft side and cortical bone thickness by gender (P < .05). CONCLUSIONS The IZ crest was found to provide sufficient support for the insertion of a miniplate, particularly in the superior and anterior regions, ensuring primary stability in growing Thai patients with UCLP.
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Affiliation(s)
- Ploypailin Phusantisampan
- Division of Orthodontics, Department of Orthodontic and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Marasri Chaiworawitkul
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Arsenina OI, Abakarov SI, Popova NV, Makhortova PI, Popova AV, Khachieva AV. [The use of fixed expanders with orthodontic miniscrews support in children with mesial occlusion]. STOMATOLOGIIA 2024; 103:61-70. [PMID: 38741537 DOI: 10.17116/stomat202410302161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Prevention of the development of pronounced skeletal abnormalities in patients with mesial occlusion. MATERIALS AND METHODS Biometric analysis of control and diagnostic models of dentition was performed in 60 patients with dental anomalies before and after treatment in 3 mutually perpendicular planes to identify violations in the formation of dental arches by sagittal and transversal dimensions, and alveolar processes - by vertical dimensions (methods of A. Pont, G. Korkhaus). Measurements of 23 parameters of TRG and sections of CBCT were carried out using the modified Nad-Ars technique with analysis of skeletal parameters before and after treatment. Treatment was carried out using dilators for the upper jaw in combination with a facial mask and further dynamic observation using active retention devices. RESULTS The results of treatment showed an increase in the length of the anterior segment of the upper dental arch by 2.8±0.55 mm (p<0.05 mm); expansion in the area of temporary molars by 2.85±0.65 mm (p<0.05); in the area of permanent molars by 2.75±0.55 mm (p<0.05); in the area of the apical basis of HF by 3.82±0.45 mm (p<0.05). The length of the lower dental arch in the anterior segment has not changed. Analysis of TRG parameters showed a significant increase in the values of CONCLUSION Early orthodontic treatment made it possible to create favorable conditions and prepare the patient's occlusion for a change of teeth, to form dental alveolar arches, to reduce the degree of complexity of therapeutic measures that may be needed after the completion of skeletal growth.
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Affiliation(s)
- O I Arsenina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S I Abakarov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - N V Popova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
- Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - P I Makhortova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
- Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - A V Popova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A V Khachieva
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Friang V, Khawam C, Fawaz P, Vannet BV. Evaluation of orthodontic habits regarding the use of miniplates in the correction of Skeletal Class III. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101666. [PMID: 37898299 DOI: 10.1016/j.jormas.2023.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/15/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
AIMS To determine the habits of Orthodontists in the management of moderate skeletal class III patients by using miniplates, and to assess the relationship between the factors that may hinder the implementation of such treatment. MATERIAL AND METHODS A questionnaire was carried out using the Google Form® platform, which included 18 questions relating to the seniority of the practice of the orthodontists, the preferential treatment, the difficulties encountered, the results obtained, and the frequency of a relapse. RESULTS Experienced orthodontists (more than 10 years) treated skeletal class III malocclusion with the conventional facemask therapy, whereas orthodontists with less than 5 years of experience shifted to the miniplate technique which presented less dental effect and more skeletal correction with a decreased frequency of relapse. CONCLUSION High financial cost and increased care load were considered the main obstacles regarding the placement of the titanium miniplates in treating skeletal class III patients.
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Affiliation(s)
- Valentin Friang
- Orthodontic Department Université de Lorraine, Nancy, France.
| | | | - Paul Fawaz
- Orthodontic Department Université de Lorraine, Nancy, France.
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Si M, Hao Z, Fan H, Zhang H, Yuan R, Feng Z. Maxillary Protraction: A Bibliometric Analysis. Int Dent J 2023; 73:873-880. [PMID: 37380594 PMCID: PMC10658433 DOI: 10.1016/j.identj.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVES The aim of this analysis was to investigate the historical development, current status, and research hot spots related to maxillary protraction in the treatment of maxillary hypoplasia. METHODS The term "TS = maxillary protraction" was used to search for articles in the Web of Science Core Collection at the library of Capital Medical University. The results were analysed using CiteSpace6.2.R1 software, including the examination of annual publication trends and analysis of author, country, institution, and keywords. RESULTS A total of 483 papers were included in this study. The annual publications showed an overall increasing trend. The top 5 authors with the most published papers were Lorenzo Franchi, Tiziano Baccetti, Seung-Hak Baek, Paola Cozza, and U Hagg. The top 5 countries with the highest publication counts were the US, Turkey, South Korea, Italy, and China. The top 5 institutions in terms of the number of published papers were the University of Florence, the University of Michigan, Kyung Hee University, Seoul National University, and Gazi University. The top 3 journals with the most citations were the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, and the European Journal of Orthodontics. Furthermore, "Maxillary protraction," "Class III malocclusion," and "Maxillary expansion" were the most common keywords. CONCLUSIONS The effective age range for maxillary protraction has been expanded with the introduction of skeletal anchorage and the combination of maxillary expansion and protraction. Skeletal anchorage offers significant advantages over dental anchorage, but there is a need for further research to further substantiate its stability and safety. In recent years, the positive effects of maxillary protraction on the nasopharyngeal area have been well established, but its impact on the oropharyngeal area remains a topic of debate. Therefore, it is crucial to conduct further investigations into the effects of maxillary protraction on the oropharyngeal area and explore the factors that influence different outcomes.
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Affiliation(s)
- Minmin Si
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Zhaonan Hao
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Hao Fan
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Huan Zhang
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Rui Yuan
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Zhiyuan Feng
- Department of Orthodontics, Shanxi Provincial People's Hospital, Taiyuan, China; The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China.
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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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Shyagali TR, Patidar R, Gupta A, Kapoor S, Tiwari A. Evaluation of stresses and displacement in the craniofacial region as a reaction to bone-anchored maxillary protraction in conjugation with posterior bite plane and rapid maxillary expansion in patients with Class III malocclusion: A finite element analysis study. Am J Orthod Dentofacial Orthop 2023; 164:253-264. [PMID: 36959013 DOI: 10.1016/j.ajodo.2022.12.015] [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: 08/01/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Treating a Class III malocclusion is often challenging for orthodontists. Bone-anchored maxillary protraction (BAMP) is known for achieving a significant maxillary protraction. The study aimed to evaluate the stress distribution and displacement of craniofacial bones as a reaction to the forces of BAMP, along with rapid maxillary expander and the posterior bite plane, in growing patients with skeletal Class III malocclusion using a finite element method. METHODS An finite element model was constructed from the spiral computed tomographic images of a skull from an 11-year-old growing patient with skeletal Class III malocclusion along with BAMP, rapid maxillary expander, and the posterior bite plane. The created model had 105,189 nodes and 481,066 elements. After assigning the appropriate material properties and the boundary condition, 800 g of transverse force per side and a Class III intraoral elastic 250 g of force per side were applied to the model, and after the postprocessing, the results were obtained in the form of color bands. RESULTS The maxilla and the attached structures were displaced and expanded transversely. The maxilla was displaced anteriorly by 0.692 mm, and the mandible was displaced backward by 0.204 mm in the sagittal direction. The anterior region of the maxilla and mandible, dentition, and nasal bone were rotated counterclockwise. Displacement in an upward direction was greatest at the symphysis region of the mandible. The stresses experienced by most of the bones were tensile, with the maxilla and maxillary dentition experiencing the maximum. CONCLUSIONS Favorable changes were appreciated with maxillary forward and mandibular backward displacement, with appreciable tensile stresses in all the bones.
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Affiliation(s)
- Tarulatha R Shyagali
- Department of Orthodontics and Dentofacial Orthopedics, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India.
| | - Rahul Patidar
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Abhishek Gupta
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Shanya Kapoor
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Anil Tiwari
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
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Kamel AM, Tarraf NE, Fouda AM, Hafez AM, El-Bialy A, Wilmes B. Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial. Prog Orthod 2023; 24:22. [PMID: 37303011 DOI: 10.1186/s40510-023-00473-4] [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: 09/14/2022] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The introduction of bone-anchored maxillary protraction eliminated the side effects of facemask in the early treatment of patients with maxillary retrusion. This study aimed to evaluate the effects of miniscrew-anchored maxillary protraction (MAMP) and compare them with the growth changes in an untreated control group in growing patients with Class III malocclusion. METHODS Forty growing patients with Class III malocclusion and retrognathic maxilla were randomly allocated into two groups: treated and control groups. In the treated group, patients were treated with full-time intermaxillary Class III elastics (C3E) anchored by a hybrid hyrax (HH) in the maxilla and a bone-supported bar in the mandible. Protraction was stopped after obtaining a positive overjet. Cephalometric radiographs were acquired before and after the treatment. Data were statistically analyzed on an intention-to-treat basis. Intergroup comparisons were also made using analysis of covariance with the readings at T0 as a covariate. RESULTS Forty patients agreed to participate, and 30 of them completed the study (treated group, n = 17; control group, n = 13). The average treatment duration was 11.9 months. MAMP resulted in a significant maxillary advancement (A-VR, 4.34 mm) with significant control over the mandibular growth. No significant increase in the mandibular plane angle was found in the treated group compared with the control group. The upper and lower incisors showed significant protrusion in the treated group. CONCLUSIONS Within the limitations of this study and high attrition rate, the MAMP protocol can effectively increase maxillary forward growth with good control over the growth of the mandible antero-posteriorly and vertically.
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Affiliation(s)
- Ahmed Mohamed Kamel
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, 1 El-Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
| | - Nour Eldin Tarraf
- Department of Orthodontics, Faculty of Medicine and Health, Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, University of Sydney, Sydney, Australia
| | - Ahmed Maher Fouda
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, 1 El-Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Ahmad Mohammed Hafez
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, 1 El-Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Ahmed El-Bialy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, 1 El-Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
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Maino GB, Maino G, Cremonini F, Lombardo L. Class III treatment with mini-implants anchorage in young adult patients: short and long-term results. Dental Press J Orthod 2023; 28:e23spe2. [PMID: 37283427 DOI: 10.1590/2177-6709.28.2.e23spe2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. OBJECTIVE To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. CONCLUSION The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.
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Affiliation(s)
| | - Giovanna Maino
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
| | | | - Luca Lombardo
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
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Hodecker LD, Kühle R, Weichel F, Roser CJ, Lux CJ, Bauer CAJ. Concept for the Treatment of Class III Anomalies with a Skeletally Anchored Appliance Fabricated in the CAD/CAM Process-The MIRA Appliance. Bioengineering (Basel) 2023; 10:616. [PMID: 37237686 PMCID: PMC10215846 DOI: 10.3390/bioengineering10050616] [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: 04/25/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. CLINICAL CASE In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. DISCUSSION The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. CONCLUSION The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization.
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Affiliation(s)
- Lutz D. Hodecker
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Reinald Kühle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Frederic Weichel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Christoph J. Roser
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Christopher J. Lux
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Carolien A. J. Bauer
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
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Tarraf NE, Dalci O, Dalci K, Altug AT, Darendeliler MA. A retrospective comparison of two protocols for correction of skeletal Class III malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask. Prog Orthod 2023; 24:3. [PMID: 36683080 PMCID: PMC9868197 DOI: 10.1186/s40510-022-00446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study compared the skeletal and dental effects of a hybrid maxillary expander with mandibular miniplates (HE-MP) and Class III elastics to conventional tooth-borne rapid maxillary expander and face mask (RME-FM) in skeletal Class III treatment. METHODS This retrospective study included 36 skeletal Class III patients. Eighteen patients (mean age 10.24 ± 1.31 years) were treated with a hybrid expander, two mandibular L-shaped miniplates and full-time Class III elastics (HE-MP group). Their results were compared to a group of patients treated with conventional RME-FM (n = 18; mean age 10.56 ± 1.41 year). Radiographs were taken before (T1) and after treatment (T2). All patients were in cervical maturation stages CS1-CS3 at T1. The measured outcomes were the changes in sagittal and vertical skeletal and dental cephalometric measurements. RESULTS Treatment time was approximately 15.5 ± 2.8 months with the HE-MP and 11.85 ± 3.41 months for the RME-FM. The Class III malocclusion was corrected in both groups with significant changes. The maxilla advanced more in the HE-MP group, with an increase in SNA of 4.26° ± 2.15° compared to 1.14 ± 0.93 in the RME-FM group (p < 0.001). The effect on the mandible was similar in both groups, while the overall skeletal change was significantly greater with HE-MP, with an increase in the ANB of 5.25° ± 2.03° and a Wits appraisal increase of 6.03 ± 3.13 mm, as opposed to 2.04° ± 1.07° and 2.94 ± 1.75 mm with the RME-FM (p < 0.001). Dental changes were significantly higher with RME-FM, with an increase in incisor inclination (U1-SN) of 5.02° ± 3.93° (p < 0.001), with no significant changes in the HE-MP group. The mandibular incisors retroclined by 5.29° ± 3.57° at L1-MP with the RME-FM, while they advanced slightly with the HE-MP by 2.87° ± 5.37° (p < 0.001). CONCLUSION The use of skeletal anchorage for maxillary expansion and protraction significantly increases skeletal effects and reduces dental side effects compared to tooth-borne maxillary expansion and protraction. These results need to be investigated in the long term.
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Affiliation(s)
- Nour Eldin Tarraf
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kerem Dalci
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ayse Tuba Altug
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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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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Fully automated condyle segmentation using 3D convolutional neural networks. Sci Rep 2022; 12:20590. [PMID: 36446860 PMCID: PMC9709043 DOI: 10.1038/s41598-022-24164-y] [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: 06/02/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to develop an auto-segmentation algorithm for mandibular condyle using the 3D U-Net and perform a stress test to determine the optimal dataset size for achieving clinically acceptable accuracy. 234 cone-beam computed tomography images of mandibular condyles were acquired from 117 subjects from two institutions, which were manually segmented to generate the ground truth. Semantic segmentation was performed using basic 3D U-Net and a cascaded 3D U-Net. A stress test was performed using different sets of condylar images as the training, validation, and test datasets. Relative accuracy was evaluated using dice similarity coefficients (DSCs) and Hausdorff distance (HD). In the five stages, the DSC ranged 0.886-0.922 and 0.912-0.932 for basic 3D U-Net and cascaded 3D U-Net, respectively; the HD ranged 2.557-3.099 and 2.452-2.600 for basic 3D U-Net and cascaded 3D U-Net, respectively. Stage V (largest data from two institutions) exhibited the highest DSC of 0.922 ± 0.021 and 0.932 ± 0.023 for basic 3D U-Net and cascaded 3D U-Net, respectively. Stage IV (200 samples from two institutions) had a lower performance than stage III (162 samples from one institution). Our results show that fully automated segmentation of mandibular condyles is possible using 3D U-Net algorithms, and the segmentation accuracy increases as training data increases.
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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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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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Schneider-Moser UEM, Moser L. Very early orthodontic treatment: when, why and how? Dental Press J Orthod 2022; 27:e22spe2. [PMID: 35703618 PMCID: PMC9191856 DOI: 10.1590/2177-6709.27.2.e22spe2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Several orthodontic problems should already be treated at an early age to prevent the necessity of future complex and expensive procedures. Scientific evidence suggests that posterior crossbites, mild to moderate Class III, as well as certain Class II malocclusions, open bites and arch length discrepancies can benefit from simple, but efficient interceptive therapy. Objective: To summarize the existing evidence-based literature on early orthodontic treatment, and to illustrate its application and effectiveness by showcasing multiple clinical examples. Conclusion: Early short-term interceptive orthodontic treatment with simple appliances, in the deciduous or early mixed dentition phase, can efficiently correct certain malocclusions and help to either reduce the complexity or even avoid the necessity of complex and expensive procedures during puberty. For certain patients with significant arch length discrepancy the concept of serial extractions should be part of the orthodontic armamentarium.
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Affiliation(s)
- Ute E M Schneider-Moser
- Private practice (Bolzano, Italy).,University of Ferrara, Ferrara School of Orthodontics (Ferrara, Italy).,University of Pennsylvania, School of Dental Medicine (Philadelphia/PA, USA)
| | - Lorenz Moser
- Private practice (Bolzano, Italy).,University of Ferrara, Ferrara School of Orthodontics (Ferrara, Italy)
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Shaikh AA, Kumar GA, Ramesh GC, Chinthan G, Indra S. Non-surgical correction of Class III adolescent patient with TADs and Damon system: A case report. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_101_2021] [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
Here is a case report of a 16 year old female patient with Class III malocclusion with Class III molar relation on both sides. The patient was diagnosed with normodivergent face pattern, proclined upper anterior, and crowded lower anterior, concave profile, potentially competent lips, reverse overjet and 0% overbite, and shallow mentolabial sulcus. The treatment was planned with a maxillary splint, mini-screws in mandible, and Class III elastics for Phase 1 and Phase 2 fixed appliance using the passive self-ligation system. The facial changes produced as a result of treatment were directly related to skeletal and dentoalveolar modifications that were designed as goals for patient treatment.
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Affiliation(s)
| | - G Arun Kumar
- Department of Orthodontics and Dentofacial Orthopedics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India,
| | - G. C Ramesh
- Department of Orthodontics and Dentofacial Orthopedics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India,
| | - Ganesh Chinthan
- Department of Orthodontics and Dentofacial Orthopedics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India,
| | - Shanthiprasad Indra
- Department of Orthodontics and Dentofacial Orthopedics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India,
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Skeletal, Dental, and Soft Tissue Changes after Applying Active Skeletonized Sutural Distractor (ASSD) for Class III Malocclusion Patients. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Nonsurgical treatment of Class III malocclusion may reduce the chances for orthognathic surgery in the future. This study aimed to determine the post-treatment skeletal, dental and soft tissue changes in the anteroposterior plane applying active skeletonized sutural distractor (ASSD) in late adolescent Class III malocclusion patients. Materials and Methods: After screening 13,500 students from 18 secondary schools, a sample of 26 subjects was recruited for this study, with a mean age of 15(±1.4) years after considering the inclusion and exclusion criteria. ASSD appliances were inserted into patients, and lateral cephalometric x-rays were taken for pre- and post-treatment analysis. Dental casts of the patients were also taken and scanned using a 3D laser scanner for comparisons. Results: The intraclass correlation coefficients (ICC) for inter-examiner were 0.87 to 0.99 and 0.96 to 0.99 for lateral cephalometric and dental cast measurements, respectively. The difference in pre- and post-treatment of cephalometric measurements of the mandible showed statistically significant changes for mandibular plane angle (p < 0.001) and SNB angle (p = 0.029). The dental cast measurements showed statistically significant changes of inter-molars width (p < 0.001) as well as palatal (p = 0.002). Conclusions: The results showed statistically significant improvement in skeletal, dental, and soft tissue changes after treatment applying ASSD for Class III malocclusion patients.
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Miranda F, Cunha Bastos JCD, Magno Dos Santos A, Janson G, Pereira Lauris JR, Garib D. Dentoskeletal comparison of miniscrew-anchored maxillary protraction with hybrid and conventional hyrax expanders: A randomized clinical trial. Am J Orthod Dentofacial Orthop 2021; 160:774-783. [PMID: 34509329 DOI: 10.1016/j.ajodo.2021.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This randomized clinical trial aimed to compare the skeletal and dental effects of miniscrew-anchored maxillary protraction (MAMP) using hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients with Class III malocclusion. METHODS This was a randomized, parallel, controlled trial. Forty growing patients with Class III malocclusion and maxillary deficiency (Wits appraisal of less than -1 mm) were randomized into 2 groups. Patients were recruited at the Orthodontic Clinic of Bauru Dental School, University of São Paulo, Brazil. The HH group was composed of patients with Class III malocclusions in the late mixed or early permanent dentition treated with a HH expander with 2 miniscrews in the maxilla and 2 miniscrews in the anterior region of the mandible. Class III elastics were used from the maxillary first molars to the mandibular miniscrews placed between permanent canines and first premolars. The CH group was composed of patients treated with a similar protocol except for the use of a CH expander in the maxilla. The primary outcomes included the frequency of overjet correction and sagittal skeletal effects produced with treatment. Allocation was performed with a simple randomization process. Blinding was performed only during assessments. Data were analyzed blindly on an intention-to-treat basis. Intergroup comparison was performed using analysis of covariance. Mean differences (MD) and 95% confidence interval (CI) were obtained for all variables. RESULTS The final sample for the HH group was 20 subjects (8 female, 12 male; initial age of 10.7 years), whereas the final sample for the CH group was 15 subjects (6 female, 9 male; initial age of 11.5 years). The frequency of overjet correction observed in the HH and CH groups was 94.4% and 71.4% (risk ratio, 1.32; 95% CI, 0.93-1.88), respectively. Both groups presented similar skeletal sagittal and vertical outcomes after maxillary protraction. The maxillary length (CoA) showed a similar increase in both groups (MD, 1.12 mm; 95% CI, -0.03 to 2.27). The CH group demonstrated a greater mesial displacement of maxillary first molars after treatment than the HH group (MD, 1.22 mm; 95% CI, 0.33-2.11). HH and CH groups produced 2.88 and 1.97 overjet corrections (MD, 0.53 mm; 95% CI, -0.52 to 1.59), respectively. CONCLUSIONS MAMP using HH and CH expanders produced a frequency of overjet correction of 94.4% and 71.4%, respectively. Similar skeletal effects were observed between MAMP using HH and CH expanders. Greater control of the mesial displacement of maxillary first molar during maxillary protraction using hybrid expanders was observed. REGISTRATION The trial was registered at http://ClinicalTrials.gov, under the identifier NCT03712007. PROTOCOL This trial protocol was not published. FUNDING This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) - Finance Code 001, and by the São Paulo Research Foundation (FAPESP) - Grants nos. 2017/04141-9, 2017/24115-2, and 2019/03175-2.
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Affiliation(s)
- Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | | | | | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - José Roberto Pereira Lauris
- Discipline of Statistics, Department of Public Health, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Individualized 3D-Printed Bone-Anchored Maxillary Protraction Device for Growth Modification in Skeletal Class III Malocclusion. J Pers Med 2021; 11:jpm11111087. [PMID: 34834439 PMCID: PMC8619151 DOI: 10.3390/jpm11111087] [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: 09/27/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
Bone-anchored maxillary protraction (BAMP) is effective for skeletal Class III malocclusion. However, infection, screw and plate loosening, and device failures occur with conventional plates. This pilot prospective study analyzed the feasibility of individualized BAMP using preoperative simulation and 3D titanium printing in patients referred by the orthodontic department for four BAMP miniplates. Preoperative cone beam computed tomography data were analyzed using CAD/CAM software to fabricate the individualized 3D-printed BAMP device. The customized plates were printed using selective laser sintering and inserted onto the bone through an adjunct transfer jig. The accuracy of preoperative simulation and actual placement of the BAMP device were tested by superimposing simulated positioned digital images and postoperative computed tomography data. The growth modification effect depended on superimposition of lateral cephalograms and comparative changes in SNA, SNB, ANB, and Wits. Two male patients were finally included in the study. BAMP decreased the ANB difference (−4.56 to −1.09) and Wits appraisal (−7.52 to −3.26) after 2 years. Normal measurement indices for sagittal and vertical growth indicated successful growth modification. The mean accuracy between preoperative simulation and actual surgery was 0.1081 ± 0.5074 mm. This treatment modality involving preoperative simulation and 3D titanium printing for fabricating and placing customized BAMP devices precisely at planned locations is effective for treating skeletal Class III malocclusion.
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Facio-Umaña JA, Chaurand J, Gonzalez-Luna PIV. Early class III treatment with maxillary protraction-miniscrew-assisted rapid palatal expansion (MARPE) and mandibular miniplates. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hu S, An K, Peng Y. Comparative efficacy of the bone-anchored maxillary protraction protocols for orthopaedic treatment in skeletal Class III malocclusion: A Bayesian network meta-analysis. Orthod Craniofac Res 2021; 25:243-250. [PMID: 34468065 DOI: 10.1111/ocr.12532] [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: 02/26/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the treatment effects of five bone-anchored maxillary protraction protocols (BAC3E, BAMP, BARME-FM, BARME-ME, SAFM) for skeletal Class III malocclusion. METHODS We conducted a systematic literature search through CENTRAL, EBSCO, PubMed and Web of Science and included the randomized controlled trials and clinical controlled trials, which met the criteria. A Bayesian network meta-analysis (NMA) for SNA, SNB, ANB, SN-MP and Wits appraisal was performed in R software using a random consistency model. The additional analyses included node-splitting analysis, statistical heterogeneity analysis, sensitivity analysis and ranking probability by SUCRA. RESULTS A total of 598 articles were initially obtained; 13 articles involving 482 individuals were eventually included. Among the five bone-anchored maxillary protraction protocols, the largest increment in SNA and Wits appraisal was observed in the BAMP group and BAC3E group, respectively; the SAFM, BAC3E and BAMP groups showed similar capability in terms of changes of ANB; least clockwise rotation of the mandible was found in the BARME-ME group, followed by the BAMP group; dental compensation appears to be most pronounced in the BAC3E group; and intermaxillary traction seems to reduce the lingual inclination of lower incisors and even cause labial inclination. CONCLUSIONS The SAFM, BAMP and BAC3E groups seem to be advantageous in the improvement of the maxillo-mandibular relationship, followed by the BARME-FM and BARME-ME groups. The findings of this study should be interpreted with caution as only short-term effects were compared and the quality of evidence ranged from very low to moderate. More RCTs with high-quality and long-term investigation are needed.
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Affiliation(s)
- Shoushan Hu
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ke An
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yiran Peng
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, Sichuan, China
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Mehta S, Chen PJ, Upadhyay M, Yadav S. Intermaxillary elastics on skeletal anchorage and MARPE to treat a class III maxillary retrognathic open bite adolescent: A case report. Int Orthod 2021; 19:707-715. [PMID: 34452857 DOI: 10.1016/j.ortho.2021.08.001] [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: 07/02/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Class III malocclusion when accompanied with transverse and vertical maxillomandibular discrepancies such as posterior crossbite and vertical open bite leads to complicated orthodontic treatment. Proper diagnosis and treatment planning are important in such patients for a successful orthodontic outcome. A common treatment approach for patients with class III malocclusion is to wait for the completion of growth and plan orthognathic surgery in conjunction with orthodontic treatment. However, performing no treatment and waiting for growth to be completed during teen years could lead to negative effects on the patient's self-esteem. In such cases, a non-surgical option with skeletal anchorage could be used to correct the malocclusion without surgical intervention. This case report shows that in patients with severe class III malocclusion, skeletal anchorage can be used for the correction of anterior crossbite with intermaxillary elastics.
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Affiliation(s)
- Shivam Mehta
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA.
| | - Po-Jung Chen
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Madhur Upadhyay
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
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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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Lim LI, Choi JY, Ahn HW, Kim SH, Chung KR, Nelson G. Treatment outcomes of various force applications in growing patients with skeletal Class III malocclusion. Angle Orthod 2021; 91:449-458. [PMID: 33587106 DOI: 10.2319/090320-768.1] [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: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate skeletal, dentoalveolar, and soft tissue changes between intraoral light force application and extraoral heavy force application in growing patients with skeletal Class III malocclusion. MATERIALS AND Methods: A retrospective study was conducted with pretreatment and posttreatment lateral cephalometric data from 50 subjects with skeletal Class III malocclusion. In the first group (15 boys, 10 girls; 8.67 ± 2.13 years old), each subject wore a biocreative horseshoe appliance (CHS) with two Class III elastics that exerted a force of 200 g. In the second group (13 boys, 12 girls; 8.96 ± 1.82 years old), each subject wore a Petit-type facemask and a lingual arch with hooks fixed to the maxillary arch with a total force of 700 g. Both groups of patients were instructed to wear the appliance approximately 14 hours a day, and 22 linear measurements and 8 angular measurements were evaluated. Changes of measurements from each group were compared by paired t-tests, considering a 5% significance level. RESULTS Forward growth of the maxilla, improvement of the maxilla-mandible relationship, and upper incisor flaring were achieved in both groups without any statistically significant difference between them. Lateral cephalometric analysis also showed that U1 exposure, IMPA (Angle between mandibular plane and mandibular incisor axis), FMIA (Angle between FH plan and mandibular incisor axis), and L1-APog (Angle formed by the intersection of tooth axis of lower incisor and A-Pog line, Distance from lower incisor edge to A-Pog line) showed statistically significant differences. Lower incisors were inclined lingually in the CHS group. CONCLUSIONS During treatment of skeletal Class III malocclusion, the CHS with light Class III intermaxillary elastics therapy exhibits similar orthopedic changes to the maxillary complex and more dental changes to the lower anterior teeth compared with facemask therapy.
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Liang S, Wang F, Chang Q, Bai Y. Three-dimensional comparative evaluation of customized bone-anchored vs tooth-borne maxillary protraction in patients with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop 2021; 160:374-384. [PMID: 34172344 DOI: 10.1016/j.ajodo.2020.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of this prospective study was to assess the 3-dimensional skeletal and dental effects induced by a new maxillary protraction approach using customized miniplates for anchorage compared with a control group of traditional tooth-borne maxillary protraction. METHODS Forty-one growing patients at prepubescent stage with skeletal Class III malocclusion participated in this study. These patients were randomly split into 2 groups. In group 1 (n = 20), patients underwent maxillary protraction anchored with customized miniplates. The miniplates were individually designed and inserted using the surgical templates. In group 2 (n = 21), patients underwent tooth-borne maxillary protraction. Pretreatment and posttreatment cone-beam computed tomography scans were obtained, and 30 measurements of cone-beam computed tomography images were acquired and calculated. The changes after treatment and the comparison of the 2 groups were assessed. RESULTS After maxillary protraction, group 1 showed a greater forward movement of the maxilla than group 2. The maxilla length increased more in group 1 than in group 2. The rotations of the palatal and mandibular planes in group 1 were less than those in group 2. In group 1, the maxillary incisors proclined less, the mandibular incisors retroclined less, and the maxillary first molars extruded less. CONCLUSIONS Compared with tooth-borne maxillary protraction, customized miniplates anchored maxillary protraction produced more maxillary growth, fewer dental changes, and less maxillary and mandibular plane rotation.
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Affiliation(s)
- Shuran Liang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Fan Wang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Qiao Chang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China.
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Biomechanical analysis for total mesialization of the maxillary dentition: A finite element study. Am J Orthod Dentofacial Orthop 2021; 159:790-798. [DOI: 10.1016/j.ajodo.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 12/26/2022]
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Vracar TR, Claro W, Vracar ME, Jenkins RS, Bland L, Dayeh AA. Sutural deformation during bone-anchored maxillary protraction. J Oral Biol Craniofac Res 2021; 11:447-450. [PMID: 34094844 DOI: 10.1016/j.jobcr.2021.05.008] [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: 03/05/2021] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Bone-anchored maxillary protraction (BAMP) is an emerging treatment option for orthopedic correction of maxillary deficiency in young patients. Compared to reverse pull headgear (RPHG), it is believed that forces generated during BAMP result in greater circum-maxillary sutural separation, mandibular retrusion, and improved maxillary protraction. Mechanical loading of the circum-maxillary sutures during BAMP is still poorly understood. Methods 20 ex-vivo pig heads were used. Miniplates and molar tubes were installed like clinical procedures. A series of five 200 g-force (gf) elastics were applied on the right and left side until 1000gf were reached. Strain gauges were installed across the zygomatico-maxillary (ZMS), zygomatico-temporal (ZTS), and nasofrontal suture (NFS). Differential variable reluctance transducers (DVRTs) were installed across the ZTS. Deformation of the sutures during BAMP and RPHG was measured and compared. Results Higher average sutural deformation of the ZTS and ZMS was seen in BAMP than RPHG: 36.6 ± 20.6με vs 18.0 ± 12.4με and 54.7 ± 28.5με vs 12.5 ± 14.8με, respectively. Similarly, higher NFS deformation was seen in BAMP (18.4 ± 12.9με vs. -0.8 ± 12.0με). DVRT data showed higher ZTS separation in BAMP than RPHG (6.3 ± 5.2 μm vs. 1.7 ± 2.1 μm). These differences were all statistically significant using the Wilcoxon-signed rank test. Conclusion Both RPHG and BAMP forces separate the ZTS and ZMS. BAMP resulted in higher levels of sutural separation at the ZTS and ZMS by 2- and 5-fold, respectively.
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Affiliation(s)
- Taylor Rae Vracar
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Wanda Claro
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Michael Eli Vracar
- Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Randall Stetson Jenkins
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Lane Bland
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
| | - Ayman Al Dayeh
- Department of Orthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, 38163, USA
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Long-term maxillary anteroposterior changes following maxillary protraction with or without expansion: A meta-analysis and meta-regression. PLoS One 2021; 16:e0247027. [PMID: 33617540 PMCID: PMC7899359 DOI: 10.1371/journal.pone.0247027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Maxillary protraction with or without expansion is a widely known orthopedic treatment modality in growing skeletal Class III patients. However, limited data are available regarding the outcomes of long-term changes in the maxilla. Aim of this meta-analysis was to assess the effectiveness of the long-term maxillary anteroposterior changes following a facemask therapy with or without rapid maxillary expansion in growing skeletal Class III patients. METHODS A comprehensive literature search was conducted using the databases of PubMed, Science Direct, Web of Science, and Embase. Randomized controlled trials and cohort studies, published up to Sep. 2020, with maxillary protraction and/or expansion as keywords were included in this meta-analysis. Risk of bias within and across studies were assessed using the Cochrane tools (RoB2.0 and ROBINS-I) and GRADE approach. Overall and subgroup comparisons with the random-effect model were performed in this meta-analysis. Meta-regression models were designed to determine potential heterogeneity. RESULTS There was a statistically significant increase (Mean difference, 2.29°; 95% confidence interval, 1.86-2.73; and p < 0.001 after facemask (FM) protraction. Mean difference, 1.73°; 95% confidence interval, 1.36-2.11; and p < 0.001 after rapid maxillary expansion(RME) and facemask protraction) in the Sella-Nasion-A point (SNA) angle in the treatment groups as compared with the control groups, when measured during the less than 3-year follow-up period. However, no statistically significant changes (Mean difference, 0.28°; 95% confidence interval, -0.57-1.13; and p = 0.52 after facemask protraction. Mean difference, 0.34°; 95% confidence interval, -0.64-1.33; and p = 0.50 after rapid maxillary expansion and facemask protraction) were observed in the SNA angle in the groups, when measured after 3 years of follow-up. Meta-regression analysis also showed that with increased follow-up duration, the effectiveness of maxillary protraction decreased. CONCLUSION This meta-analysis revealed that maxillary protraction therapy could be effective for a short-term in correcting maxillary hypoplasia and the treatment result was not affected by mean age and sex. However, with increased follow-up duration, the sagittal maxillary changes gradually decreased. Limitations on this review were only the SNA angle was used and clinical heterogeneity was not discussed. The quality of evidence was moderate. Further long-term observational studies are necessary for a comprehensive evaluation of the effects on maxillary skeletal changes.
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Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction-A 3.5-Year Follow-Up. J Clin Med 2021; 10:jcm10040750. [PMID: 33668503 PMCID: PMC7918916 DOI: 10.3390/jcm10040750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023] Open
Abstract
This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.
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Ahn HW, Kim SJ, Baek SH. Miniplate-anchored maxillary protraction in adolescent patients with cleft lip and palate: A literature review of study design, type and protocol, and treatment outcomes. Orthod Craniofac Res 2020; 24 Suppl 1:21-30. [PMID: 33253469 DOI: 10.1111/ocr.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To review the study design, type, protocol, and treatment outcomes of miniplate-anchored maxillary protraction (MAMP) in adolescent patients with unilateral or bilateral cleft lip and palate. SETTING/SAMPLE POPULATION Five retrospective and two prospective studies (n = 138 patients) were selected as per the inclusion criteria. MATERIALS AND METHODS The study design, type, protocol of MAMP and the amount of skeletodental change were investigated. RESULTS Two studies adopted type 1 (two miniplates at the infrazygomatic crest with a facemask), four studies adopted type 2 (four miniplates at the infrazygomatic crest and mandibular symphysis and use of intermaxillary elastics), and one study compared the two types. The mean start age was older than 10 years except one study. The mean duration was less than 1 year in two studies, between 1 and 2 years in three studies, and more than 2 years in two studies. The type 1 used 500 g/side for 12-14 h/d, and the type 2 used three increase methods (100, 200, 250 g/side; 75, 150, 250 g/side; 150, 200, and 250 g/side) for 24 h/d. The ranges of A point advancement were 0.5°-4.2° in ΔSNA and 1.7-5.6 mm in ΔA-vertical reference plane, respectively. The ranges of rotation of the palatal plane, occlusal plane, and mandibular plane were -1.5° to 2.0°, -2.0° to 2.0°, -1.5° to 3.2°, respectively. The increase of overjet was ranged from 2.3 to 5.8 mm. CONCLUSION The MAMP therapy is effective for the correction of maxillary hypoplasia in adolescent cleft patients despite different types and protocols.
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Affiliation(s)
- Hyo-Won Ahn
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Su-Jung Kim
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
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Gera S, Cattaneo PM, Hartig LE, Cornelis MA. Computer-aided design and manufacturing of bone- and tooth-borne maxillary protraction with miniscrews and Class III elastics: Can we contemporize Class III treatments in growing patients? Am J Orthod Dentofacial Orthop 2020; 159:125-132. [PMID: 33223373 DOI: 10.1016/j.ajodo.2020.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this clinical report is to illustrate an innovative treatment plan for a patient with Class III malocclusion. The plan combined the versatility of computer-aided design and manufacturing technology with miniscrews. Maxillary and mandibular fully customized metal framework anchored to 4 miniscrews was digitally designed and constructed for a growing patient with midface hypoplasia and a skeletal Class III malocclusion. The patient wore Class III elastics between hooks on the maxillary and mandibular frameworks full time for 10 months. Overcorrection was obtained with limited dental side effects, and a significant improvement of the profile was achieved. With the advantages of computer-aided design and manufacturing technology and less invasive insertion procedure compared with miniplate surgery, this patient-specific treatment approach was simple and effective.
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Affiliation(s)
- Shadi Gera
- 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
| | - Lill Egekvist Hartig
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Marie A Cornelis
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
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Liang S, Xie X, Wang F, Chang Q, Wang H, Bai Y. Maxillary protraction using customized mini-plates for anchorage in an adolescent girl with skeletal Class III malocclusion. Korean J Orthod 2020; 50:346-355. [PMID: 32938827 PMCID: PMC7500574 DOI: 10.4041/kjod.2020.50.5.346] [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: 07/17/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
The treatment of skeletal Class III malocclusion in adolescents is challenging. Maxillary protraction, particularly that using bone anchorage, has been proven to be an effective method for the stimulation of maxillary growth. However, the conventional procedure, which involves the surgical implantation of mini-plates, is traumatic and associated with a high risk. Three-dimensional (3D) digital technology offers the possibility of individualized treatment. Customized miniplates can be designed according to the shape of the maxillary surface and the positions of the roots on cone-beam computed tomography scans; this reduces both the surgical risk and patient trauma. Here we report a case involving a 12-year-old adolescent girl with skeletal Class III malocclusion and midface deficiency that was treated in two phases. In phase 1, rapid maxillary expansion and protraction were performed using 3D-printed mini-plates for anchorage. The mini-plates exhibited better adaptation to the bone contour, and titanium screw implantation was safer because of the customized design. The orthopedic force applied to each mini-plate was approximately 400-500 g, and the plates remained stable during the maxillary protraction process, which exhibited efficacious orthopedic effects and significantly improved the facial profile and esthetics. In phase 2, fixed appliances were used for alignment and leveling of the maxillary and mandibular dentitions. The complete two-phase treatment lasted for 24 months. After 48 months of retention, the treatment outcomes remained stable.
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Affiliation(s)
- Shuran Liang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Xianju Xie
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Fan Wang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Qiao Chang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Hongmei Wang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
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Faco R, Yatabe M, Cevidanes LHS, Timmerman H, De Clerck HJ, Garib D. Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal. Eur J Orthod 2020; 41:537-543. [PMID: 30865780 DOI: 10.1093/ejo/cjz005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the cephalometric outcome of bone-anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). MATERIAL AND METHODS The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P < 0.05). RESULTS BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. CONCLUSIONS BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.
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Affiliation(s)
- Renato Faco
- Department of Maxillofacial Surgery, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | - Hugo J De Clerck
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
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Lee WC, Shieh YS, Liao YF, Lee CH, Huang CS. Long-term maxillary three dimensional changes following maxillary protraction with or without expansion: A systematic review and meta-analysis. J Dent Sci 2020; 16:168-177. [PMID: 33384794 PMCID: PMC7770293 DOI: 10.1016/j.jds.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
Background/purpose Maxillary protraction with or without expansion appears to be an effective orthopedic treatment in skeletal class III growing patients, but the long-term effect on maxilla changes is less clear. The aim of this meta-analysis was to evaluate long-term three dimensional skeletal effects on maxilla through face mask (FM) with or without rapid maxillary expansion (RME) in skeletal CIII growing patients. Materials and methods We searched database including PubMed, Science Direct, Embase and Web of Science through Feb 2020. Inclusion criteria were randomized controlled trials or cohort studies recruiting growing patients who received maxillary protraction and/or expansion and comparing the treatment groups with untreated controls. The follow-up periods were more than 3 years. Risk of bias was assessed using the Cochrane tools (RoB2.0 and ROBINS-I). GRADE was used to qualify the evidence. Results This meta-analysis included 6 studies comprising 327 participants in total. No statistically significant changes were observed on the degree of Sella-Nasion-A point (SNA) in the treated groups when compared with the untreated controls. However, significant increase on maxillary rotation degree (mean difference: 8.20, 95% CI = 6.87–9.53, p < 0.001) and maxillary base width (mean difference: 2.27, 95% CI = 1.39–3.15, p < 0.001) in the treated groups, if compared with untreated controls. Conclusion Our results indicated that FM and FM/RME treatments might not be long-term effective on correcting maxillary anteroposterior hypoplasia in growing patients. Additionally, more long-term studies are still necessary to further assess its skeletal benefits on maxilla in vertical and transverse dimension.
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Affiliation(s)
- Wei-Cheng Lee
- Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Craniofacial and Dental Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Shing Shieh
- Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Fang Liao
- Graduate Institute of Craniofacial and Dental Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Dentistry, Chang Gung Craniofacial Research Center, Chang Gung Memorial Hospital at Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiung Shing Huang
- Graduate Institute of Craniofacial and Dental Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Dentistry, Chang Gung Craniofacial Research Center, Chang Gung Memorial Hospital at Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan
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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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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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Early class III treatment with hybrid rapid palatal expander combined with facemask. Int Orthod 2020; 18:624-635. [PMID: 32534993 DOI: 10.1016/j.ortho.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Class III patients are characterized by a deficiency of the maxilla and/or a prognathism of the mandible and require early treatment. DIAGNOSIS This case report describes the treatment of a 5-year-old patient with a skeletal class III relationship, a significant mandibular symphysis deviation towards the right side and a different height of the mandibular angles. MANAGEMENT AND OUTCOME The patient was treated with rapid maxillary expander combined with miniscrew, facemask and aligners. A functional and aesthetic occlusion in an improved facial profile was established at the end of the orthodontic treatment. Pre-treatment, post-treatment and one year retention records for the patient are presented. DISCUSSION Class III patients require early treatment in order to optimize the traditional expander effects; subsequently hybrid anchorage allowed to maximize skeletal advancement. In addition, loss of space for the erupting teeth and dento-alveolar tipping were avoided. The good results of the phase I treatment and of the active retainer meant that a complex case would become relatively simple at the phase II treatment.
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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: 2] [Impact Index Per Article: 0.5] [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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Pellegrino M, Caruso S, Cantile T, Pellegrino G, Ferrazzano GF. Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3587. [PMID: 32443794 PMCID: PMC7277547 DOI: 10.3390/ijerph17103587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this investigation was to show how to manage an anterior crossbite in early mixed dentition with an eruption guidance appliance (EGA). The analyzed clinical case reported an anterior crossbite, a bimaxillary retrusion tendency, and a horizontal growth pattern. The anterior crossbite was an unfavorable occlusal condition that could lead to a class III malocclusion growth pattern. An early treatment approach was suggested to reach a correct sagittal jaw relationship. Hence, the selected approach acted on the dentoalveolar sector, aiming to have effects on the posterior vertical dimension and to improve the sagittal jaw's relation. An EGA was selected to treat the patient in early mixed dentition. After 7 months of therapy with night-time use, the dental malocclusion was completely resolved. The patient continued to be treated with the same device, used as active retention. With the EGA treatment, the erupting forces, rather than the active forces, were used to resolve the dental malocclusion. This approach allowed a low compliance requirement and had a minimum psychosocial and psychological impact on the patient. The early treatment was essential to give a functional occlusion and a good balance of the soft perioral tissues and muscles.
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Affiliation(s)
| | - Silvia Caruso
- Department of Health, Life and Environmental Science, University of L’Aquila, 67100 L’Aquila, Italy; (S.C.); (G.P.)
| | - Tiziana Cantile
- Department of Neuroscience, Reproductive and Oral Sciences, School of Paediatric Dentistry, University of Naples, Federico II, 80138 Naples, Italy; (T.C.); (G.F.F.)
| | - Gioacchino Pellegrino
- Department of Health, Life and Environmental Science, University of L’Aquila, 67100 L’Aquila, Italy; (S.C.); (G.P.)
| | - Gianmaria Fabrizio Ferrazzano
- Department of Neuroscience, Reproductive and Oral Sciences, School of Paediatric Dentistry, University of Naples, Federico II, 80138 Naples, Italy; (T.C.); (G.F.F.)
- UNESCO Chair in Health Education and Sustainable Development: Oral Health in Paediatric Age, University of Naples Federico II, 80138 Naples, Italy
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Dogan E, Seckin O. Maxillary protraction in patients with unilateral cleft lip and palate : Evaluation of soft and hard tissues using the Alt-RAMEC protocol. J Orofac Orthop 2020; 81:209-219. [PMID: 32342120 DOI: 10.1007/s00056-020-00220-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the hard and soft tissue effects and differences of the Alt-RAMEC protocol to the facemask and conventional facemask protocols in patients with unilateral cleft lip and palate. METHODS This prospective study was carried out with 30 patients with unilateral cleft lip and palate with skeletal and dental class III malocclusions who were referred to a university department of orthodontics. The patients were evaluated with the cervical vertebral maturation method and divided into two groups, each consisting of 15 patients. The patients in group I (mean age 10.00 ± 0.73 years) were treated according to conventional facemask protocol, and the patients in group II (mean age 10.07 ± 2.43 years) were treated according to the Alt-RAMEC protocol before facemask application. Lateral cephalometric radiographs were evaluated by using the Dolphin Imaging Software version 11.7. The skeletal, dentoalveolar and soft tissue differences and treatment times were evaluated. RESULTS Group II demonstrated a 5.73° increase in SNA, which was statistically significant, while this increase was 3.13° in group I (p < 0.001). Results for Co‑A and A‑PTV showed a significant increase for group II only (group I: 1.02 mm, 1.06 mm, group II: 3.02 mm, 2.21 mm; p < 0.05 and p < 0.01, respectively). In addition, group II presented significant increase for the values of ANB, N‑A-Pg, SN/MP, Wits, U1-SN, U1-L1, U1-PTV, U1-FHP, U6-PTV, U6-FHP, overjet, Ss-PTV, UL-PTV and UL‑S line (p < 0.001). The treatment mean times were 7.3 months in group I and 4.7 months in group II (p < 0.01). CONCLUSION Applying the facemask after having followed the Alt-RAMEC protocol induced more skeletal, dentoalveolar and soft tissue changes in comparison to the conventional facemask protocol in patients with unilateral cleft lip and palate.
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Affiliation(s)
- Ege Dogan
- Department of Orthodontics, Private Clinic, Ali Cetinkaya Bulvari Servet Apartmani no:14 kat:1 daire:1 Alsancak, Izmir, Turkey.
| | - Ozlem Seckin
- Department of Orthodontics, Faculty of Dentistry, Ege University, Bornova, Izmir, Turkey
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Miranda F, Bastos JCDC, Dos Santos AM, Vieira LS, Aliaga-Del Castillo A, Janson G, Garib D. Miniscrew-anchored maxillary protraction in growing Class III patients. J Orthod 2020; 47:170-180. [PMID: 32166995 DOI: 10.1177/1465312520910158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this article is to report a case series of a miniscrew-anchored maxillary protraction therapy (MAMP). Two male patients presenting with Class III malocclusion were included in this report. The treatment consisted of a hybrid expander and two miniscrews at the anterior region of the mandible anchoring Class III elastics for maxillary protraction. Effective maxillary length, ANB angle and Wits appraisal increased after treatment. Slight dental effects were observed. MAMP therapy produced substantial skeletal effects and might be a good treatment option for Class III growing patients.
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Affiliation(s)
- Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | | | | | - Luiz Sergio Vieira
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | | | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil.,Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
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