Protracted Therapy 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.

Fabrication and Evaluation of Luliconazole contains Cationic Guar Gum intended to use for Topical application

The novel imidazole topical drug luliconazole (LCZ) has potent antifungal efficacy against a wide variety of fungi. When applied to the skin, LCZ has tremendous promise as an antifungal agent, however, constrained by its poor skin permeability and limited solubility, requiring protracted therapy and repeated dosage to achieve full recovery. The current work explains the formulation and characterization of a cationic gel prepared by using Guar Gum (GG) and pH was adjusted by using NaOH solution. The created formulation was white in color. The FTIR spectroscopy analysis shows that the medication and polymer did not react with one another. The cumulative percentage drug release suggested that LCZ was released from the formulations. All the release kinetics show that drug release from the formulation was in Fickian transport nature. The correlation value was found to be more than 0.90 in all the fitted release models. The pH of each formulation fell within the predetermined range.The prepared LCZ gel shows a viscosity between 13000 to 28000 cps, which is a very good topical application.

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.

Monitoring of Drug Release via Intra Body Communication with an Edible Pill

AbstractOral drug administration provides a convenient and patient‐compliant way for drug delivery, especially for chronic diseases and prolonged pharmacological treatments. However, due to the repetitiveness of such therapeutic approach, the patients are led to neglect/forget the therapy affecting the healthcare delivery. Indeed, the non‐adherence to pharmacological prescriptions and the unknown amount of real‐time drug release result in a non‐compliant therapeutic drug level over the protracted therapies. The proposed technology will enable the monitoring of both pharmacological adherence and real‐time drug release. The approach exploits a passive intrabody communication (IBC) activation in order to enable an edible pill, realized starting from food additives and food‐grade materials, to monitor pharmacological adherence. Following activation, the signal is modulated by IBC coupling switching triggered by pill degradation in a gastrointestinal tract, resulting in a monitored drug release. The proof‐of‐concept is designed for a targeted release and monitoring of Metformin in the intestine. The system shows an in vitro limit of cumulative drug release detection of 18 µg mL−1 and a limit of real‐time drug release detection of 2 µg mL−1 min−1. This platform represents the first solution to monitor passive drug release in real‐time, from intake to complete absorption, enabling unique and long‐sought healthcare therapy and treatment opportunity.

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.

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.

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.

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.

Three-dimensional finite element analysis of initial displacement and stress on the craniofacial structures of unilateral cleft lip and palate model during protraction therapy with variable forces and directions

Maxillary protraction and expansion is recommended to treat midfacial deficiency in patients with cleft lip and palate (CLP), where amount and direction of forces can change displacement and stress. This study assessed the initial displacement and stresses using Facemask and Maxgym forces with and without RME at +20∘, 0∘, and -20∘ angulation using a finite element (FE) model of unilateral cleft lip and palate (UCCLP). The Initial displacement and stress were more for protraction with expansion as compared to only protraction. Asymmetric displacement was observed with more on cleft than on noncleft side and more on dental than skeletal structures. Palatal plane rotated less upward, increased arch width and decreased arch length was observed with protraction with expansion.

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.

The molecular basis of pyrazinamide activity on Mycobacterium tuberculosis PanD

Pyrazinamide has been a mainstay in the multidrug regimens used to treat tuberculosis. It is active against the persistent, non-replicating mycobacteria responsible for the protracted therapy required to cure tuberculosis. Pyrazinamide is a pro-drug that is converted into pyrazinoic acid (POA) by pyrazinamidase, however, the exact target of the drug has been difficult to determine. Here we show the enzyme PanD binds POA in its active site in a manner consistent with competitive inhibition. The active site is not directly accessible to the inhibitor, suggesting the protein must undergo a conformational change to bind the inhibitor. This is consistent with the slow binding kinetics we determined for POA. Drug-resistant mutations cluster near loops that lay on top of the active site. These resistant mutants show reduced affinity and residence time of POA consistent with a model where resistance occurs by destabilizing the closed conformation of the active site.

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.

Miltefosine is fungicidal to Paracoccidioides spp. yeast cells but subinhibitory concentrations induce melanisation

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the dimorphic fungi Paracoccidioides spp. The duration of antifungal treatment ranges from months to years and relapses may nevertheless occur despite protracted therapy. Thus, there remains an urgent need for new therapeutic options. Miltefosine (MLT), an analogue of alkylphospholipids, has antifungal activity against species of yeast and filamentous fungi. The aim of this study was to evaluate the antifungal effects of MLT on the yeast forms of Paracoccidioides brasiliensis and Paracoccidioides lutzii. MLT demonstrated inhibitory activity from 0.12 to 1 µg/mL, which was similar to amphotericin B or the combination trimethoprim/sulfamethoxazole but was not more effective than itraconazole. The fungicidal activity of MLT occurred at concentrations ≥1 µg/mL. Ultrastructural alterations were observed following exposure of the fungus to a subinhibitory concentration of MLT, such as cytoplasmic membrane alteration, mitochondrial swelling, electron-lucent vacuole accumulation and increasing melanosome-like structures. Melanin production by yeasts following MLT exposure was confirmed by labelling with antibodies to melanin. In addition, the combination of a subinhibitory concentration of MLT and tricyclazole, an inhibitor of DHN-melanin biosynthesis, drastically reduced yeast viability. In conclusion, MLT had a fungicidal effect against both Paracoccidioides spp., and a subinhibitory concentration impacted melanogenesis. These findings suggest that additional investigations should be pursued to establish a role for MLT in the treatment of PCM.