Orthopedic Traction of the Maxilla With Miniplates: A New Perspective for Treatment of Midface Deficiency

Abstract

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, often resulting in an anterior crossbite and a concave profile. 1 Young patients with maxillary hypoplasia are usually treated with a facemask: heavy anterior traction is applied on the maxilla to stimulate its growth and to restrain or redirect mandibular growth. Forward and downward movement of the maxilla as well as favorable changes in the amount and direction of mandibular growth has been reported. [2][3][4][5] However, these forces generally result in a posterior rotation of the mandible and an increased vertical dimension of the face. 2,4,6 Moreover, dental compensations (proclination of the upper incisors and uprighting of the lower incisors) are observed as a consequence of the application of forces on the teeth, 4,7 and facemask wear is usually limited to 14 hours per day at best. Titanium miniplates used for anchorage now offer the possibility to apply pure bone-borne orthopedic forces between the maxilla and the mandible for 24 hours per day, avoiding any dentoalveolar compensations.

Orthopaedic Protraction of the Maxilla with Miniplates: Treatment of Midface Deficiency

“…However, dentoalveolar compensations rather than alterations of the facial growth were mostly responsible for the improvement seen in the dental arch relationships [2]. To eliminate the dental side effects, titanium miniplates shown to be well tolerated by patients can now be used to apply orthopaedic forces [7].…”

“…A comparison of two protocols for maxillary protraction highlighted some clinical aspects: the face mask protocol requires the appliance to be worn for fewer hours per day but the face mask is more bulky and less easily tolerated than intraoral class III elastics [10]. It is generally recommended that facemask therapy be started before the age of 8 years [2]. Currently 2 types of TSADs are used: screw implants and bone plates [9].…”

“…Miniplate placement surgery in young patients is complicated by the reduced height of the maxillary alveolar bone, cannot be placed before mandibular canine eruption, orthopaedic traction on miniplates usually cannot be started before the age of 10 years [2,10]. The location of miniplates, point of exposure to the oral cavity is absolutely critical [2,6].…”

“…The location of miniplates, point of exposure to the oral cavity is absolutely critical [2,6]. A higher exposure point may lead to mucosal irritation, inflammation and hypertrophy.…”

“…Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile [2]. Treatment of young patients with maxillary deficiency is generally directed towards achieving positive overjet through a combination of dentoalveolar and skeletal effects.…”