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Background: Maxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask. Methods: Cephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05. Results: The cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%. Conclusions: Both treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed overall quality of life (QoL) over time in youth with cleft lip and palate (CLP) undergoing maxillary protraction treatment or orthognathic surgery for class III malocclusion to identify any differences in QoL based on treatment group and outcome success. Materials and Methods: A prospective longitudinal cohort study was conducted in two pediatric hospitals. The Short Form Health Survey (SF‐12) measured physical and mental QoL prior to treatment, at maximal correction, at treatment completion, and at 1‐year post treatment. Analyses included one‐sample, two‐sample, and paired t‐tests and analyses of variance and covariance. Results: Participants (N = 91) either completed protraction (n = 53) at age 11–14 or surgery (n = 38) at age 16–21. Participants were mostly Latinx (67%) males (55%) born with unilateral CLP (81%) and there were no demographic differences between the two groups other than age. The total sample's QoL was in the average range and significantly higher than national norms. No significant differences were found in QoL‐based outcome success; however, the protraction group showed a gradual physical QoL improvement over time, while the surgery group experienced a temporary drop in physical QoL postoperatively. At treatment completion, higher physical QoL was associated with higher socioeconomic status. At a year post treatment, mental QoL was significantly higher for males. Conclusion: Both protraction and surgery appear to be acceptable treatment options in terms of overall QoL for youth with CLP. While treatment success did not impact QoL, there were some differences in physical QoL coinciding with the treatment phase as well as individual factors. [ABSTRACT FROM AUTHOR]

Abstract Background Maxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask. Methods Cephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p

Objective·To analyze the anatomical and macroscopic characteristics of the pterygopalatine suture (PPS) in Chinese population using cone-beam computed tomography (CBCT) technology, and to preliminarily investigate its developmental pattern and its association with the correction of maxillary underdevelopment.Methods·A total of 134 CBCT images, taken from July to August 2023 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, were categorized into six age groups. The PPS landmarks were utilized to determine the overall transverse position (XPPS), sagittal position (YPPS), insertion angle (IAP), insertion width of the pyramidal process (IWP), and insertion depth of the pyramidal process (IDP). The pterygomaxillary junction was identified through multiplanar observations. Regression analysis was performed to assess the correlation of these parameters with age and gender, and pairwise comparisons were made to determine the stable age range for parameter changes. Paired t-tests and paired chi-squared tests were conducted to analyze the bilateral parameter differences.Results·Results showed that YPPS and IDP did not exhibit significant correlation with age, whereas XPPS, IAP, IWP, and the incidence of pterygomaxillary fusion were significantly positively correlated with age (P

Cleft lip and palate is a common congenital developmental defect, which is mainly manifested as congenital oral and maxillofacial malformations. In patients with cleft lip and palate, jaw deformity often involves three-dimensional orientation, among which the correction of sagittal dysmorphism is the key point and difficulty in its diagnosis and treatment. In this article, we will elaborate on the indications and corrective methods for the treatment of maxillary retraction of cleft lip and palate, and introduce our experience in the sequential treatment of cleft lip and palate maxillary retraction in order to promote the standardization of its diagnosis and treatment.

Objective • To analyze the anatomical and macroscopic characteristics of the pterygopalatine suture (PPS) in Chinese population using cone-beam computed tomography (CBCT) technology, and to preliminarily investigate its developmental pattern and its association with the correction of maxillary underdevelopment. Methods • A total of 134 CBCT images, taken from July to August 2023 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, were categorized into six age groups. The PPS landmarks were utilized to determine the overall transverse position (XPPS), sagittal position (YPPS), insertion angle (IAP), insertion width of the pyramidal process (IWP), and insertion depth of the pyramidal process (IDP). The pterygomaxillary junction was identified through multiplanar observations. Regression analysis was performed to assess the correlation of these parameters with age and gender, and pairwise comparisons were made to determine the stable age range for parameter changes. Paired t-tests and paired chi-squared tests were conducted to analyze the bilateral parameter differences. Results • Results showed that YPPS and IDP did not exhibit significant correlation with age, whereas XPPS, IAP, IWP, and the incidence of pterygomaxillary fusion were significantly positively correlated with age (P<0.01). Gender differences were only significant for XPPS, with males demonstrating greater values than females (P<0.01). Analysis of age-related trends indicated significant differences in XPPS between group 1 (6 yearsWage<9 years) and group 2 (9 yearsWage<12 years) (female: F=0.006, male: F=0.004); significant differences in IAP were observed between group 2 and group 3 (12 years Wage<15 years)孑=0.042), with 98.5% of samples having an IAP greater than 45 degrees; IWP differences were significant between group 1 and group 3 (P=0.016), and the pterygomaxillary fusion incidence was significantly different among group 1, 2, and 3 (group 1 vs. 2: P<0.001, group 2 vs 3: P=0.037, group 1 vs 3: P<0.001), with an incidence rate exceeding 90% in adults. No significant bilateral differences were found for all parameters. Conclusion • No significant changes were observed in YPPS and IDP after the age of 6, indicating a trend towards fusion of the maxilla with the pterygoid process. The overall transverse position of the PPS tends to stabilize around 12 years of age, while the IAP and IWP continue to increase and reach stability around 15 years of age,with a sagittal insertion orientation of the pyramidal process into the pterygoid notch. [ABSTRACT FROM AUTHOR]

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.

Background: Four different designs of mini-implant-assisted rapid palatal expansion (MARPE) and protraction in nasomaxillary complex and mid-palatal sutures in late adolescent skeletal Class III malocclusion were compared using a three-dimensional finite element analysis. Methods: A finite element model of skull and related sutures was constructed using the computed tomography scan of a 16-year-old female patient with skeletal Class III and ANB of −2°. Four appliance designs: Type I: MARPE with palatal force, Type II: MARPE with buccal force, Type III: Hybrid hyrax with palatal force, and Type IV: Hybrid hyrax with buccal force. Protraction vectors were and analyzed using Ansys software (ANSYS 2021 R2). The displacement pattern of the nasomaxillary structures and the stress distribution in the sutures were examined in all four appliance designs. Results: All the appliance designs resulted in a forward movement of the maxilla, while Type I and III, which used palatal protraction force, caused the greatest forward displacement. In Type I, II, and III, along with forward movement, a clockwise rotation of maxilla was observed, while in Type IV, an anticlockwise rotation of maxilla was observed. Type I, II, and III resulted in higher stress distribution around the superior structures, while Type IV resulted in less stress distribution around the superior structures of maxilla. Conclusion: The forward displacement was enhanced when palatal plates were used to protract the maxilla. The effective appliance design for skeletal class III with open bite case was Type I, II, and III and Type IV for deep bite cases.

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.

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. 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. 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]. 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. [ABSTRACT FROM AUTHOR]

Background: Four different designs of mini-implant-assisted rapid palatal expansion (MARPE) and protraction in nasomaxillary complex and mid-palatal sutures in late adolescent skeletal Class III malocclusion were compared using a three-dimensional finite element analysis. Methods: A finite element model of skull and related sutures was constructed using the computed tomography scan of a 16-year-old female patient with skeletal Class III and ANB of -2°. Four appliance designs: Type I: MARPE with palatal force, Type II: MARPE with buccal force, Type III: Hybrid hyrax with palatal force, and Type IV: Hybrid hyrax with buccal force. Protraction vectors were and analyzed using Ansys software (ANSYS 2021 R2). The displacement pattern of the nasomaxillary structures and the stress distribution in the sutures were examined in all four appliance designs. Results: All the appliance designs resulted in a forward movement of the maxilla, while Type I and III, which used palatal protraction force, caused the greatest forward displacement. In Type I, II, and III, along with forward movement, a clockwise rotation of maxilla was observed, while in Type IV, an anticlockwise rotation of maxilla was observed. Type I, II, and III resulted in higher stress distribution around the superior structures, while Type IV resulted in less stress distribution around the superior structures of maxilla. Conclusion: The forward displacement was enhanced when palatal plates were used to protract the maxilla. The effective appliance design for skeletal class III with open bite case was Type I, II, and III and Type IV for deep bite cases. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Abstract Objective The objective of the study is to evaluate the skeletal, dentoalveolar and soft tissue changes before and after treatment with Alt-RAMEC protocol and protraction headgear in comparison to the controls. Material and methods A quasi experimental study was conducted in the orthodontic department on 60 patients of cleft lip and palate. These patients were divided into two groups. Group I was the Alt-RAMEC group that underwent Alt-RAMEC protocol followed by facemask therapy while group II was the control group that underwent RME and facemask therapy. Total treatment time in both the groups was approximately 6 to 7 months. Mean and standard deviation was calculated for all the quantitative variables. Pre and post treatment changes between treatment and control groups were made using paired t-test. Intergroup comparison between treatment and control group was analyzed using independent t-test. Significance for all tests was predetermined at a P-value of ≤ 0.05. Results The Alt-RAMEC group showed significant forward movement of maxilla and improvement in the maxillary base. A remarkable improvement in SNA was seen. The overall outcome was better maxillo-mandibular relationship as shown by positive ANB values and angle of convexity. More effect on maxilla and least effect on mandible was notified with Alt-RAMEC protocol and facemask therapy. Improvement in transverse relationship was also evident in the Alt-RAMEC group. Conclusion Alt-RAMEC protocol in combination with protraction headgear is a better alternative to treat cleft lip and palate patients in comparison to the conventional protocol.

AbstractThe airflow behaviour and particle deposition before and after the maxillary expansion are evaluated using the computational fluid dynamics method. A pediatric patient was subjected to maxillary expansion and the CT scans of pre and post were recorded. The procured CT scans were developed into 3D models using Materialise MIMICS 21.0 (Materialise, Ann Arbor, MI). The analysis was performed using ANSYS FLUENT 2020 R2 with three different flow rates defined at the nostril inlet as 5, 10, and 15 LPM. The surface area and nasal volume increased by 5.1% and 16.5%, respectively, for the post-maxillary expansion case. The velocity profiles show a maximum value at the nasal valve regions followed by a decreased velocity in the mid-nasal region with an 85% lower velocity observed at the nasal valve for the post-maxillary expansion case. The nasal resistance and pressure drop decrease by 46% to 66% in post-maxillary expansion cases. The maximum WSS at the nasal valve region is observed which is reduced by around 47% for post-maxillary expansion cases. Particle deposition studies show a reduction in particle depositions in post cases indicating a greater number of inhaled particles reaching the lungs. The pressure drop and the nasal resistance values were reduced by more than 50% for post-maxillary expansion. The particle deposition studies show increased depositions at higher flow rates for both cases.

BACKGROUND: Previous studies have shown that there are significant differences in occlusal and maxillofacial changes in patients with skeletal class III malocclusion of different ages after maxillary protraction treatment. However, the difference of temporomandibular joint changes in patients with different ages remains unknown. OBJECTIVE: To study the influence of age on the changes of the temporomandibular joint after maxillary protraction treatment of skeletal class III malocclusion. METHODS: Fifty-eight children with skeletal class III malocclusion aged 8-14 years were divided into two groups. Twenty-nine children aged 8-11 years were diagnosed with late mixed dentitions. Twenty-nine children aged 12-14 years were diagnosed with early permanent dentitions. X-ray lateral cephalograms were taken pre- and post-treatment, and cephalometric analysis of occlusal and maxillofacial regions and quantitative analysis of temporomandibular joint position in the coordinate system were carried out. Paired t-test was used for intragroup comparison. Independent t-test was used for intergroup comparison. Pearson correlation analysis was used to analyze the correlation between occlusal and maxillofacial changes and temporomandibular joint changes. RESULTS AND CONCLUSION: The occlusal and maxillofacial structure and the temporomandibular joint changed significantly in the two groups after treatment. In the sagittal direction of the occlusal and maxillofacial structure, subspinale-nasion-supramental angle (ANB) in the 8-11-year-old group increased by 4.76°, and nasion-subspinale line and pogonion-subspinale line angle (NA-PA) increased by 9.02°, which was significantly larger than those in the 12-14-year-old group (3.97° and 6.88°) (P < 0.05). In the vertical direction, the mandible plane and sella-nasion line angle (MP-SN) and Frankle plane and sella-nasion line angle (FH-MP) in the 8-11-year-old group increased by 1.92° and 3.02° respectively, which was significantly higher than those in the 12-14-year-old group (1.02° and 0.78°) (P < 0.05). There were significant changes in the temporomandibular joint between the two age groups. Fossa summit on the X axis (S-Fsx) in the 8-11-year-old group moved backward more significantly than that in the 12-14-year-old group. Fossa posterior on the X axis (S-Fpx) in the 8-11-year-old group moved backward, while that in the 12-14-year-old group moved forward. Condyle anterior (S-Cix) and condyle tangent on the X axis (S-T4x) in the two groups both moved backward, which were more significant in the 8-11-year-old group than the 12-14-year-old group. The changes of the temporomandibular joint were correlated with the changes of the occlusal and maxillofacial structure. In the 8-11-year-old group, there was a negative correlation between S-Fpx and sella-nasion-supramental angle (SNB), nasion-pogonion line and Frankle plane angle (NP-FH) (P < 0.05, r=-0.489; P < 0.05, r=-0.424). In the 12-14-year-old group, S-Fpx was positively correlated with the distance from the upper incisor to the nasion-subspinale line (U1-NAmm) (P < 0.01, r=0.439). In the 8-11-year-old group, S-Cix, S-T4x and the condyle superior on the X axis (S-Cox) were negatively correlated with SNB, NP-FH and MP-SN. To conclude, age has obvious effects on the changes of the temporomandibular joint in skeletal class III malocclusion following maxillary protraction. In the 8-11-year-old group, articular fossa and condyle moved backward obviously, fossa anterior moved up, and the posterior joint space increased. In the 12-14-year-old group, the fossa posterior moved forward and the condyle anterior moved down, but the joint space did not change. There are different occlusal and maxillofacial factors affecting temporomandibular joint changes at different ages. [ABSTRACT FROM AUTHOR]

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

Copyright of Knowledge: International Journal is the property of Institute for Knowledge Management and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The objective of the study is to evaluate the skeletal, dentoalveolar and soft tissue changes before and after treatment with Alt-RAMEC protocol and protraction headgear in comparison to the controls. Material and methods: A quasi experimental study was conducted in the orthodontic department on 60 patients of cleft lip and palate. These patients were divided into two groups. Group I was the Alt-RAMEC group that underwent Alt-RAMEC protocol followed by facemask therapy while group II was the control group that underwent RME and facemask therapy. Total treatment time in both the groups was approximately 6 to 7 months. Mean and standard deviation was calculated for all the quantitative variables. Pre and post treatment changes between treatment and control groups were made using paired t-test. Intergroup comparison between treatment and control group was analyzed using independent t-test. Significance for all tests was predetermined at a P-value of ≤ 0.05. Results: The Alt-RAMEC group showed significant forward movement of maxilla and improvement in the maxillary base. A remarkable improvement in SNA was seen. The overall outcome was better maxillo-mandibular relationship as shown by positive ANB values and angle of convexity. More effect on maxilla and least effect on mandible was notified with Alt-RAMEC protocol and facemask therapy. Improvement in transverse relationship was also evident in the Alt-RAMEC group. Conclusion: Alt-RAMEC protocol in combination with protraction headgear is a better alternative to treat cleft lip and palate patients in comparison to the conventional protocol. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements. A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Maxillary protraction treatment can effectively change the craniofacial structural relationship and the temporomandibular joint structure of children with skeletal Class III malocclusion. However, there are no definitive findings regarding the correlation between changes in the temporomandibular joint and craniomaxillofacial changes after maxillary protraction. OBJECTIVE: To analyze the correlation between dentofacial changes and temporomandibular joint changes in children with skeletal class III malocclusion before and after maxillary protraction and to investigate the effect of maxillary protraction on the temporomandibular joint of children. METHODS: A total of 29 children with skeletal class III malocclusion, including 16 boys and 13 girls, aged 8-11 years, were treated by maxillary protraction. The changes of dentofacial and temporomandibular joint were subjected to cephalometric analysis and coordinate system positioning measurement. Paired t-test, Mann-Whitney test and Pearson correlation analysis were conducted. RESULTS AND CONCLUSION: The sagittal relationship of the jaw changed obviously before and after maxillary protraction. The glenoid fossa and condyle changed significantly in the X axis but not in the Y axis. The posterior space of the temporomandibular joint was significantly reduced. Correlation analysis revealed a moderate correlation between the temporomandibular joint and dentofacial structural changes. To conclude, after maxillary protraction, both dentofacial and temporomandibular joint structures have significant changes, and there is a moderate correlation between temporomandibular joint remodeling and dentofacial changes, but no close correlation exists between them. [ABSTRACT FROM AUTHOR]

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.

The airflow behaviour and particle deposition before and after the maxillary expansion are evaluated using the computational fluid dynamics method. A pediatric patient was subjected to maxillary expansion and the CT scans of pre and post were recorded. The procured CT scans were developed into 3D models using Materialise MIMICS 21.0 (Materialise, Ann Arbor, MI). The analysis was performed using ANSYS FLUENT 2020 R2 with three different flow rates defined at the nostril inlet as 5, 10, and 15 LPM. The surface area and nasal volume increased by 5.1% and 16.5%, respectively, for the post-maxillary expansion case. The velocity profiles show a maximum value at the nasal valve regions followed by a decreased velocity in the mid-nasal region with an 85% lower velocity observed at the nasal valve for the post-maxillary expansion case. The nasal resistance and pressure drop decrease by 46% to 66% in post-maxillary expansion cases. The maximum WSS at the nasal valve region is observed which is reduced by around 47% for postmaxillary expansion cases. Particle deposition studies show a reduction in particle depositions in post cases indicating a greater number of inhaled particles reaching the lungs. The pressure drop and the nasal resistance values were reduced by more than 50% for post-maxillary expansion. The particle deposition studies show increased depositions at higher flow rates for both cases. [ABSTRACT FROM AUTHOR]

Objective:The enhanced effect of maxillary protraction following the Alternate Rapid Maxillary Expansion-Constriction/Reverse Headgear (AltRAMEC/RH) protocol over the Rapid Maxillary Expansion/Reverse Headgear (RME/RH) protocol has been well documented. However, it is not known if the airway dimensions also follow a similar enhancement. This retrospective cohort study therefore aims to compare dimensional changes in the pharyngeal airway after maxillary protraction following RME/RH, versus AltRAMEC/RH.Methods: Pre- and post-treatment lateral cephalograms of 46 skeletal Class III patients with maxillary retrusion, who had undergone maxillary protraction using the AltRAMEC/RH or RME/RH protocol were compared for 20 dentoskeletal and airway variables. The waiting period of 6-8 months before initiating treatment served as the control period. The results were statistically evaluated using the paired t-test, the independent t-test, and the intraclass correlation coefficient.Results: The nasopharyngeal airway indicators in the AltRAMEC/RH group (PNS-ad1, PNS-ad2, UPD) showed a statistically significant mean increase of 2.09 mm, 2.74 mm, and 1.30 mm respectively. This was significantly more pronounced than the RME/RH group (P < .001). The control period did not show any significant change, thus showing the negligible effect of growth on the airway dimension. No significant changes were observed in the oropharyngeal airway indicators for both groups (P > .001).Conclusions: The AltRAMEC/RH protocol produced more significant improvement in the nasopharyngeal airway dimensions as compared to the RME/RH protocol. The changes in the oropharyngeal airway were insignificant with both the protocols.

Introduction: Although correction of maxillary hypoplasia could be challenging for orthodontists, its effectiveness has been demonstrated by several studies that prescribed orthopaedic protraction of the upper jaw before puberty. Positive results have also been reported especially after the alternating expansion and constriction (Alternating Rapid Maxillary Expansion and Constriction, Alt-RAMEC) of the maxilla. Our aim was to investigate how the use of the Alt-RAMEC protocol prior to facemask therapy enhances the protraction the upper jaw. Method: Twenty pre-pubertal patients’ lateral cephalograms taken before and after treatment were evaluated. Patients with retrognathic maxilla were included in the study and they were treated with Hyrax and facemask according to the Alt- RAMEC protocol. Treatment efficacy was assessed by measuring the SNA, SNB, ANB angles, the Wits appraisal, ML-NL angle, and overjet (OJ). Results: SNA: +1,41° (SD 1,09), SNB: –0,67° (SD 2,0), ANB: +2,06° (SD 1,85), Wits: +3,50 mm (SD 2,30), NL-ML: +0,93° (SD 1,98), OJ: +3,83 mm (SD 1,85). Conclusions: During the prepubertal period, maxillary protraction with facemask after performing the Alt-RAMEC protocol promotes the maxillary growth and varies the lower facial height.

Objectives: This systematic review and meta‐analysis aimed to evaluate the effectiveness of using maxillary protraction during different stages of the dentition by assessing changes in the jaws and inclination of incisors. Materials and methods: MEDLINE (PubMed), Embase, Cochrane, Web Of Science, China National Knowledge Infrastructure and Wanfang Databases were searched without time limitations up to 15 January 2022. Google Scholar was used to search grey literature. We included cohort studies that compared the effect of maxillary protraction by analysing primary outcomes and were grouped in age‐related conditions. Mean differences and 95% confidence intervals were used for statistical analysis, followed by Grading of Recommendations Assessment, Development and Evaluation analysis. Results: Six studies were finally included. The heterogeneity test showed P ≥.1 and I2 ≤ 50%, and a fixed‐effect model was applied. Patients in the early treatment group (ETG) were mainly in the early‐mixed dentition stage, while patients in the late treatment group (LTG) were in the late‐mixed and early‐permanent dentition stage. Meta‐analysis showed that there were no statistical differences (P >.05) between the ETG and LTG groups in terms of SNA (the angle composed by point Sella‐Nasion‐Subspinale), SNB (the angle composed by point Sella‐Nasion‐Supramentale), ANB (the angle composed by point Subspinale‐Nasion‐Supramentale), Wits, U1/SN (the angle composed by the axis of upper incisors and Sella‐Nasion plane) and L1/MP (the angle composed by the axis of lower incisors and the mandibular plane). Conclusion: Our analysis showed that maxillary protraction applied in the late‐mixed or early‐permanent dentition stage did not cause different effects on the maxillary growth, the correction of the intermaxillary relationship, the inhibition of mandibular growth and dental tipping of skeletal class III patients when compared to that in the early‐mixed dentition stage. Collectively, these data provide a theoretical basis for widening the applicable age period of maxillary protraction and choosing the best treatment opportunity for children patients after a comprehensive assessment. [ABSTRACT FROM AUTHOR]

To investigate the optimal timing of maxillary protraction in children with Class III malocclusion to aid comprehension of this still non-consensual topic. In all, the data of 97 children with Class III malocclusion treated by using the Delaire facemask with maxillary expansion were collected retrospectively and divided into three groups according to their dentition stages; those subjects in the mixed dentition group were further divided into three subgroups. All patients were regrouped by the cervical vertebral maturation index (CVMI) and observed closely by cephalograms at the beginning of treatment (T0) and after facemask removal (T1). Comparisons between subgroups, within groups, and the final evaluation of the increment of maxillary length were performed by different statistical methods. Similar favorable maxillary traction effects were achieved in all stages. Intragroup comparisons showed changes without significance in aspect ratio during the mixed dentition stage, while there was a significant decrease during the deciduous and permanent dentition stages. The largest increment of maxillary length was obtained when the maxillary protraction began at Cervical Stage (CS)2. However, no significant difference was found in all skeletal measurements among the three groups (deciduous, mixed and permanent dentition stages) and the three subgroups with mixed dentition. The univariable linear regression analysis also showed that CVMI and dentition stage at T1 did not have a significant impact on the increment of maxillary length. In our center, Class III malocclusion patients treated with the Delaire facemask achieved similar skeletal changes in short term, when they began the treatment at different dentition stages or CVMI stages. Starting the maxillary protraction at CS2 was likely a reliable choice for those who desired more maxillary advancement., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Class III malocclusion due to a retrognathic maxilla is common in patients with cleft lip and palate. Skeletally anchored maxillary protraction using screw-anchored mini-plates combined with intraoral elastics has shown promising results in achieving orthopedic changes and maintaining the outcome until the completion of the growth. This case report presents the course of treatment in a patient with unilateral cleft lip and palate and multiple congenitally missing teeth treated with bone-anchored maxillary protraction until the end of growth. Four mini-plates (Bollard plates) were used during comprehensive fixed orthodontic treatment to protract the dentition and close the space where teeth were missing, extrude the canine, and force eruption of the second premolar using extension arms and cantilevers. A 2-year follow-up at age 17 showed stable occlusion and maintenance of soft tissue results. Bone-anchored maxillary protraction treatment in a patient with cleft lip and palate demonstrates proper orthopedic results and could be a viable alternative to orthognathic surgery., (© 0000 by The EH Angle Education and Research Foundation, Inc.)

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.

Aim and Objective: The aim of this study was to evaluate the effect of maxillary protraction on airway dimensions in growing patients. Materials and Methods: The research was conducted using literature reviews. Articles included in databases such as PubMed, Embase, Google Scholar and Cochrane were reviewed via inputting keywords such as maxillary protraction, maxilla retrusion, retrognathic, class III malocclusion, face mask, reverse head gear, Delaire, protraction head gear, reverse occlusion, anterior crossbite, growing patient, bone anchorage, dental anchorage. The search period for articles ranged from January 2005 to April 2021. Results: 7 articles with inclusion criteria were included in the study; the results of the studies showed the effectiveness of maxillary protraction on increasing the dimensions of the airway. Studies have shown a significant increase in the size of the upper airway, especially the nasopharynx, following maxillary protraction with tooth-borne and bone-borne appliances. Conclusion: Maxillary protraction can increase the size of the upper airway in growing patients. However, further studies are needed to elucidate the effects on changes in the pharyngeal airway, respiratory indicators (such as the apnea-hypopnea index), and its long-term effects. Keywords: Maxillary protraction; Maxilla retrusion; Retrognathic; Class III malocclusion; Face mask; Reverse head gear; Delaire; Protraction head gear; Reverse occlusion; Anterior crossbite; growing patient; Bone anchorage; Dental anchorage.

Objective: The enhanced effect of maxillary protraction following the Alternate Rapid Maxillary Expansion-Constriction/Reverse Headgear (AltRAMEC/RH) protocol over the Rapid Maxillary Expansion/Reverse Headgear (RME/RH) protocol has been well documented. However, it is not known if the airway dimensions also follow a similar enhancement. This retrospective cohort study therefore aims to compare dimensional changes in the pharyngeal airway after maxillary protraction following RME/RH, versus AltRAMEC/RH. Methods: Pre- and post-treatment lateral cephalograms of 46 skeletal Class III patients with maxillary retrusion, who had undergone maxillary protraction using the AltRAMEC/RH or RME/RH protocol were compared for 20 dentoskeletal and airway variables. The waiting period of 6-8 months before initiating treatment served as the control period. The results were statistically evaluated using the paired t-test, the independent t-test, and the intraclass correlation coefficient. Results: The nasopharyngeal airway indicators in the AltRAMEC/RH group (PNS-ad1, PNS-ad2, UPD) showed a statistically significant mean increase of 2.09 mm, 2.74 mm, and 1.30 mm respectively. This was significantly more pronounced than the RME/RH group (P < .001). The control period did not show any significant change, thus showing the negligible effect of growth on the airway dimension. No significant changes were observed in the oropharyngeal airway indicators for both groups (P > .001). Conclusions: The AltRAMEC/RH protocol produced more significant improvement in the nasopharyngeal airway dimensions as compared to the RME/RH protocol. The changes in the oropharyngeal airway were insignificant with both the protocols. [ABSTRACT FROM AUTHOR]

Copyright of Fogorvosi Szemle is the property of Hungarian Dental Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Objective: Evaluate the effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol on patients with unilateral cleft lip and palate (UCLP) along with maxillary protraction using cone beam computed tomography (CBCT) records and a finite element modeling (FEM) model. Materials and Methods: Twenty-five patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective single-arm cohort study after obtaining necessary informed consent. A 9-week Alt-RAMEC protocol using a custom-made fan-shaped expansion screw was initiated, which was followed by 6-month facemask wear. Pre (T1) and posttreatment (T2) records including CBCT were taken and were evaluated for treatment changes in all 3 dimensions using paired t test. Additionally, a FEM model (ANSYS 15.0) using the Alt-RAMEC protocol was also analyzed for the displacement and stress on various craniofacial structures. Results: Significant forward movement of the maxilla along with clockwise rotation of mandible along with statistically significant increase in lower molar height and upper incisor proclination (P <.05) was observed. CBCT evaluation showed a statistical significant decrease in buccal alveolar bone thickness and increase in molar inclination (P <.05). Finite element modeling analysis highlighted that the maximum displacement occurred at the anterior region with stresses radiating till the anterior nasal spine, zygomatic arch, and sphenoid bone. Conclusion: Alt- RAMEC protocol combined with facemask protraction can lead to significant maxillary advancement, with some transient decrease in buccal bone thickness noted thereby warranting long-term studies to further assess its effect on the dentofacial apparatus. [ABSTRACT FROM AUTHOR]

Background: Melanotic neuroectodermal tumor of infancy (MNTI) is a very rare tumor, and case reports of orthodontic treatment for patients with MNTI may be previously unreported. This article describes the orthodontic treatment for a 7-year-old girl with MNTI in the mandible. Case: Her chief complaint was anterior crossbite. Although she had an MNTI diagnosis at the age of 8 months, it remained subclinical. Therefore, she has been regularly followed-up by computed tomography (CT) and magnetic resonance (MR) imaging without aggressive treatment. We had worried about the stimulation of MNTI on the mandible by changing her occlusal position with orthodontic treatment. Therefore, we sufficiently explained to her and her family that orthodontic treatment was at risk for worsening MNTI. However, they desired treatment that consisted of maxillary protraction and slow expansion to correct anterior crossbite and encourage the permanent tooth eruption. After 19 months of active orthodontic treatment, the anterior crossbite was improved, and the eruption of permanent teeth made good progress. No evidence of progression and exacerbation of MNTI has been found by both CT and MR imaging. As the observation period is still short, we need a careful and long-term follow-up of her occlusion and MNTI. Furthermore, when we encounter rare cases without previous experience and reports, informed consent was of particular importance. [ABSTRACT FROM AUTHOR]

Objective: To assess the oral health status and microbiota of subgingival plaque in patients with surgically repaired cleft lip and palate (CLP) during orthodontic treatment for maxillary protraction with two different orthodontic appliances., Design: Randomized controlled trial., Setting: Institutional., Participants: A total of 90 patients with surgically repaired Unilateral Cleft Lip and Palate, out of initially enrolled 120 patients, were divided into 3 groups: experimental group I, experimental group II and control group, with 30 subjects each. Patients with a history of oral prophylaxis in last 6 months or antibiotic therapy within 3 months were excluded from the study., Interventions: Bone Anchored Maxillary Protraction was done in experimental group I, while facemask with acrylic occlusal splint was used for maxillary protraction in experimental group II and no orthodontic intervention in control group., Mean Outcome Measures: Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), Probing Depth (PD), and microbiota of subgingival plaque ( P. gingivalis , P. intermedia , Veillonella and Capnocytophaga ) were compared at baseline (T 0 ) and after 8 months (T 1 )., Results: The PI, GI, GBI and PD were observed to be significantly higher in experimental group II followed by experimental group I as compared to control group at 8 months interval ( P  < .001). The microbiota counts increased significantly in experimental group II and experimental group I ( P  < .001), as compared to control group., Conclusion: Maxillary protraction with facemask and bone plates was found to be a better alternative than facemask with occlusal splint, considering the overall oral health of patients with CLP., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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. [ABSTRACT FROM AUTHOR]

Cleft lip and palate is a congenital defect that affects the oral cavity. Depending on its severity, alveolar graft surgery and maxillary orthopedic therapies must be carried out as a part of the treatment. It is widely accepted that the therapies should be performed before grafting. Nevertheless, some authors have suggested that mechanical stimuli such as those from the maxillary therapies could improve the success rate of the graft. The aim of this study is to computationally determine the effect of maxillary therapies loads on the biomechanical response of an alveolar graft with different degrees of ossification. We also explore how the transverse width of the cleft affects the graft behavior and compare results with a non-cleft skull. Results suggest that stresses increase within the graft as it ossifies and are greater if maxillary expansion therapy is applied. This has consequences in the bone remodeling processes that are necessary for the graft osseointegration. Maxillary orthopedic therapies after graft surgery could be considered as a part of the treatment since they seem to act as a positive extra stimulus that can benefit the graft. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Copyright of Revista Estomatología is the property of Universidad del Valle and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Maxillary protraction with facemask (FM) is an orthopedic approach for treatment of Class III growing patients. Aim of the present investigation was to analyze tension loads produced by two different facial mask (FM) designs on facial skin of subject with skeletal Class III. Methods A three-dimensional (3D) geometry of Delaire and Petit FM models were reconstructed from the original Computer Aided Design (CAD) 3D prototype using software package (ANSYS 5.7). A traction load of 9.8 N inclined of 30° to the occlusal plane was applied combining analytical FM models with a 3D facial model. Resulting stresses and deformations on the skin layer were tested through the von Mises yield criterion. Results Overall tensions were mostly developed on the chin area, while lower stresses were observed on forehead area for both FM designs. When Delaire FM model was tested, maximum stresses were observed on the upper border of the chin cup corresponding to the inferior lip and to marginal gingiva of lower incisors. After Petit FM application, maximum stresses were more extensively localized at the level of both upper border and central area of the chin. Stresses measured on the chin area were significantly higher with Petit FM when compared with Delaire FM (44 KPa versus 29 KPa, respectively). Conclusions Delaire FM determined lower stresses and tensile tensions than Petit FM model. Highest tensions were observed at the level of chin cup area for both Delaire and Petit FM. Stresses following Delaire FM application were mostly observed on the upper border of the chin cup, while Petit FM determined stresses more extensively distributed to the central area of the chin.

BACKGROUND: For skeletal Class III malocclusions, the positional relationship between the upper and lower jaws and abnormal occlusion can impact the shape of the condyle and the glenoid fossa, as well as the movement of the mandible and the function of the masticatory muscles. Maxillary protraction appliances are one of the effective methods for the treatment of skeletal Class III malocclusion in adolescents, which can reconstruct the positional relationship of the jaws and improve the glenoid fossa-disc-protrusion relationship in patients with skeletal Class III malocclusion. OBJECTIVE: To evaluate the temporomandibular joint changes in adolescents with skeletal Class III malocclusions treated with maxillary protraction. METHODS: Twenty-nine patients (11 girls and 18 boys; age range from 12-14, with a mean age of (12.90±0.99) years were treated with maxillary protraction. Lateral cephalograms were taken before and after treatment. A coordinate system was set to quantitatively analyze the changes of temporomandibular joint fossa, condyle and temporomandibular joint spaces in sagittal and vertical directions. RESULTS AND CONCLUSION: After maxillary protraction, no displacement of the gleniod fossa and the condyle in the sagittal direction was observed (P > 0.05). Simultaneously, in the vertical direction, there was no significant displacement of the gleniod fossa as well as no posterior and superior condyle displacement (P > 0.05). However, the anterior condyle moved upward (P < 0.05). No significant changes in the anterior, superior and posterior space of the temporomandibular joint were observed (P > 0.05). These findings indicate that maxillary protraction treatment can adaptively remodel the temporomandibular joint in adolescents with skeletal Class III malocclusion will undergo adaptive remodeling, but will not adversely affect the function of the temporomandibular joint due to the unchanged joint space. [ABSTRACT FROM AUTHOR]

Objectives: Greater advancement of the maxilla can be achieved with skeletal-anchored facemasks (SAFM) using miniplates than with conventional tooth-borne facemasks (TBFM). The purpose of this study was to compare the effects of TBFM and SAFM on midfacial soft tissue and nasal bone up to two years after treatment.Settings and Sample Population: Sixty-seven growing patients with Class III malocclusions were treated with facemasks. They were divided into a SAFM group with 31 subjects (average age 11.1 years) and a TBFM group with 36 subjects (average age 11.0 years).Materials and Methods: Cephalometric analysis was conducted using linear and angular midfacial measurements. Lateral cephalograms were taken initially (T0), after treatment (T1) and at two years post-treatment (T2). Significance was assessed between the two groups.Results: Comparing changes in the midfacial area between the SAFM and TBFM groups during the traction period (T0-T1), angular measurements such as SNOr (1.34°), nasolabial angle (4.20°), nasal angles 1 and 2 (1.23°, 2.14°) and linear measurements such as Prn, Sn, A' distance (approximately 2 mm) increased significantly more in the SAFM group. Over the entire treatment period (T0-T2), the changes in SNOr (1.33°), nasolabial angle (6.54°), nasal angles 1 and 2 (1.45°, 2.99°) and Prn, Sn, A' distance (approximately 2 mm) remained significant (P < .05).Conclusions: In the treatment of growing patients with Class III malocclusions with maxillary deficiency, it was possible to achieve significantly greater advancement in the midfacial area with SAFM treatment than with TBFM treatment. This significant difference was well maintained at two years post-treatment. [ABSTRACT FROM AUTHOR]

Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient’s age was determined by Pearson’s chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p