Maxillary Protraction at Early Ages. The Revolution of New Bone Anchorage Appliances

Purpose: An update is provided on the different types of early treatment for class III malocclusions of maxillary origin. There is an increasing tendency to prescribe maxillary orthopedic treatment with skeletal an-chorage, with the purpose of enhancing the skeletal and reducing the dentoalveolar effects - offering a management option for children with important deformations that otherwise would have to wait until adult age to receive surgical treatment. Method: A literature review has been made of maxillary bone orthopedic traction appliances in growing children with class III malocclusions. A Medline (PubMed) search was made using the following MeSH terms: Cephalometric, Child, Malocclusion class III / therapy, Extraoral traction appliances, Palatal expansion, Bone plates, Skeletal anchorage, Orthodontic anchorage. Results: Many articles show that the greatest maxillary advances are obtained at very early ages, though with a greater tendency towards relapse. However, skeletal anchorage has been seen to afford a lesser relapse rate and greater dentofacial orthopedic efficiency due to its low dentoalveolar impact. In any case, further randomized clinical studies are needed to firmly establish the quantifiable differences in terms of maxillary advance, optimum traction age, optimum traction appliance and potential side effects. At present, the incorporation of surgically inserted bone anchorage appliances (miniplates and miniscrews) offers a purely orthopedic approach to treatment, with minimization of the undesirable side effects of traditional dentofacial orthopedic compensation based on dentoalveolar anchorage. Nevertheless, further studies are needed to consolidate the supporting scientific evidence in this field.

1. Toffol LD, Pavoni C, Baccetti T, Franchi L, Cozza P. Orthopedic treatment outcomes in Class III malocclusion. A systematic review. Angle Orthod; 78: 561-573. 2008

2. Allwright WC, Burndred WH. A survey of handcapping dentofacial anomalies among Chinese in Hong-Kong. International Dental Journal; 14: 505-519. 1964

3. Irie M, Nakamura S. Orthopedic approach to severe skeletal Class III malocclusion. Am J Orthod; 67: 377-392. 1975

4. Iwagaki H. Hereditary influence of malocclusion. American Journal of Oral and Maxillofacial Surgery; 24: 328-338. 1983

5. Tang EL. The prevalence of malocclusion amongst Hong Kong male dental students. Br J Orthod; 21: 57-63. 1994

6. Baik HS, Han HK, Kim DJ, Proffit WR. Cephalometric characteristics of Korean Class III surgical patients and their relationship to plans for surgical treatment. Int J Adult Orthodon Orthognath Surg; 15: 119-128. 2000

7. Chan GK. Class III malocclusion in Chinese: etiology and treatment. Am J Orthod; 65: 152–157. 1974

8. J Jin, J Lin. Prevalences of malocclusion in Chinese children age 9-15. Clinical Dentridty; 6: 57-65. 1985

9. Massler M, Frankel JM. Prevalence of malocclusion in children aged 14 to 18 years. Am J Orthod; 37: 751-768. 1951

10. Thilander B, Myrberg N. The prevalence of malocclusion in Swedish schoolchildren. Scand J Dent Res; 81: 12-21. 1973

11. Foster TD, Day AJ. A survey of malocclusion and the need for orthodontic treatment in a Shropshire school population. Br J Orthod; 1: 73-78. 1974

12. McNamara J A Jr, Behrents R G. Components of Class III malocclusion injuveniles and adolescents. Angle Orthontist; 5 6: 7-30.1986

13. Mills LF. Epidemiological studies of occlusion IV. The prevalence of malocclusion in a population of 1,455 school children. J Dent Res; 45: 332-336. 1966

14. Silva RG, Kang DS. Prevalence of malocclusion among Latino adolescents. Am J Orthod Dentofacial Orthop; 119: 313-315. 2001

15. Fränkel R. Maxillary retrusion in Class III and treatment with the function corrector III. Trans Eur Orthod Soc; 46: 249-259. 1970

16. Graber LW. Chin cup therapy for mandibular prognathism. Am J Orthod; 72: 23-41. 1977

17. Ferro A, Perillo Nucci L, Ferro F, Gallo C. Long-term stabil- ity of skeletal Class III patients treated with splints, Class III elastics, and chincup. Am JOrthod Dentofacial Orthop; 123: 423-434. 2003

18. Rey D, Angel D, Oberti G, Baccetti T. Treatment and posttreat- ment effects of mandibular cervical headgear followed by fixed appliances in Class III malocclusion. Am J Orthod Dentofacial Orthop; 133: 371-378. 2008

19. Delaire J. Le syndrome prognathique mandibulaire. Orthod Fr; 47: 203-219. 1976

20. Potpeschnigg. Deutsche vierteljahrschrift fur zahnheikunde. Monthly Rev Dent Surg; 3:464-465. 1875

21. Delaire J. The crescent maxilla: deductive therapeutics. Trans Eur Orthod Soc;81-102. 1971

22. Petit H. Adaptation following accelerated facial mask therapy. In: McNamara JA Jr, Ribbens KA, Howe PR, editors. Clinical alteration of the growing face. Monograph 14, craniofacial growth series. Ann Arbor: Center for Human growth and Development, University of Michigan; 253- 89. 1983.

23. Ngan P, Yiu C, Hu A, Hägg U, Wei SH, Gunel E. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod; 20: 237-254. 1998.

24. Westwood PV, McNamara JA Jr, Baccetti T, Franchi L, Sarver DM: Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 123:306-320. 2000.

25. Cozza P, Baccetti T, Mucedero M, Pavoni C, Franchi L. Treatment and posttreatment effects of a facial mask combined with a bite-block appliance in Class III malocclusion. Am J Orthod Dentofacial Orthop; 138: 300-310. 2010.

26. Küçükkeleş N,Nevzatoğlu S, Koldaş T. Rapid maxillary expansion compared to surgery for assistance in maxillary face mask protraction. Angle Orthod; 81: 44-51. 2011

27. Vaughn GA, Mason B, Moon HB: Turley PK. The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop; 128: 299–309. 2005.

28. Saadia M, Torres E. Dentoalveolar response after protraction mask and expansion in males and females in the mixed dentition J Clin Pediatr Dent; 25:113-117. 2001.

29. Baccetti T, Franchi L, McNamara JA Jr. Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy. Am J Orthod Dentofacial Orthop; 126: 16-22. 2004.

30. Franchi L, Baccetti T, McNamara JA Jr. Mandibular growth as related to cervical vertebral maturation and body height. Am J Orthod Dentofacial Orthop; 118: 335-340. 2000.

31. Hiyama S, Suda N, Ishii-Suzuki M, Tsuiki S, Ogawa M, Suzuki S, Kuroda T. Effects of maxillary protraction on craniofacial structures and upper-airway dimension. Angle Orthod; 72: 43–47. 2002. 32. Oktay H, Ulukaya E. Maxillary protraction appliance effect on the size of the upper airway passage. Angle Orthod; 78: 209–214. 2008.

33. Kuster R, Ingervall B. The effect of treatment of skeletal open bite with two types of bite-blocks. Eur J Orthod; 14: 489-499. 1992.

34. Baccetti T, Franchi L, McNamara JA Jr. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop; 118: 404–413. 2000.

35. Pangrazio-Kulbersh V, Berger J, Kersten G. Effects of protraction mechanics on the midface. Am J Orthod Dentofac Orthop; 114: 484-491. 1998.

36. Kurt G, Uysal T, Yagci A. Soft and hard tissue profile changes after rapid maxillary expansion and face mask therapy. World J Orthod; 11: e10-18. 2010.

37. Ghiz MA, Ngan P, Gunel E. Cephalometric variables to predict future success of early orthopedic Class III treatment. Am J Orthod Dentofacial Orthop; 127: 301-306. 2005.

38. Lee DY, Kim ES, Lim YK, Ahn SJ. Skeletal changes of maxillary protrac-tion without rapid maxillary expansion. Angle Orthod; 80: 504-510. 2010.

39. Gallagher RW, Miranda F, Buschang PH. Maxillary protraction: treatment and posttreatment effects. Am J Orthod Dentofac Orthop; 113: 612-619. 1998.

40. Kajiyama K, Murakami T, Suzuki A. Comparison of orthodontic and orthopedic effects of a modified maxillary protractor between deciduous and early mixed dentitions. Am J Orthod Dentofacial Orthop; 126: 23–32. 2004.

41. Kim JH, Viana MAG, Graber TM, Omerza FF, BeGole EA. The effec-tiveness of protraction face mask therapy: a meta-analysis. Am J Orthod Dentofacial Orthop; 115: 675-685. 1999.

42. Saadia M, Torres E. Vertical changes in Class III patients after maxillary protraction with expansion in the primary and mixed dentitions. Pediatr Dent;23:125-130.2001.

43. Saadia M, Torres E. Sagittal changes after maxillary protraction with expansion in class III patients in the primary, mixed, and late mixed dentitions: a longitudinal retrospective study. Am J Orthod Dentofacial Orthop;117:669-680. 2000.

44. Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I. Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop; 113: 333–343. 1998.

45. Takada K, Petdachai S, Sakuda M. Changes in dentofacial morphology in skeletal Class III children treated by a modified maxillary protraction head-gear and chin cup: a longitudinal cephalometric appraisal. Eur J Orthod; 15: 211–221. 1993.

46. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop; 113: 204–212. 1998.

47. Suda N, Ishii-Suzuki M, Hirose K, Hiyama S, Suzuki S, Kuroda T. Effec-tive treatment plan for maxillary protraction: is the boneage useful to deter-mine the treatment plan? Am J Orthod Dentofacial Orthop; 118: 55-62. 2000.

48. Kilic ̧oglu H, Kirlic ̧ Y. Profile changes in patients with Class III malocclu-sions after Delaire mask therapy. Am J Orthod Dentofacial Orthop; 113: 453–462. 1998.

49. Gokalp H, Güney V, Kurt G. Late growth period orthopedic therapy versus bimaxillary surgery for correction of skeletal class III. J Craniofac Surg; 21: 741- 747. 2010.

50. León-Salazar V, Janson G, de Freitas MR, de Almeida RR, León-Salazar R. Nonextraction treatment of a skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop; 136: 736-745. 2009.

51. Creekmore TD, Eklund MK. The possibility of skeletal anchorage. J Clin Orthod; 17: 266-269. 1983.

52. Leung MT, Lee TC, Rabie AB, Wong RW. Use of miniscrews and miniplates in orthodontics. J Oral Maxillofac Surg; 66: 1461-1466. 2008.

53. Keles A, Tokmak EC, Erverdi N, Nanda R. Effect of varying the force direction on maxillary orthopedic protraction. Angle Orthod; 72: 387-396. 2002.

54. Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod; 3: 265-274. 1997.

55. Shanker S, Ngan P, Wade D, Beck M, Yiu C, Hagg U, Wei SHY. Cephalo-metric A point changes during and after maxillary protraction and expan-sion. Am J Orthod; 110: 423–430. 1996.

56. Staggers JA, Germane N, Legan H. Clinical considerations in the use of protraction headgear. J Clin Orthod; 26: 87–92. 1992.

57. Gallangher RW, Miranda F, Buschang PH. Maxillary protraction treatment and post treatment effects. Am J Orthod; 113: 612–629. 1998.

58. Hata S, Itoh T, Nakagawa M, Kamogashira K, Ichikawa K, Matsumoto M, Chaconas SJ. Biomechanical effects of maxillary retraction on the cranio-facial complex. Am J Orthod; 91: 305-311. 1987.

59. Nanda R. Biomechanical and clinical considerations of a protraction head-gear. Am J Orthod; 78: 125-139. 1980.

60. Alcan T, Keles A, Erverdi N. The effects of a modified protraction headgear on maxilla. Am J Orthod; 117: 27–38. 2000.

61. Liou EJW. Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis. Prog Orthod; 6: 154-171. 2005.

62. Liou EJ, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J; 42: 121-127. 2005.

63. Chun YS, Jeong SG, Row J, Yang SJ. A new appliance for orthopedic correction of Class III malocclusion. J Clin Orthod; 33: 705-711. 1999.

64. Kircelli BH, Pektaş ZO, Uçkan S. Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia. Angle Orthod; 76: 156-163. 2006.

65. Tung AW, Kiyak HA. Psychological influences on the timing of orthodontic treatment. Am J Orthod Dentofacial Orthop; 113: 29-39. 1998.

66. Xue SA, Lam CW, Whitehill TL, Samman N. Effects of Class III maloc-clusion on young male adults’ vocal tract development: a pilot study. J Oral Maxillofac Surg; 69: 845-852. 2011.

67. Delaire J. Maxillary development revisited: relevance to the orthopaedic treatment of Class III malocclusions. Eur J Orthod; 19: 289-311. 1997.

68. Kama JD, Ozer T, Baran S. Orthodontic and orthopaedic changes associ-ated with treatment in subjects with Class III malocclusions. Eur J Orthod; 28: 496-502. 2006.

69. Turley PK. Managing the developing Class III malocclusion with palatal expansion and facemask therapy. AmJ Orthod Dentofacial Orthop; 122: 349- 352. 2002.

70. Cha KS. Skeletal changes of maxillary protraction in patients exhibiting skeletal Class III malocclusion: a comparison of three skeletal maturation groups. Angle Orthod; 73: 26-35. 2003.

71. Cornelis MA, Scheffler NR, Mahy P, Siciliano S, De Clerck HJ, Tulloch JF. Modified miniplates for temporary skeletal anchorage in orthodontics: placement and removal surgeries. J Oral Maxillofac Surg; 66: 1439-1445. 2008.

72. Kokich VG, Shapiro PA, Oswald R, Koskinen-Moffett L, Clarren SK. Ankylosed teeth as abutments for maxillary protraction: a case report. Am J Orthod; 88: 303-307. 1985.

73. Smalley WM, Shapiro PA, Hohl TH, Kokich VG, Branemark PI. Osse-ointegrated titanium implants for maxillofacial protraction in monkeys. Am J Orthod Dentofacial Orthop; 94: 285-295. 1988.

74. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results. Am J Orthod Dentofacial Orthop; 133: 440-449. 2008.

75. Zhou YH, Ding P, Lin Y, Qiu LX. Facemask therapy with miniplate implant anchorage in a patient with maxillary hypoplasia. Chin Med J; 120: 1372-1375. 2007.

76. Cha BK, Choi DS, Ngan P, Jost-Brinkmann PG, Kim SM, Jang IS. Maxil-lary protraction with miniplates providing skeletal anchorage in a growing Class III patient. Am J Orthod Dentofacial Orthop; 139: 99-112. 2011.

77. Baek SH, Kim KW, Choi JY. New treatment modality for maxillary hypo-plasia in cleft patients. Protraction facemask with miniplate anchorage. Angle Orthod; 80: 595-603. 2010.

78. Tanne K, Matsubara S, Sakuda M. Location of the centre of resistance for the nasomaxillary complex studied in a three dimensional finite element model. Br J Orthod; 22: 227–232. 1995.

79. Cheng SJ, Tseng IY, Lee JJ, Kok SH. A prospective study of the risk factors associated with failure of mini-implants used for orthodontic anchorage. Int J Oral Maxillofac Implants; 19: 100-106. 2004.

80. De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC, Tulloch CJ. Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency. J Oral Maxillofac Surg; 67: 2123-2129. 2009.

81. Heymann GC, Cevidanes L, Cornelis M, De Clerck HJ, Tulloch JF. Three-dimensional analysis of maxillary protraction with intermaxillary elastics to miniplates. Am J Orthod Dentofacial Orthop; 137: 274-284. 2010.

82. De Clerck EE, Swennen GR: Success rate of miniplate anchorage for bone anchored maxillary protraction. Angle Orthod; 81: 1010-1013. 2011.

83. De Clerck H, Cevidanes L, Baccetti T. Dentofacial effects of bone-an-chored maxillary protraction: a controlled study of consecutively treated Class III patients. Am J Orthod Dentofacial Orthop; 138: 577-581. 2010.

84. Baccetti T, De Clerck HJ, Cevidanes LH, Franchi L: Morphometric anal-ysis of treatment effects of bone-anchored maxillary protraction in growing Class III patients. Eur J Orthod; 33: 121-125. 2011.

85. Cornelis MA, Scheffler NR, Nyssen-Behets C, De Clerck HJ, Tulloch JF. Patients’ and orthodontists’ perceptions of miniplates used for temporary skeletal anchorage: a prospective study. Am J Orthod Dentofacial Orthop; 133: 18-24. 2008.

86. Cevidanes L, Baccetti T, Franchi L, McNamara JA Jr, De Clerck H. Compar-ison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion. Angle Orthod; 80: 799-806. 2010.

87. Sar C, Arman-Özçırpıcı A, Uçkan S, Yazıcı AC. Comparative evaluation of maxillary protraction with or without skeletal anchorage. Am J Orthod Dentofacial Orthop; 139: 636-649. 2011.