No abstract

Both treatment modalities were successful in moving the maxilla forward, proclining the maxillary incisors and retroclining the mandibular incisors. The more simple design of the tongue plate might therefore confer some advantages to this system in comparison with a facemask.

Both face mask and reverse chin cup appliances are successful at moving the maxilla forward.

Introduction. Numerous devices have been introduced for correction of Class III malocclusion and maxillary deficiency. Aim. To assess the dentoskeletal effects of miniplates combined with Class III traction in treating Cl III malocclusion and maxillary deficiency in growing patients. Methods. This case describes the treatment of a maxillary-deficient 11-year-old boy by using miniplates. The patient's parents rejected the use of extraoral appliances and major surgical correction; therefore the treatment was done by using Class III elastics connected from two mandibular miniplates to an upper removable appliance. Two miniplates were inserted in the anterior part of the mandible in the canine areas under local anaesthesia. The treatment lasted for 10 months after which favourable correction of the malocclusion was observed. Results. The SNA and ANB angles increased by 5.1° and 4.4°, respectively. Lower 1 to mandibular plane decreased by 3.4°. Conclusions. This case demonstrates that miniplates can be a suitable method to extraoral appliances and major surgery in maxillary deficiency cases.

This case report illustrates the treatment of a 12-year-old boy with maxillary deficiency using miniscrew implants. The patient rejected the use of extraoral appliances and future surgical correction; therefore the patient was treated using Class III elastics connected from two mandibular miniscrew implants to an upper removable appliance. The miniscrews were inserted between the permanent canines and first premolars under local anaesthesia. The treatment lasted for 8 months after which favourable correction of the malocclusion was observed. The SNA and ANB angles increased by 3 degrees and the IMPA increased by 4 degrees . This case demonstrates that miniscrews can be a suitable alternative method to extraoral appliances and possibly surgery in mild Class III cases.

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13+/-2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9+/-1.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.

The purpose of this study was to compare the effects of a differently designed functional appliance (the R-appliance) with a twin-block (TB)-treated group. Thirty patients (18 girls and 12 boys) with a mean age of 10.5±0.7 years were treated with the R-appliance for 16.2±0.3 months and 25 (11 boys and 14 girls) with a mean age of 11.2±1.3 years with a TB for 16.1±1.4 months (control). All had a Class II division 1 malocclusion due to mandibular deficiency. Lateral cephalograms obtained at the beginning (T1) and end (T2) of the study were analysed. Paired t-tests showed that SNB significantly increased in both groups. The incisor mandibular plane angle (IMPA) was reduced in the R-appliance group by 1.9±4.9 degrees (P<0.04) but increased by 0.5±5.1 degrees (P<0.6) in the TB group. SNA in the R-appliance group showed an increase of 0.2±1.8 degrees (P<0.5), while it was decreased by 0.2±1.3 degrees (P<0.3) in the TB group. Both treatment modalities were successful in moving the mandible forward. However, with the R-appliance, this was achieved without retroclination of the lower incisors.

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate. The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.