Bone-Anchored Maxillary Protraction With Bollard Modified Miniplates: An Interim Study in Patients with Cleft Palate

Abstract

Purpose: Patients with cleft lip and/or palate (CLP) often present with Class III malocclusions resulting from maxillary deficiency. Although orthognathic surgery can correct this, it is not performed until skeletal maturity. Bone-anchored maxillary protraction (BAMP) can be used during adolescence to stimulate maxillary growth. We report the outcomes of BAMP therapy in 10 patients with CLP. Methods: Beginning in 2019, patients born with CLP with mild, moderate, or severe Class III malocclusion started BAMP therapy. Four Bollard miniplates were surgically placed in each patient following a standard protocol under general anesthesia. Miniplates were secured using self-tapping titanium screws. Orthodontic elastics were initiated 2 weeks after surgery with an initial loading force of 100 g bilaterally and later increased to 200 g at 12 weeks postoperatively. Before (T1) and after (T2), Cone Beam CT (CBCT) radiographs were taken and reviewed by a single examiner. Results: Ten patients met the inclusion criteria. Their mean age at the time of Bollard miniplate placement was 12.2 (range, 9-14) years. Before treatment, the average cephalometric measurements for the SNA, SNB, and ANB were 73.3°, 78.0°, and −4.7°, respectively. After treatment, the average cephalometric measurements for SNA, SNB, and ANB were 74.4°, 77.7°, and −3.3°, respectively. Conclusion: We have demonstrated positive results with BAMP therapy. BAMP therapy led to corrective orthopedic maxillary protraction and induced favorable dental and skeletal outcomes, improving overall facial balance. Cleft surgeons should consider this modality after alveolar bone grafting when treating pediatric patients with Class III malocclusions.