Effects Of Maxillary Protraction Research Articles

Three-dimensional finite element analysis on the effects of maxillary protraction with an individual titanium plate at multiple directions and locations.

: A three-dimensional-printed individual titanium plate was applied for maxillary protraction to eliminate side effects and obtain the maximum skeletal effect. This study aimed to explore the stress distribution characteristics of sutures during maxillary protraction using individual titanium plates in various directions and locations. : A protraction force of 500 g per side was applied at forward and downward angles between 0° and 60° with respect to the Frankfort horizontal plane, after which the titanium plate was moved 2 and 4 mm upward and downward, respectively. Changes in sutures with multiple protraction directions and various miniplate heights were quantified to analyze their impact on the maxillofacial bone. : Protraction angle of 0-30° with respect to the Frankfort horizontal plane exhibited a tendency for counterclockwise rotation in the maxilla. At a 40° protraction angle, translational motion was observed in the maxilla, whereas protraction angles of 50-60° tended to induce clockwise rotation in the maxilla. Enhanced protraction efficiency at the lower edge of the pyriform aperture was associated with increased height of individual titanium plates. : Various protraction directions are suitable for patients with different types of vertical bone surfaces. Furthermore, when the titanium plate was positioned lower, the protraction force exhibited an increase.

The effect of maxillary protraction, with or without rapid palatal expansion, on airway dimensions: A systematic review and meta-analysis.

The use of maxillary protraction appliances (MPAs) and Facemask (FM), with or without a rapid maxillary expansion (RME), have become a routine orthopaedic treatment procedure for the treatment of Class III in growing individuals; several authors have suggested that maxillary protraction could have a positive impact on airway dimensions. The purpose of this systematic review and meta-analysis was to assess the efficacy of maxillary protraction appliances (MPAs), with or without a rapid maxillary expansion (RME), on airway dimensions in children in mixed or early permanent dentition. An electronic search was performed on PubMed, Medline, Scopus, The Cochrane Library, EMBASE and the System for Information on Grey Literature in Europe until November 30th, 2019. The Newcastle-Ottawa (NOS) scale was used to assess the studies' quality. Review Manager 5.3 (provided by the Cochrane Collaboration) was used to synthesize the effects on airway dimensions. After full text assessment, 8 studies were included in the qualitative and quantitative synthesis. NOS scores ranged 6 to 9 indicating high quality. The effects of two therapeutic protocols were compared, treatment with MPAs only (113 subjects treated - 65 controls) and the treatment with MPAs + RME (137 subjects treated- 87 controls). The MPAs only treatment group displayed a significantly increase in nasopharyngeal airway dimension at PNS-AD1 (random: mean difference, 1.39 mm, 95% CI, 0.32 mm, 2.47 mm, p= 0.01) and at PNS-AD2 (random: mean difference, 1.70 mm, 95% CI, 1.14 mm, 2.26 mm, p= 0.00001). No statistically significant changes were found post treatment in MPAs + RME treatment groups at PNS-AD1 (P= 0.15), PNS-AD2 (P= 0.17), McNamara's upper pharynx (MPAs + RME P= 0.05, MPAs P= 0.99) and McNamara lower pharynx (MPAs + RME P= 0.25, MPAs P= 0.40). MPAs only treatment can increase the pharyngeal thickness after treatment both at PNS-A1 and PNS-AD2. MPA+ RME had no effect on sagittal widths compared with controls, but the effect on the transverse dimension could not be assessed.

The Effects of Maxillary Protraction with Rapid Maxillary Expansion on the Upper Airway

The Effects of Maxillary Protraction with Rapid Maxillary Expansion on the Upper Airway

Effects of Maxillary Protraction with Skeletal Anchorage and Petit-Type Facemask in High-Angle Class III Patients: A Retrospective Study

Effects of Maxillary Protraction with Skeletal Anchorage and Petit-Type Facemask in High-Angle Class III Patients: A Retrospective Study

Immediate and late follow-up effects of class III early correction in cleft lip and palate patients treated with maxillary protraction

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<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.

The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis.

We conducted a comprehensive meta-analysis of 12 studies to examine whether maxillary protraction face mask associated with rapid maxillary expansion (FM/RME) could be an effective treatment for Class III malocclusion and to evaluate the effect of timing on treatment response. Patients with a maxillary deficiency who were treated with FM with or without RME were compared with those who had an untreated Class III malocclusion. In both treatment groups, forward displacement of the maxilla and skeletal changes were found to be statistically significant. In addition, posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the control group. However, no significant differences were observed between the early treatment groups and late treatment groups. The results indicated that both FM/RME and FM therapy produced favorable skeletal changes for correcting anterior crossbite, and the curative time was not affected by the presence of deciduous teeth, early mixed dentition or late mixed dentition in the patient.

Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis.

Class III therapy using a face mask is a common approach for treatment of a deficient maxilla and reverse overbite. Usually, maxillary protraction is combined with transverse palatal expansion using intraoral appliances. The purpose of this study was to systematically review the effectiveness of face mask therapy in combination with concepts of palatal expansion and compression. A systematic review and meta-analysis were performed to identify studies that address class III treatment using a face mask. The search was carried out using common electronic databases as well as hand search. Both screening and study eligibility analysis were performed with consideration of PRISMA and Cochrane Guidelines for systematic reviews. Several terms describing class III face mask treatment were searched. Particular attention was paid to new strategies of enhancing maxillary protraction. The initial search identified 2048 studies. After a thorough selection process, a total of 22 articles met the inclusion criteria. After assessment of the individual quality scoring of each article, eight studies were provided for meta-analysis of the cephalometric parameters. The statistical analysis of treatment changes advocates a positive influence on sagittal maxillary development, which is not primarily influenced by transverse expansion. Dental side effects are more distinct when no expansion was carried out. For the concept of alternating activation/deactivation of the expansion appliance (alt-RAMEC), two articles of high methodological scoring were identified. They indicate an enhancement of face mask treatment. The findings are consistent with results of previous literature studies regarding the efficiency of class III face mask treatment. A further need for more randomized controlled studies was identified especially with regard to the new concept of alternating maxillary expansion and compression, which showed a positive influence on the maxillary protraction based on two studies. Class III therapy using extraoral face mask anchorage is effective for maxillary protraction. The recently discussed new protocols potentially improve this treatment.

Effectiveness of maxillary protraction using a hybrid hyrax-facemask combination: a controlled clinical study.

To evaluate the treatment effects of a hybrid hyrax-facemask (FM) combination in growing Class III patients. A sample of 16 prepubertal patients (mean age, 9.5 ± 1.6 years) was investigated by means of pre- and posttreatment cephalograms. The treatment comprised rapid palatal expansion with a hybrid hyrax, a bone- and toothborne device. Simultaneously, maxillary protraction using an FM was performed. Mean treatment duration was 5.8 ± 1.6 months. The treatment group was compared with a matched control group of 16 untreated Class III subjects. Statistical comparisons were performed with the Mann-Whitney U-test. Significant improvement in skeletal sagittal values could be observed in the treatment group over controls: SNA: 2.4°, SNB: -1.7°, Co-Gn: -2.3 mm, Wits appraisal: 4.5 mm. Regarding vertical changes, maintenance of vertical growth was obtained as shown by a small nonsignificant increase of FMA and a small significant decrease of the Co-Go-Me angle. The hybrid hyrax-FM combination was found to be effective for orthopedic treatment in growing Class III patients in the short term. Favorable skeletal changes were observed both in the maxilla and in the mandible. No dentoalveolar compensations were found.

Homology and heterology of cephalometric landmarks: methodological consequences

Sir, With interest I read the study ‘Effects of maxillary protraction for early correction of class III malocclusion’ by Celikoglu and Oktay (1). The authors should be complimented for careful work. Apparently, much effort was taken to avoid traditional pitfalls in the (prospective) collection of study subjects and controls, in reporting measurement technique and in statistical procedures. But why then do conclusions from this study raise doubts? My …

Effects induced after the use of maxillary protraction appliances: a literature review

OBJECTIVE: The present literature review, examined the effects of maxillary protraction in patients treated with different types of facial masks. METHODS: The review searched for relevant articles, including randomized controlled trials, controlled clinical trials and uncontrolled trials. Comparisons were made between eight different types of facial masks: Delaire; Grummons; Petit; Turley; Batista; "Sky Hook"; Nanda and Türbinger. Following aspects were evaluated: a) the type of anchorage; the origin, direction and magnitude of forces and b) the relevant results of following skeletal and dental measurements: angular (SNA and SNB), linear (AFAI); vertical angles (SN.GoGn, FMA); dental (IMPA) and linear (1-NA, 1-NB). CONCLUSION: The results showed that there was no uniformity in the choice of anchorage type and form of application of forces between the facial masks examined, but there were similarities in skeletal and dental aspects: Anterior displacement of the maxillary complex (increase in SNA) ; anterior displacement of the upper anterior teeth (increase of 1-NA), the lingual inclination of mandibular incisors (decrease of 1-NB), down and back rotation of the mandible (increase AFAI, SN.GoGn, FMA, decrease in SNB).

Treatment of Class III Malocclusions Using Miniplate and Mini-Implant Anchorage

Orthodontic miniplates and mini-implants have become essential tools for anchorage management. This article presents the treatment of growing Class III patients with the use of the facemask in conjunction with the mini-plate (FM/MP), and also the treatment of postadolescent Class III patients camouflaged by the use of mini-implants as skeletal anchorage. For FM/MP therapy, an orthopedic force of more than 500 g per side with a vector of 30° downward and forward from the occlusal plane was applied 12-14 hours per day after placement of the curvilinear type surgical miniplates in the zygomatic buttress areas of the maxilla. After 16 months of maxillary protraction, significant forward displacement of the maxilla (point A) was found. Side effects of maxillary protraction, such as labial tipping of the upper incisors, extrusion of the upper molars, clockwise rotations of the mandibular plane, and bite opening, which are usually observed using tooth-borne anchorage, were minimized. Therefore, FM/MP can be an effective alternative treatment modality for maxillary hypoplasia with minimal unwanted side effects. Class III patients in the postadolescent period can be camouflaged with fixed appliance by the use of mini-implants as skeletal anchorage. The authors prefer to install the mini-implants in the buccal attached gingiva between the upper second premolar and the first molar. Class I intraarch elastics can be used to decompensate the already labially inclined upper incisors. Class III interarch elastics can be used for distal en masse movement of the lower dentition. Vertical elastics can be used to correct an open bite problem if present. Extrusion or intrusion of the lower molars can be controlled with strategic positioning of the mini-implants in the lower arch. With an understanding of biomechanics, the careful use of miniplates and mini-implants can expand the boundaries and scope of conventional fixed appliance therapy.

The effects of maxillary protraction and its long-term stability--a clinical trial in Chinese adolescents

The purpose of this study was to evaluate the effect of reverse pull headgear (RPHG) in the treatment of Class III malocclusions in the late mixed and early permanent dentition and its long-term stability at the time when facial growth was close to completion. The treatment group comprised 22 subjects (12 males and 10 females, mean age: 11.38 ± 0.69 years). The control group included 17 subjects (7 males and 10 females, mean age: 11.54 ± 1.07 years). The mean RPHG treatment time was 1.5 ± 0.95 years and the observation time for the control group was 1.75 ± 0.83 years. For each subject, lateral cephalograms were obtained before (T1) and after (T2) treatment or observation. These cephalograms were traced and analyzed and the differences between T1 and T2 values were examined with paired t-tests. Of the 22 treated cases, 10 patients were followed up until at the mean age of 16.18 years (T3). Since there was no relapse in anterior crossbite, the long-term effects of RPHG were evaluated by measuring the maxillary and mandibular skeletal changes. The follow-up patients were divided into two groups based on the change in ANB: a stable group (decrease in ANB < 2 degrees) and an unstable group (decrease in ANB > 2 degrees). The skeletal effects of RPHG in treating Class III anomalies just before or at the beginning of the pubertal growth spurt include protraction of the maxilla and dentition and inhibition of forward growth of the mandible. With regard to the long-term change, a slight alteration in the position of the maxilla and in the position and growth direction of the mandible resulted in a slight decrease in ANB in the stable group. The slight retrusion in the maxilla, combined with the significant protrusion in the mandible and the more horizontal mandibular growth direction, resulted in a decrease in ANB in the unstable group. This indicated that the maxilla remained relatively stable and that the unstable factor was continuing mandibular growth during the pubertal and post-pubertal period. For patients with an excessive mandible, orthopaedic therapy should start at the beginning of pubertal growth and orthodontic fixed appliance should follow immediately after RPHG so that mandibular growth in the sagittal direction during puberty or even after pubertal growth may be effectively inhibited.

Effects of maxillary protraction with or without expansion on the sagittal pharyngeal dimensions in Class III subjects

The aim of this cephalometric study was to analyze the effects of rapid maxillary expansion (RME) and facemask (FM), or FM combined with bite block (BB), on the sagittal pharyngeal dimensions in subjects with Class III malocclusion when compared with an untreated Class III control group. Thirty-nine subjects (22 girls, 17 boys) were divided into 2 groups: the FM/BB group (22 subjects; mean ages, 8.9 years +/- 1.5 before treatment and 10.5 years +/- 1.3 after treatment) and the RME/FM group (17 subjects; mean ages, 7.1 years +/- 1.8 before treatment and 9.2 years +/- 1.8 after treatment). The treated groups were compared with an untreated Class III control group of 20 subjects (mean ages, 8.1 years +/- 1.2 at the first observation and 10 years +/- 1.7 at the second observation). All subjects were at prepubertal stage of skeletal maturity at both times. Comparisons of these changes between the 3 groups were analyzed with the Kruskal-Wallis 1-way analysis of variance (ANOVA) on ranks with post-hoc tests. The favorable skeletal maxillary and mandibular changes produced by maxillary protraction with or without RME were not associated with significant changes in the sagittal oropharygeal and nasopharyngeal airway dimensions. Orthopedic treatment of Class III malocclusion does not produce a significant increase in airway dimensions in the short term.

Maxillary Protraction Effects on Anterior Crossbites

To test the hypothesis that there is no difference between the effects of maxillary protraction on anterior crossbites in repaired unilateral cleft lip and palate (UCLP) and noncleft prepubertal boys. Eighteen operated UCLP boys with anterior crossbite (aged 9.54 +/- 1.21 years) were the experimental subjects. Eighteen noncleft boys with similar malocclusion (aged 9.75 +/- 1.46 years) were selected as a control group. A Hyrax appliance and reverse headgear were applied. Lateral cephalometric radiographs were taken before and after the treatment. Computerized cephalometric analysis and statistics were carried out. There were no significant differences in anterior movement of point A between the two groups (P > .05). ANB increased by 3.82 degrees and A-Pg (FH) increased by 5.89 mm in the UCLP group. ANB increased by 2.68 degrees and A-Pg (FH) increased by 3.66 mm in the noncleft group. The change of sagittal skeletal intermaxillary relationships was significantly larger in the UCLP group than in the noncleft group (P < .05). The change of lower lip in the UCLP group was less than in the noncleft group (P < .05). : The hypothesis is rejected. The changes of sagittal skeletal intermaxillary relationship and mandibular clockwise rotation were larger in the operated UCLP patients than in the noncleft subjects. The amount of the lower lip retrusion was significantly less in the UCLP patients.

Effects of maxillary protraction on craniofacial structures and upper-airway dimension.

This study was conducted to examine the effect of treatment with a maxillary protraction appliance on the development of the craniofacial structures and upper-airway dimensions. A total of 25 patients (mean age: 9.8 years) with Class III malocclusions were evaluated by the use of lateral cephalograms. A significant increase in maxillary forward growth, inhibition of mandibular forward growth, and clockwise rotation of the mandible were observed. The maxillary incisors were significantly proclined and the mandibular incisors significantly retroclined. A multiple-regression analysis revealed that maxillary growth had a significant positive effect on the superior upper-airway dimension. These findings indicate that the superior upper-airway dimension can be altered during maxillary protraction.

Effects of maxillary protraction determined by laser metrology

In this work we studied some of the main effects of the maxillary protraction orthopedic device. The initial dento-craniofacial reactions induced by maxillary protraction similar to that commonly employed in clinical practice are reported. The fringe counting holographic interferometry technique is used to measure displacements. The experiments were performed on a dried human skull; traction application points were situated over the permanent lateral incisors or over the first permanent molars. The results fundamentally reveal an anterior rotation of the dentomaxillary complex, more intense when traction is applied to the lateral incisors, as shown by a more marked extrusion of the molars in this case. Moreover, major deformation patterns could be observed in inner hard structures of the skull base when applying orthopaedic forces.