Maxillary Protraction Therapy Research Articles

Maxillofacial growth changes after maxillary protraction therapy in children with class III malocclusion: a dual control group retrospective study

PurposeTo investigate the balance between post-treatment effect and continued nature growth after maxillary protraction treatment in patients with skeletal class III malocclusion.Methods31 patients aged 8.79 ± 1.65 years with skeletal Class III malocclusion had been treated with maxillary protraction and the treatment lasted an average of 1.16 years. The average observation duration after treatment in the maxillary protraction group was 2.05 ± 0.39 years. In the control groups, a sample of 22 patients (9.64 ± 2.53 years) with untreated skeletal class III malocclusion and 24 patients (9.28 ± 0.96 years) with skeletal class I malocclusion were matched to the treatment group according to age, sex and observation period. The mean observation interval of the control groups was 2.39 ± 1.29 years in the class III group and 1.97 ± 0.49 years in the class I group.ResultsThe active orthopedic treatment effect showed a opposite trend to the natural craniomaxillofacial growth effect after treatment in many aspects. In the observation duration of treatment group, decrease in ANB, Wits appraisal and BAr-AAr were statistically significant compared to class I control group (p < 0.001), and there was a significant increase in NA-FH (P < 0.001) which was contrary to class III control group. Treatment group presented a significant increase in Gn-Co (P < 0.01) and Co-Go (P < 0.001), except for changes in the extent of the mandibular base (Pog-Go, P = 0.149) compared to class I control group. The vertical maxillomandibular skeletal variables (Gonial; MP-SN; MP-FH; Y-axis) in treatment group decreased significantly compared to those in class III control group (P < 0.01). U1-SN and L1-MP showed a significant increase, which was similar to the class I group (P > 0.05), and overjet decreased significantly relative to both of the two control groups (P < 0.05).ConclusionMaxillary protraction therapy led to stable outcomes in approximately 77.42% of children with Class III malocclusion approximately 2 years after treatment. Unfavorable skeletal changes were mainly due to the greater protrusion of the mandible but maxillary protraction did have a certain degree of postimpact on the mandibular base. Protraction therapy does not fundamentally change the mode of maxillary growth in Class III subjects except for the advancement of the maxilla. Craniomaxillofacial region tend to restabilize after treatment and lead to skeletal growth rotation and more dentoalveolar compensation.

Pain and discomfort perception during miniscrew-anchored maxillary protraction: secondary data analysis of a randomized clinical trial.

To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders. Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%). Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P = .608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P < .001; T2: 23.15, P < .001; T3: 9.35, P = .008). MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders.

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.

Quantitative measurement of the palatal mucosa in cleft lip and palate using elastography

ABSTRACT Purpose Cleft lip and palate (CLP) are the most common congenital abnormalities in the craniofacial region. Patients with CLP usually have palatoplasty in early childhood, which causes scar tissue on the palatal mucosa. Scar tissue prevents growth of the maxilla. However, no studies have quantitatively evaluated the characteristics of the palatal mucosa. This study aimed to quantitatively evaluate the physical characteristics of the palatal mucosa after palatoplasty in patients with CLP using elastography. We also aimed to investigate the association between the physical characteristics of the palatal mucosa and the use of maxillary protraction therapy (MPA). Materials and methods We enrolled 57 patients with CLP (mean age, 20.82 ± 3.50 years) and 30 control subjects without CLP (mean age, 26.97 ± 2.09 years) and measured the stiffness of the palatal mucosa using elastography. Among the patients with CLP, we investigated the association between the use of MPA and the stiffness of the palatal mucosa. Results The palatal mucosa in patients with CLP was significantly stiffer than that in control subjects. Moreover, the palatal mucosa in the MPA group was significantly stiffer when adjusted for cleft type compared with the group with no MPA. Conclusions Our findings suggest that there are characteristic differences in the palatal mucosa between patients with CLP and subjects without CLP and between those with and without MPA use. Elastography could be a new and effective diagnostic tool in orthodontic treatment for patients with CLP.

Long-term maxillary anteroposterior changes following maxillary protraction with or without expansion: A meta-analysis and meta-regression.

Maxillary protraction with or without expansion is a widely known orthopedic treatment modality in growing skeletal Class III patients. However, limited data are available regarding the outcomes of long-term changes in the maxilla. Aim of this meta-analysis was to assess the effectiveness of the long-term maxillary anteroposterior changes following a facemask therapy with or without rapid maxillary expansion in growing skeletal Class III patients. A comprehensive literature search was conducted using the databases of PubMed, Science Direct, Web of Science, and Embase. Randomized controlled trials and cohort studies, published up to Sep. 2020, with maxillary protraction and/or expansion as keywords were included in this meta-analysis. Risk of bias within and across studies were assessed using the Cochrane tools (RoB2.0 and ROBINS-I) and GRADE approach. Overall and subgroup comparisons with the random-effect model were performed in this meta-analysis. Meta-regression models were designed to determine potential heterogeneity. There was a statistically significant increase (Mean difference, 2.29°; 95% confidence interval, 1.86-2.73; and p < 0.001 after facemask (FM) protraction. Mean difference, 1.73°; 95% confidence interval, 1.36-2.11; and p < 0.001 after rapid maxillary expansion(RME) and facemask protraction) in the Sella-Nasion-A point (SNA) angle in the treatment groups as compared with the control groups, when measured during the less than 3-year follow-up period. However, no statistically significant changes (Mean difference, 0.28°; 95% confidence interval, -0.57-1.13; and p = 0.52 after facemask protraction. Mean difference, 0.34°; 95% confidence interval, -0.64-1.33; and p = 0.50 after rapid maxillary expansion and facemask protraction) were observed in the SNA angle in the groups, when measured after 3 years of follow-up. Meta-regression analysis also showed that with increased follow-up duration, the effectiveness of maxillary protraction decreased. This meta-analysis revealed that maxillary protraction therapy could be effective for a short-term in correcting maxillary hypoplasia and the treatment result was not affected by mean age and sex. However, with increased follow-up duration, the sagittal maxillary changes gradually decreased. Limitations on this review were only the SNA angle was used and clinical heterogeneity was not discussed. The quality of evidence was moderate. Further long-term observational studies are necessary for a comprehensive evaluation of the effects on maxillary skeletal changes.

Maxillary Protraction Therapy in Class III Patients With and Without Cleft Lip and Palate: An Interim Report of a Prospective Comparative Study.

To investigate and compare the effects of maxillary protraction therapy on Class III patients with unilateral cleft lip and palate (UCLP) and Class III patients with noncleft. Prospective controlled clinical trial. Twenty-six Class III patients with UCLP (mean age: 10.32 ± 1.29 years) and 26 Class III patients with noncleft (mean age: 9.82 ± 1.03 years) were included and treated with maxillary protraction therapy. Maxillary protraction therapy was performed with an intraoral Hyrax appliance and extraoral facemask. Cone beam computed tomography scans were taken before and after treatment. Pretreatment skeletal and dental characteristics and treatment changes were analyzed and compared. The average treatment duration was 18.44 ± 4.16 months in the UCLP group, which was substantially longer than the 12.46 ± 4.03-month average treatment duration in the noncleft group (P < .001). No significant difference was found in the maxillary changes (length, advancement of point A, and SNA angle) and improvement of intermaxillary relationship (ANB angle) between the 2 groups. The UCLP group had 1.40° more mandibular clockwise rotation (P = .034). Regarding dental changes, the UCLP group had more upper incisor proclination (P = .006) and less lower incisor retroclination (P = .023). Approximately extended maxillary protraction therapy in patients with UCLP could be as effective as in patients with noncleft. Further study is required to follow patients until completion of growth to elucidate the long-term stability of the treatment.

Maxillary Protraction with Miniscrew Assisted Rapid Palatal Expander in Children with Skeletal Class III Malocclusions

Protraction headgear therapy with a rapid palatal expansion appliance used as an intraoral anchorage is common in children with Class III malocclusion and maxillary deficiency. However, it can show anchorage loss or failure of protraction in older age children. Therefore, some clinicians proposed the use of skeletal anchorage such as miniplates in the infrazygomatic crest area or miniscrews in the palate. These case reports describe maxillary protraction therapy in children with the miniscrews assisted rapid palatal expander (MARPE). At first, MARPE has been developed for the maxillary expansion in adults, but it could also serve as a good skeletal anchorage for protraction therapy in children.

Miniscrew-anchored maxillary protraction in growing Class III patients.

The aim of this article is to report a case series of a miniscrew-anchored maxillary protraction therapy (MAMP). Two male patients presenting with Class III malocclusion were included in this report. The treatment consisted of a hybrid expander and two miniscrews at the anterior region of the mandible anchoring Class III elastics for maxillary protraction. Effective maxillary length, ANB angle and Wits appraisal increased after treatment. Slight dental effects were observed. MAMP therapy produced substantial skeletal effects and might be a good treatment option for Class III growing patients.

Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate.

This study evaluated the long-term stability of maxillary protraction (MP) in patients with complete unilateral cleft lip and palate (UCLP) and identified factors influencing relapse and long-term outcomes. Twenty-three adolescents with UCLP who underwent MP therapy were recalled when craniofacial growth was close to completion. Subjects exhibiting reverse/positive overjets were assigned to unstable/stable groups. Lateral cephalometric measurements were made before treatment (T0), after active treatment (T1), and at the end of the growth spurt (T2). About 63% of the subjects exhibited positive overjets during follow-up. The unstable group demonstrated higher B-x and Co-Gn distances than the stable group (both P < .05) at T0. More short-term (T0-T1) sagittal advancement of point A (A-y) was evident in the unstable group than in the stable group ( P < .05), but no long-term difference was apparent between the two groups ( P = .481). During the posttreatment period (T1-T2), the SNA angle and maxillary incisor protrusion (U1-SN angle) were considerably lower in the unstable group than in the stable group (both P < .05). Overall, the unstable group exhibited a lower increase in the vertical extent of point A (A-x) than the stable group from T0 to T2 ( P < .05). In the long term, MP affords favorable maxillary advancement in patients with UCLP. A mandibular excess at T0 and vertical maxillary hypoplasia may contribute to the long-term relapse of a reverse overjet.

Bone-anchored maxillary protraction in patients with unilateral complete cleft lip and palate and Class III malocclusion

ObjectiveThis prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models.Materials and subjectsEighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls. Profile photos and CBCT scans for each patient were taken before (T0) and 18 months after the protraction (T1). 3D measurements were made on CBCT surface models from the treatment group using tomographic color mapping method. Cephalometric measurements were made on lateral cephalogram reconstructed from the CBCT scans and were compared with those obtained from the control groups.ResultsTwo thirds of the treatment subjects showed improved lip projection towards more convex facial profile. The most significant skeletal changes on 3D surface models were observed at the zygomatic regions (mean 1.5-mm forward, downward, and outward displacement) and at the maxillary complex (mean 1.5-mm forward displacement). Compared with the control groups, the treatment subjects showed significant increase in the SNA and ANB angles, increased Wits appraisal, a more forward movement of point A and overjet improvement (p < 0.05).ConclusionsBAMP in cleft patients gives a significant forward displacement of the zygomaxillairy complex in favor of the Class III treatment.Clinical relevanceThis treatment method shows clearly favorable outcome in cleft patients after 1.5 years of BAMP.

Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis.

The objective of this study was to evaluate the stability of treatment effects of maxillary protraction therapy in Class III children. Multiple electronic databases were searched from 01/1996 to 10/2016. Randomized clinical trials, controlled clinical trials, and cohort studies with untreated Class III controls and a follow-up over 2years were considered for inclusion. The methodological quality of the studies and publication bias were evaluated. Mean differences and 95% confidence intervals (CI) of six variables (SNA, SNB, ANB, mandibular plane angle, overjet, and lower incisor angle) were calculated. Ten studies were included in the qualitative analysis, and four studies were included in the quantitative analysis. Compared with the control group, after treatment, the treated group showed significant changes: SNA +1.79° (95% CI: 1.23, 2.34), SNB -1.16° (95% CI -2.08, -0.24), ANB +2.92° (95% CI 2.40, 3.44), mandibular plane angle +1.41° (95% CI 0.63, 2.20), overjet +3.94mm (95% CI 2.17, 5.71) and lower incisor angle -3.07° (95% CI -4.92, -1.22). During follow-up, the changes in five variables reflected significant relapse. Overall, the treated group showed significant changes only in ANB +1.66° (95% CI 0.97, 2.35) and overjet +2.41mm (95% CI 1.60, 3.23). Maxillary protraction can be a short-term effective therapy and might improve sagittal skeletal and dental relationships in the medium term. But some skeletal and dental variables showed significant relapseduring the follow-up period.Long-term studies are still required to further evaluate its skeletal benefits. The study evaluated the medium-term stability of skeletal and dental effects of maxillary protraction in Class III childrenand discussed whether the therapy can reduce the need for orthognathic surgery.

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects.

The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate. The cleft group comprised 24 patients with unilateral cleft lip and palate and Class III malocclusion with mean initial and final ages of 11.8 and 13.2years, respectively. The noncleft group comprised 24 noncleft patients with Class III malocclusion with mean initial and final ages of 11.9 and 12.9years, respectively. Cone-beam computed tomography examinations were performed before and after BAMP therapy in both groups and superimposed at the cranial base. Three-dimensional displacements of maxillary landmarks were quantified and visualized with color-coded maps and semitransparent superimpositions. The t test corrected for multiple testing (Holm-Bonferroni method), and the paired t test was used for statistical comparison between groups and sides, respectively (P<0.05). BAMP produced anterior (1.66mm) and inferior (1.21mm) maxillary displacements in the cleft group with no significant differences compared with the noncleft group. The maxillary first molars of the cleft group showed significantly greater medial displacement than did those in the noncleft group. The zygoma showed significantly greater lateral displacement at the cleft side compared with the noncleft side. BAMP caused similar amounts of maxillary protraction in patients with and without unilateral cleft lip and palatem with discrete differences between the cleft side and the noncleft side.

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment.

To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

Effects of maxillary protraction therapy on the pharyngeal airway in patients with repaired unilateral cleft lip and palate: A 3-dimensional computed tomographic study.

The purposes of this study were to assess the effects of maxillary protraction therapy on the pharyngeal airways in patients with repaired unilateral cleft lip and palate (UCLP) 3 dimensionally. Eighteen patients with repaired UCLP and anterior crossbite (ages, 10.4±1.3years) were enrolled in the study group. Hyrax appliances and reverse headgears were used. Cone-beam computed tomography volume scans were taken before and immediately after treatment. Fourteen patients (ages, 9.6±1.7years) with UCLP who did not receive orthopedic treatment served as the control group. The volumes of the pharyngeal airways, cross-sectional areas, sagittal diameters, and transversal diameters of 3 levels of airway cross-section were measured. After protraction, the volumes of the pharyngeal airway increased significantly. Cross-sectional area, sagittal diameter, and transversal diameter of the upper and lower pharyngeal airways also had significant increases. These changes were significant when compared with the untreated subjects except for the transversal diameter of the lower pharyngeal airway. Dimensions of the middle pharyngeal airway remained unchanged. Maxillary protraction therapy significantly affects airway dimensions in patients with repaired UCLP 3 dimensionally.

Stresses in the midpalatal suture in the maxillary protraction therapy: a 3D finite element analysis.

BackgroundThe aim of the present work was to evaluate the stress magnitudes and directions along the midpalatal suture in the maxillary protraction therapy.MethodsThe geometry of the maxilla and teeth were digitally reconstructed based on computer tomography images obtained from the skull of a girl in a mixed dentition stage with skeletal and dental class III malocclusion. An appliance commonly used for rapid palatal expansion (RPE) was also digitally modeled for anchorage of the protraction force and meshed for finite element analysis. The maxillary protraction was simulated applying 600 cN (300 cN for each side) directed 30° forward and downward to the maxillary occlusal plane.ResultsThe principal stresses, through the force application, exhibited similar distribution patterns. A higher stress area was observed in the region of the midpalatal suture located in front of the incisive canal. All the sections showed vectors of compressive nature.ConclusionsBecause of the compressive nature of the stresses distributed along the midpalatal suture in the maxillary protraction therapy simulation, which is opposite to the natural growth transversal tendency, maxillary expansion is advisable in clinical cases.

Treatment of class III Malocclusion with maxillary expansion and face-mask therapy: A case report

The developing class III malocclusion is one of the most challenging problems for the practicing orthodontist to manage clinically. True class III malocclusion is rare in our region as compared to Class II and Class I malocclusion. With adults, orthognathic surgery and dental camouflage is the viable treatment option. A variety of treatment alternatives exists for patients in the developing stages of a Class III malocclusion. In the past much of the therapy has focused on restriction of mandibular growth with chin cups and functional appliances. This is based on the traditional thought that developing Class III malocclusions were the result of prognathic mandible. Recently, however, there has been a growing awareness that the majority of patients with a developing Class III skeletal pattern exhibit a maxillary deficiency with a normal or only slightly prognathic mandible. Therefore, considerable attention has been given to early treatment using maxillary protraction therapy. Using facemask therapy in conjunction with maxillary expansion has been shown in clinical reports to be a successful and predictable treatment option. Treatment should be carried out as early as possible with the aim to prevent it from becoming severe. A case treated with biphasic therapy – orthopaedic appliance followed by fixed orthodontic treatment is presented here. DOI: http://dx.doi.org/10.3126/jmcjms.v2i1.11539 Janaki Medical College Journal of Medical Sciences (2014) Vol. 2 (1):59-63

Increase in Sagittal Depth of the Bony Nasopharynx following Maxillary Protraction in Patients with Unilateral Cleft Lip and Palate

Objective : To study the change in the sagittal depth of the bony nasopharynx in patients with unilateral cleft lip and palate (UCLP), following maxillary protraction using reverse headgear. Methods : Nineteen patients (14 male, five female; aged 9.36 ± 2.89 years) with repaired complete UCLP underwent maxillary protraction with a Delaire type reverse headgear at a tertiary-care referral teaching hospital. Control data were taken from five patients (four male, one female; aged 8.25 ± 2.25 years) who did not receive any orthopedic/orthodontic treatment for a similar duration of time as the treated patients. Average treatment/observation period was 11.71 ± 3.39 months for the treated patients and 12.40 ± 2.60 months for the untreated subjects. Changes in the sagittal bony nasopharynx depth were measured by comparing pretreatment (T1) and posttreatment (T2) lateral cephalograms. Correlations between the changes in the bony nasopharynx depth and in other variables measured in the treated patients were analyzed. An exploratory analysis of differences in the changes from T1 to T2 between the treated patients and untreated subjects was also conducted. Results : The favorable skeletal changes seen in SNA and ANB following maxillary protraction were accompanied by a significant increase in the sagittal depth of bony nasopharynx (1.74 ± 1.10 mm; P < .001). This change was significant when compared with the data from the untreated subjects (P = .004). Correlations between the increase in bony nasopharynx depth and changes in other variables studied in the treated patients were weak and not statistically significant. Conclusion : Sagittal depth of the bony nasopharynx in patients with repaired UCLP increased following maxillary protraction therapy using reverse headgear.

Comparative evaluation of maxillary protraction with or without skeletal anchorage

The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group. Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests. Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups. The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period.