Bone-anchored Maxillary Protraction Research Articles

Bone-anchored maxillary protraction: A review

Facemasks are worn during protraction therapy for maxillary deficiency, which is used to treat skeletal class III malocclusion. The maxillary dentition has historically been linked to facemask therapy, which accounts for some of the counterproductive effects such as the chin's rotation backward and downward, the elevation of the lower anterior facial height, the proclination of the maxillary incisors, the retroclination of the mandibular incisors and the mesialization of the maxillary molars with extrusion and reduction of the overbite.

Bone-Anchored Maxillary Protraction for Adolescents with Cleft Palate and Class III Malocclusion: A Case Series

To describe the long-term treatment course of bone-anchored maxillary protraction (BAMP) and evaluate orthognathic surgical indications after BAMP Retrospective case series Craniofacial/Cleft Palate Program at the Orthopaedic Institute for Children in Los Angeles, CA Twelve male patients with cleft palate (CP), unilateral cleft lip and palate (UCLP), or bilateral cleft lip and palate (BCLP) and Class III malocclusion treated with BAMP (mean age: 11.4 ± 2.6 years) were included. BAMP treatment was performed by placement of bone-anchored maxillary and mandibular plates connected with intraoral Class III dental elastics or maxillary plates connected to a facemask. We retrospectively assessed BAMP treatment variables, including age at surgery, revision surgeries, and treatment duration. The primary goal was correction to class I occlusion. Twelve patients underwent BAMP treatment for an average of 4.4 ± 2.4 years. Two patients were corrected to class I occlusion at the time of this report. Le Fort I advancement was no longer required in two patients (16.7%), it was required for nine patients (75.0%) and was completed for one patient following BAMP treatment (8.3%). This preliminary report demonstrated that BAMP treatment may be associated with a minimal reduction in the requirement for Le Fort I advancement at skeletal maturity. Future studies with larger sample sizes are necessary to confirm this association.

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

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.

Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial

BackgroundThe 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.MethodsForty 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.ResultsForty 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.ConclusionsWithin 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.

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

BackgroundThe 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.

Maxillary sinus volumetric changes following Bone-anchored maxillary Protraction in patients with unilateral cleft lip and palate: A Retrospective CBCT Study

Maxillary sinus volumetric changes following Bone-anchored maxillary Protraction in patients with unilateral cleft lip and palate: A Retrospective CBCT Study

Three-dimensional assessment of short-term effects of Bone-anchored Maxillary Protraction on the oropharyngeal airway volume in patients with unilateral cleft lip and palate

Three-dimensional assessment of short-term effects of Bone-anchored Maxillary Protraction on the oropharyngeal airway volume in patients with unilateral cleft lip and palate

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

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. 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. 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. Favorable changes were appreciated with maxillary forward and mandibular backward displacement, with appreciable tensile stresses in all the bones.

Design of class III intermaxillary traction titanium plate for boneanchorage based on finite element analysis

The purpose of this article is to investigate the effect of different bending angles and traction directions of the traction arm on the stability of the titanium plate for bone-anchored maxillary protraction (BAMP). The titanium plate models with different bending angles of the upper and lower jaws were modelled in three dimensions, where the bending angles were 90°, 120°, 135°, 150°, 180° and recorded as U1-U5 and L1-L5 respectively. Finite element analysis was performed on the titanium plates with different structural parameters to complete the structural design selection study of the titanium plates. The displacement limit was defined and different angular tensile forces were applied to record the equivalent stress and displacement of the titanium plates under each working condition. A total of 120 sets of orthogonal simulation tests were designed, which showed that the stress values at U2, U3 and U4 are smaller at traction angles of 135° (66.152 MPa), 155° (59.015 MPa) and 175° (55.589 MPa) respectively. The displacement is correspondingly smaller at tensile angles of 135° (0.0073 mm), 150° (0.0056 mm) and 160° (0.0058 mm). L2 has the smallest stress value (50.491 MPa) and displacement (0.0062 mm) at a tension angle of 120°. Therefore, it is recommended to design a titanium plate with a mandibular traction arm bending angle of 120° for BAMP, and the traction arm bending angle of the maxillary titanium plate can be flexibly designed according to the clinical traction direction.

Impact of bone-anchored maxillary protraction on the quality of life of subjects with complete unilateral cleft lip and palate

This study aimed to evaluate the influence of bone-anchored maxillary protraction (BAMP) on the oral health-related quality of life (OHRQOL) in subjects with complete unilateral cleft lip and palate (UCLP) and moderate-to-severe maxillary deficiency. A longitudinal observational study was conducted with a sample of 20 patients (13 males, 7 females) aged 10-14 years (mean age, 11.8 years) with Goslon 3, 4, and 5. To assess the patient's perception of their OHRQOL, the Quality of Life Questionnaire for Orthosurgical Patients was administered in 2 stages: after the installation of the protraction plates (T1) and 18 months after the protraction therapy started (T2). The questionnaire was composed of 4 domains, distributed over 22 questions: social aspects, facial esthetics, oral function, and awareness of facial deformity. The treatment protocol improved the OHRQOL in 75% of the patients who presented UCLP. The domain social aspects of the deformity were the only one that showed a significant difference from T1 to T2 and indicated an improvement in self-esteem. The girls had worse OHRQOL than boys at T1, which was statistically significant only for the domains of social aspects of deformity and awareness of deformity. After BAMP therapy, the effect size indicated a larger change in OHRQOL in girls than in boys. BAMP therapy positively impacted the OHRQOL and self-esteem of patients with UCLP during adolescence.

Three-dimensional volumetric changes in the airway of growing unilateral complete cleft lip and palate patients after bone-anchored maxillary protraction

This prospective controlled study evaluates volumetric, length, and average cross-sectional area (aCSA) airway changes in growing patients with unilateral complete cleft lip and palate after 1.5 years of bone-anchored maxillary protraction therapy. Thirty-five growing unilateral complete cleft lip and palate patientswith maxillary deficiency were included (aged 11.3 ± 0.5 years). Cone-beam computed tomography scans were obtained before bone-anchored maxillary protraction (BAMP) therapy and after 1.5 years. Agrowing group without cleft (n= 18) patients served as a control group at 1.5 years posttreatment (aged 13.1 ± 1.2 years). Volumetric, length, and aCSA changes of the total airway, nasopharynx (NP), middle pharynx, and inferior pharynx airway were evaluated. After 1.5 years of BAMP therapy, a significant increase was observed in the total airway volume and the NP (P<0.01). The middle and inferior pharynx showed an insignificant tendency of volumetric increase. Compared with the control group, a significantly larger airway volume could be observed in the total airway and NP (P<0.05). The aCSA of the NP increased significantly compared with pretreatment. The total airway and NP volumes significantly increased in growing subjects with cleft lip and palate after 1.5 years of BAMP therapy to a level comparable to a control group without cleft. Volumetric increase in the NP in the BAMP group is mainly attributed to the increase in its cross-sectional area. BAMP can therefore be recommended as an effective therapy for patients with cleft lip and palate with positive effects on airway development.

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

IntroductionBone-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...

Efficacy of Different Methods of Bone-Anchored Maxillary Protraction in Cleft Lip and Palate Children: A Systematic Review and Meta-Analysis.

Bone-anchored maxillary protraction (BAMP) is an effective option for adolescent cleft patients with maxillary hypoplasia. Hence, this study was conducted to access the effectiveness of the many techniques of BAMP in cleft lip and palate patients. Data was compiled through a global search of random and nonrandom studies that investigated the efficacy of various techniques of BAMP in cleft lip and palate patients. The searches were conducted in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until October 12, 2021. The pertinent data of the comprised studies were extracted using predetermined extraction forms. Meta-analysis results were obtained by using inverse-variance to calculate the pooled results of the outcome measures. Five studies were submitted for meta-analysis. The BAMP therapeutic methods investigated in the studies were facemask attached to miniplates (FM-MP) and class III elastics attached to maxillary and mandibular miniplates (C3-IE: class III intermaxillary elastic). The mean differences of A-VRP, A-N Prep., ANB, wits, overjet, and SNA landmarks indicated posttreatment was encouraging, showing maxillary protrusion, and correction of class III malocclusion. SNB landmark showed no statistically significant alterations posttreatment. Subgroup analysis of the C3-IE and FM-MP subgroups indicated that the changes in ANB, SNA, and overjet parameters in the FM-MP subgroup were more pronounced than in the C3-IE subgroup. No statistically significant differences were found when the results of these 2-treatment method were compared, except for in the overjet subgroup. After undergoing BAMP treatment, the maxilla showed a more horizontal growth, but no changes in the vertical dimension were observed and the mandible did not rotate clockwise. In addition, using facemask-miniplates was more effective in increasing overjet compared with using class III elastics with bone anchors. In conclusion, BAMP treatment is a suitable alternative for adolescents with cleft lip and palate malformation.

Clinical effectiveness of different types of bone-anchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis.

ObjectiveThis study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis.MethodsWe searched seven databases for randomized and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction, and quality assessment, we calculated the mean differences, 95% confidence intervals, and surface under the cumulative ranking scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework.ResultsSix interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-Nasion-Supramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups.ConclusionsBone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of a facemask.

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.

Treatment Efficacy and Patient Acceptance of Removable Mandibular Retractor Appliance and Bone-anchored Maxillary Protraction in Growing Skeletal Class III Patients: A Systematic Review

Treatment Efficacy and Patient Acceptance of Removable Mandibular Retractor Appliance and Bone-anchored Maxillary Protraction in Growing Skeletal Class III Patients: A Systematic Review

Three-dimensional evaluation of soft tissue changes following bone-anchored maxillary protraction protocol in patients with complete unilateral cleft lip and palate

Three-dimensional evaluation of soft tissue changes following bone-anchored maxillary protraction protocol in patients with complete unilateral cleft lip and palate

Individualized 3D-Printed Bone-Anchored Maxillary Protraction Device for Growth Modification in Skeletal Class III Malocclusion.

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.

Comparative efficacy of the bone‐anchored maxillary protraction protocols for orthopaedic treatment in skeletal Class III malocclusion: A Bayesian network meta‐analysis

To compare the treatment effects of five bone-anchored maxillary protraction protocols (BAC3E, BAMP, BARME-FM, BARME-ME, SAFM) for skeletal Class III malocclusion. 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. 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. 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.

Evaluating the use of multimedia information when recruiting adolescents to orthodontics research: A randomised controlled trial.

Objective:To compare two methods of providing information about the Bone Anchored Maxillary Protraction (BAMP) trial: standard printed information and multimedia websites, for their quality and ease of understanding, and impact on decision-making.Design:Randomised controlled trial.Setting:Orthodontic outpatient clinic in the UK.Methods:Participants were 109 adolescents (aged 11–14 years) attending for orthodontic treatment. While awaiting treatment they were asked to imagine being recruited to the BAMP clinical trial. They were individually randomised to receive the printed or the multimedia website information (comprising text, animations and ‘talking head’ videos). After reading or viewing the information, they completed a 9-item Likert scale Decision-Making Questionnaire (DMQ) (score range 0–36) plus three free-text questions on their evaluation of the information.Results:A total of 104 participants completed the questionnaire. Mean total DMQ scores were higher (more positive) in the website group (28.1 vs. 27.0), although the difference was small and not statistically significant (P = 0.20). Analysis of individual questionnaire items showed two statistically significant differences: the website information had higher ratings on ‘easy to understand’ (Z = 3.03; P = 0.003) and ‘confidence in decision-making’ (Z = 2.00; P = 0.044). On the three free-text questions, more positive and fewer negative comments were made about the websites than the printed information.Conclusion:In this hypothetical trial setting, adolescent patients found that trial information conveyed on a multimedia website was easier to understand and made them more confident in their decision about trial participation. Their subjective evaluations of the website were also more positive and less negative than about the printed information. Multimedia information has the potential to increase the quality of engagement and information exchange when seeking consent for research.