Comparison of the effects of maxillary protraction using facemask and miniplate anchorage between unilateral and bilateral cleft lip and palate patients

Abstract

Objective: To determine the difference in the effects of facemask with miniplate (FM-MP) anchorage on maxillary protraction in growing cleft patients between unilateral (UCLP) and bilateral cleft lip and palate (BCLP) groups. Materials and Methods: The samples consisted of a UCLP group (N 5 15, 13 boys and 2 girls; mean age 10.98 years; mean protraction duration 2.37 years) and a BCLP group (N 5 15, all boys; mean age 11.42 years; mean protraction duration 2.36 years), who were treated with the same surgical technique (rotation and advancement flap and double opposing Z-plasty) by one surgeon and with FM-MP by one orthodontist. Lateral cephalograms were taken before (T1) and after FM-MP (T2). Fourteen skeletal and dental variables were measured. Independent and paired t-tests were performed for statistical analysis. Results: There were no differences in mean age and values of variables at the T1 stage and in the duration of protraction between the two groups. The BCLP group showed less advancement of point A than the UCLP group (DA-vertical reference plane, 2.51 mm vs 4.06 mm, P , .05; DA-N perpendicular, 0.79 mm vs 2.26 mm, P , .05; DSNA, 0.45u vs 2.85u, P , .01). Since counterclockwise rotation of the palatal plane in two groups was minimal (20.36u vs 20.87u), no difference was observed with regard to clockwise rotation of the mandible (0.46u vs 20.07u). There were no differences in the degree of labioversion of the maxillary incisor (8.16u vs 7.10u), linguoversion of the mandibular incisor (22.66u vs 22.14u), and increase in overjet (5.39 mm vs 5.70 mm) between the two groups. Conclusion: In FM-MP therapy of growing cleft patients under the conditions of this study, the UCLP group shows a more favorable change in maxillary advancement than the BCLP group. (Angle Orthod. 2012;82:935-941.)

Asymmetric Maxillary Protraction for Unilateral Cleft lip and Palate Patients Using Finite Element Analysis

“…Numerous studies have shown that face mask has been applied to treat growing cleft lip and palate patients with mild-to-moderate maxillary hypoplasia. [3][4][5][6]14,15 Conventionally, a value of 5-N orthopedic force was applied in a direction that was 30 degrees downward and forward to the occlusal plane on the region of alveolar of maxillary canine. 8,16 Facial and skeletal balance improvement has been the main aim of contemporary orthodontics-dentofacial orthopedic treatment in patients with complete UCLP.…”

“…[3][4][5][6] Recent studies revealed that the biomechanic effects of maxillary protraction on the craniofacial skeleton in cleft patients have not been well elucidated clinically and experimentally by using a finite element method (FEM), unlike those of noncleft patients. [7][8][9] The underlying mechanism of finite element analysis (FEA) on maxillary protraction for patients with UCLP is still unbeknown.…”

Comparison of skeletal anchored facemask and tooth-borne facemask according to vertical skeletal pattern and growth stage

“…Although the rotation pattern is beneficial for low-angle, deep-bite Class III patients, many studies 20,21 have demonstrated that facemasks were contraindicated in Class III patients with high angle facial type or openbite. In order to eliminate this counterclockwise rotation effect, various locations have been used for force application 7,22,23 : the canine region, premolar, and deciduous molar region. Nonetheless, those trials showed that the counterclockwise rotation of the maxilla was inevitable after facemask use.…”

Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate:

“…2 Protraction facemask therapy is the most common approach for early treatment of these patients. 3 It has many drawbacks, including unwanted dentoalveolar effects and the excellent compliance needed with a troublesome extraoral appliance for satisfactory outcomes.…”