Comparison of the effects on the pharyngeal airway space of maxillary protraction appliances according to the methods of anchorage

Effect of SEC III protocol on upper airway dimensions in growing class III patients: a retrospective study

BACKGROUND

The primary objective of the study was to evaluate the effects of SEC III (Splints, Class III Elastics, and Chin cup) protocol on the upper airway dimensions using lateral cephalometric radiographs. The secondary objectives were to evaluate the skeletal and dental effects of the SEC III protocol using lateral cephalometric radiographs.

METHODS

The pre- and post-treatment lateral cephalometric radiographs of 24 patients treated using the SEC III protocol were used to address the aim of the study. Children in the pre-pubertal (CS-1 or CS-2) or circumpubertal (CS-3 or CS-4) skeletal maturation stage and having class III dentoskeletal malocclusion were included in the study. Patients with a history of previous orthodontic treatment, maxillofacial surgery or trauma, tonsillectomy, adenoidectomy, or craniofacial malformations were excluded. The pre-treatment and post-treatment lateral cephalometric radiographs were traced, then airway measurements, skeletal measurements, and dental measurements were performed. The results were analysed using paired samples t-test or Wilcoxon signed rank test according to the data normality.

RESULTS

Data of 6 males and 18 females were analysed (Mean age = 11.21 ± 1.02 years). Duration of active treatment was 5.75 ± 1.03 months. Treatment using SEC III protocol resulted in a significant increase in ANB angle (2.92 ± 1.50 degrees, p < 0.001) and Wits appraisal (3.31 ± 1.99 mm) (p < 0.001). The increase in the mandibular plane angle (0.75 ± 1.42 degrees, p = 0.02) and the maxillary length (2.29 ± 2.69 mm, p < 0.001) was statistically significant. Contrarily, the mandibular length did not change significantly (p = 0.10). The maxillary incisors were significantly proclined (4.38 ± 4.28 degrees; p < 0.001), while the mandibular incisors were significantly retroclined (-5.79 ± 6.21 degrees; p < 0.001) following treatment. The change in the nasopharyngeal airway and the retropalatal airway was not statistically significant. The middle and inferior pharyngeal space (retroglossal airway) significantly decreased by 1.33 ± 1.97 mm (p = 0.003) and 1.96 ± 2.48 mm (p = 0.001), respectively.

CONCLUSIONS

Early class III correction using SEC III protocol reduced the retroglossal airway dimensions but did not affect the nasopharyngeal and retropalatal airway dimensions. Correction of the class III dentoskeletal relationship was obtained through both skeletal and dental changes.

Airway dimensional changes following bone anchored maxillary protraction: a systematic review

BACKGROUND

The introduction of skeletal anchorage utilized for maxillary protraction with a face mask or class III elastics has been developed for the management of class III malocclusions with minimal dental effect. The objective of the present review was to evaluate the current evidence regarding airway dimensional changes following bone-anchored maxillary protraction. A search was conducted by two authors (S.A & B.A) in the following databases: MEDLINE via PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and Open Grey; besides a hand search in references of selected articles and developing a search alert in electronic databases. Selection criteria comprised randomized as well as prospective clinical trials evaluating airway dimensional changes following bone-anchored maxillary protraction. Relevant data were extracted after studies retrieval and selection. The risk of bias was thereafter evaluated using the revised RoB 2 tool for randomized clinical trials and the ROBINS-I tool was used for non-randomized clinical trials. The quality of studies was assessed using the modified Jadad score. After examining (eligibility) full-text articles, four clinical trials were ultimately included. These studies evaluated the airway dimensional changes, following bone-anchored maxillary protraction in comparison to different control study groups. Based on the available evidence, all the bone-anchored maxillary protraction devices used in the eligible studies in the present systematic review resulted in an improvement in the airway dimensions. However, due to the few numbers of studies available and the guarded evidence due to the low quality of evidence of three out of four included articles, there is no strong evidence to support a significant increase in the airway dimensions following bone-anchored maxillary protraction. Therefore, there is a need for more randomized controlled clinical trials with similar bone-anchored protraction devices and similar assessment methods for more valid comparisons, excluding any confounding factors, on airway dimensional changes.

Craniofacial treatment protocol for a pediatric patient with obstructive sleep apnea and skeletal Class III malocclusion: A 13-year follow-up

This report aimed to describe the long-term effects of craniofacial growth modification treatment on sleep and breathing functions in a 7-year-old girl diagnosed with skeletal Class III malocclusion and sleep-disordered breathing. Based on the flowchart of orthodontic intervention protocol that we proposed for phenotype-based patient selection and skeletal target-based treatment selection for pediatric patients with sleep-disordered breathing, a 2-phase treatment targeting the nasomaxillary complex was performed. Posttreatment 3-dimensional changes in the skeletal structure and upper airway were evaluated in association with functional assessment using a validated pediatric sleep questionnaire and home sleep test. Esthetic improvement and obstructive sleep apnea cure were achieved without skeletal surgery. The 2-year retention records showed stable occlusion and improved facial profile with normal breathing and sleep.

Bone-anchored maxillary protraction (BAMP): A review

INTRODUCTION:

Protraction therapy for maxillary deficiency in the treatment of skeletal class III malocclusion involves the use of facemask. Conventionally facemask has been anchored to the maxillary dentition, which is responsible for some of the counter-productive effects of facemask therapy including backward and downward rotation of the chin, increase in the lower anterior facial height, proclination of maxillary incisors, retroclination of mandibular incisors apart from mesialization of maxillary molars with extrusion and decreased overbite.

AIM:

The aim of this article is to highlight the nuances of Bone-Anchored Maxillary Protraction (BAMP) including a literature review, which is comprehensive and narrative and comparing the different techniques involved such as type 1 BAMP versus type 2 BAMP and BAMP versus facemask.

MATERIALS AND METHODS:

A computerized search was performed in electronic databases such as PubMed, PubMed Central, Cochrane, Embase, DOAJ, and Google scholar using key words such as “bone-anchored maxillary protraction” and “BAMP.” The search was confined to articles in English published till March 2021. Forty-seven case-controlled, cross-sectional, retrospective and prospective studies, as well as systematic reviews and meta-analysis were included in this article, which were limited to human subjects. A hand search of the reference lists of the included articles was also carried out to include missed out articles.

CONCLUSION:

To overcome these drawbacks, BAMP was introduced, which causes both maxillary protraction, restraint of mandibular growth with minimal dentoalveolar changes. BAMP is used widely nowadays in the treatment of skeletal class III malocclusion.

Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions

OBJECTIVE

This study sought to evaluate the effects of different maxillary protraction methods on the pharyngeal airway in Class III patients with maxillary retrognathia.

SETTING AND SAMPLE POPULATION

A total of 59 individuals (31 females and 28 males) with a mean age of 11.38 ± 1.24 years were included in this study.

MATERIAL AND METHODS

Fifty-nine treated maxillary retrognathic patients who underwent different protraction methods were evaluated. Twenty patients treated with RME (Rapid Maxillary Expansion) made up the first group, and 20 patients treated with 5-week Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) protocol comprised the second group. Lastly, 19 patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Sixteen linear and four areal pharyngeal airway measurements were made on lateral cephalograms before and after treatment. Differences between the groups were assessed using analysis of variance (ANOVA) tests.

RESULTS

The mean maxillary protraction levels were determined as 2.7, 3.69 and 4.01 mm in the RME, Alt-RAMEC and SA groups, respectively. In the nasopharynx, AD1-PNS, AD2-PNS, PNS-Ba and PNS-Ho measurements revealed a significant increase in the SA group compared to the other groups (P < .05). In the oropharynx, PNS-Ep measurement increased significantly in the RME group (P < .05). In the total pharyngeal airway area, an increase was detected in the SA, Alt-RAMEC, and RME groups.

CONCLUSION

The most effective protraction method in terms of pharyngeal airway dimensions, especially in the nasopharynx, is the application of the face mask with skeletal anchorage. A greater increase in vertical airway length (PNS-Ep) was observed with RME.

Patterns of adenoid and tonsil growth in Japanese children and adolescents: A longitudinal study

Lymphoid tissues, such as adenoids (Ad) and tonsils (Tn), are suggested to undergo hypertrophy during childhood and involution in adulthood. Enlargement of Ad and Tn can cause transient obstruction of the respiratory airways, thus inducing obstructive sleep apnoea. To date, the standard Ad and Tn sizes have not been reported, and there are no explicit objective criteria for evaluating their sizes or deducing whether they have enlarged, reduced, or remained constant over time. Our previous cross-sectional study revealed the age-dependent airway occupation ratio of Ad and Tn in Japanese individuals. We conducted a longitudinal observational study of the Ad and Tn sizes in Japanese individuals aged 6–20 years. Ninety individuals were retrospectively enrolled. The average and standard deviation of the sizes was calculated in 5 age-based groups.