Orthopedic Traction of the Maxilla With Miniplates: A New Perspective for Treatment of Midface Deficiency

Abstract

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, often resulting in an anterior crossbite and a concave profile.1 Young patients with maxillary hypoplasia are usually treated with a facemask: heavy anterior traction is applied on the maxilla to stimulate its growth and to restrain or redirect mandibular growth. Forward and downward movement of the maxilla as well as favorable changes in the amount and direction of mandibular growth has been reported.2–5 However, these forces generally result in a posterior rotation of the mandible and an increased vertical dimension of the face.2,4,6 Moreover, dental compensations (proclination of the upper incisors and uprighting of the lower incisors) are observed as a consequence of the application of forces on the teeth,4,7 and facemask wear is usually limited to 14 hours per day at best. Titanium miniplates used for anchorage now offer the possibility to apply pure bone-borne orthopedic forces between the maxilla and the mandible for 24 hours per day, avoiding any dentoalveolar compensations.