Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction—A 3.5-Year Follow-Up

Abstract

This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.

Early orthognathic surgery with postsurgical bone-anchored retention in unilateral cleft lip and palate: A case report

“…A slight opening of the gonial angle was also observed during the follow-up period (+2.9º). This result is in disagreement with previous studies with BAMP therapy in patients with UCLP showing gonial angle closure in adolescents (Faco et al, 2019; Garib et al, 2018; Steegman et al, 2021; Yatabe et al, 2017b). The mandibular length increased due to mandibular growth during the follow-up period.…”

“…A counterclockwise rotation of mandibular plane and a decrease of the gonial angle was also observed (Faco et al, 2019; Ren et al, 2019; Steegman et al, 2021; Yatabe et al, 2017b). Although the orthopedic effect of BAMP is effective to treat mild to moderate maxillary deficiencies, patients with more severe sagittal discrepancies usually need Le Fort I surgery with maxillary advancement (Faco et al, 2019; Ren et al, 2019; Steegman et al, 2021). In view of this problem, the combination of early orthognathic surgery, performed at puberty followed by retention with Class III elastics anchored on miniplates until the end of growth, might be an option to anticipate an improvement in aesthetics, function and quality of life.…”

“…BAMP therapy produced an increase in Wits appraisal and overjet of 2.5 mm and 2.3 mm, respectively (Faco et al, 2019). A counterclockwise rotation of mandibular plane and a decrease of the gonial angle was also observed (Faco et al, 2019;Ren et al, 2019;Steegman et al, 2021;Yatabe et al, 2017b). Although the orthopedic effect of BAMP is effective to treat mild to moderate maxillary deficiencies, patients with more severe sagittal discrepancies usually need Le Fort I surgery with maxillary advancement (Faco et al, 2019;Ren et al, 2019;Steegman et al, 2021).…”

Orthognathic surgery past, present, and future

“…How an individual patient will respond remains unpredictable. Efforts are now underway to use BAMP in cleft and other craniofacial patients, where stability is a large concern with traditional orthognathic surgery [46]. Stability is still being examined, and a better understanding will become available as studies conclude.…”

Roadmap for daily practice of CBCT in cleft lip palate paediatric patients: a pictorial review.

“…The CBCT was mainly used in CLP patients to study the secondary alveolar bone grafting . CBCT was also used to evaluate maxillary expansion in CLP patients [6,[30][31][32][33][34][35][36]. Moreover, CBCT was also used in various anatomical studies related with CLP patients: 1) Three-dimensional (3D) analysis of craniofacial structures [3,29,37], and of facial asymmetry [29,38,39]; 2) mandible [3,29,40,41]; 3) sella turcica [42]; 4) pharyngeal airway volume [3,[43][44][45][46][47][48]; 5) cortical bone thickness around the cleft area [26,27,29,49]; 6) palatal morphology and soft tissue depth [6,28,29,50,51]; 7) maxillary sinus volume [29,52,53]; 8) nasal morphology [3,29,54], and nasal airway [55]; 9) canine eruption through the alveolar graft bone [3,4,6,…”