The Effects of Two Different Daily Use Protocols in Skeletally Anchored Face-Mask Therapy on Maxilla

Abstract

ABSTRACT: This study aimed to compare the effects of two different daily use periods on the maxilla during maxillary protraction. This study was conducted on pre (T0) and post (T1) lateral cephalograms of 38 patients with skeletal Class III malocclusion treated with a miniplate anchored maxillary protraction appliance. The patients were divided into two groups on the basis of their daily appliance wearing time. The first group consisted of 19 patients (ten females, nine males; mean age 11.48±1.30 years) who used their appliance all day to provide continuous force (C.F. group). In the second group, 19 patients (twelve females, seven males; mean age 10.47±1.54 years) used their appliance for approximately 14 hours daily to provide intermittent force (IF group). Intragroup comparisons were performed with paired t tests and Wilcoxon tests, and intergroup comparisons were performed with the Mann‒Whitney U test. Significant forward movement of the maxilla was observed in both groups; however, the changes in the sagittal position of the maxilla were similar between the two groups. In the C.F. group, the treatment duration was 12.71 months, and in the IF group, it was 12.13 months, which was not significant. Full-time and part-time wearing of an extraoral appliance results in similar treatment outcomes. Therefore, breaks in wearing protraction devices during daily life might keep patients more cooperative for treatment.

Keywords

• Extraoral traction appliances
• orthodontic anchorage techniques
• orthodontic appliances

References

1. 1. Grandori F, Merlini C, Amelotti C, Piasente M, Tadini G, Ravazzani P. A mathematical model for the computation of the forces exerted by the facial orthopedic mask. Am J Orthod Dentofacial Orthop. 1992;101:441-8.
2. 2. Yepes E, Quintero P, Rueda ZV, Pedroza A. Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion. Eur J Orthod. 2014;36:586-94.
3. 3. Tanne K, Sakuda M. Biomechanical and clinical changes of the craniofacial complex from orthopedic maxillary protraction. Angle Orthod. 1991;61:145-52.
4. 4. Suda N, Ishii-Suzuki M, Hirose K, Hiyama S, Suzuki S, Kuroda T. Effective treatment plan for maxillary protraction: is the bone age useful to determine the treatment plan? Am J Orthod Dentofacial Orthop.2000;118:55-62.
5. 5. 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.2004;126:23-32.
6. 6. Ngan PW, Hagg U, Yiu C, Wei SH. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod. 1997;3:255-64.
7. 7. Merwin D, Ngan P, Hagg U, Yiu C, Wei SH. Timing for effective application of anteriorly directed orthopedic force to the maxilla. Am J Orthod Dentofacial Orthop. 1997;112:292-9.
8. 8. 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. 2000;117:669-80.

9. 9. Tortop T, Keykubat A, Yuksel S. Facemask therapy with and without expansion. Am J Orthod Dentofacial Orthop. 2007;132:467-74.
10. 10. 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. 2005;128:299-309.
11. 11. Graber TM, Vanarsdall RL.Orthodontics: current principles and techniques. 3rd ed. St Louis; Mosby: 2000.
12. 12. Mao JJ. Mechanobiology of craniofacial sutures. J Dent Res. 2002;81:810-6.
13. 13. Cederquist R. Degree of stability following experimental alteration of midfacial growth with heavy intermittent force (proceedings). Proc Inst Med Chic. 1978;32:50-51.
14. 14. 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. 2009;67:2123-9.
15. 15. Kaya D, Kocadereli I, Kan B, Tasar F. Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study. Angle Orthod. 2011;81:639-46.
16. 16. Sar C, Arman-Ozcirpici A, Uckan S, Yazici AC. Comparative evaluation of maxillary protraction with or without skeletal anchorage. Am J Orthod Dentofacial Orthop. 2011;139:636-49.
17. 17. Kircelli BH, Pektas ZO, Uckan S. Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia. Angle Orthod. 2006;76:156-63.
18. 18. Lee NK, Yang IH, Baek SH. The short-term treatment effects of face mask therapy in Class III patients based on the anchorage device: miniplates vs rapid maxillary expansion. Angle Orthod. 2012;82:846-52.
19. 19. Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Evans CA. Comparative evaluation of 2 skeletally anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop. 2016;150:751-62.
20. 20. Keles A, Tokmak EC, Erverdi N, Nanda R. Effect of varying the force direction on maxillary orthopedic protraction. Angle Orthod. 2002;72:387-96.
21. 21. Hata S, Itoh T, Nakagawa M, Kamogashira K, Ichikawa K, Matsumoto M, Chaconas SJ. Biomechanical effects of maxillary protraction on the craniofacial complex. Am J Orthod Dentofacial Orthop. 1987;91:305-11.
22. 22. Liu SS, Kyung HM, Buschang PH. Continuous forces are more effective than intermittent forces in expanding sutures. Eur J Orthod. 2010;32:371-80.
23. 23. Frost HM. A determinant of bone architecture. The minimum effective strain. Clin Orthop Relat Res. 1983;286-92.
24. 24. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results. Am J Orthod Dentofacial Orthop. 2008;133:440-449.
25. 25. Billiet T, de Pauw G, Dermaut L. Location of the centre of resistance of the upper dentition and the nasomaxillary complex. An experimental study. Eur J Orthod 2001;23:263-73.
26. 26. Lee HS, Choi HM, Choi DS, Jang I, Cha BK. Bone thickness of the infrazygomatic crest area in skeletal Class III growing patients: A computed tomographic study. Imaging Sci Dent. 2013;43:261-6.
27. 27. De Clerck H, Geerinckx V, Siciliano S. The Zygoma Anchorage System. J Clin Orthod. 2002;36:455-9.
28. 28. 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. 1998;113:204-12.
29. 29. Yuksel S, Ucem TT, Keykubat A. Early and late facemask therapy. Eur J Orthod. 2001;23:559-68.
30. 30. Sar C, Sahinoglu Z, Ozcirpici AA, Uckan S. Dentofacial effects of skeletal anchored treatment modalities for the correction of maxillary retrognathia. Am J Orthod Dentofacial Orthop. 2014;145:41-54.
31. 31. De Clerck H, Cevidanes L, Baccetti T. Dentofacial effects of bone-anchored maxillary protraction: a controlled study of consecutively treated Class III patients. Am J Orthod Dentofacial Orthop. 2010;138:577-81.
32. 32. Cevidanes L, Baccetti T, Franchi L, McNamara JA, Jr., De Clerck H. Comparison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion. Angle Orthod. 2010;80:799-806.
33. 33. Coscia G, Addabbo F, Peluso V, D'Ambrosio E. Use of intermaxillary forces in early treatment of maxillary deficient class III patients: results of a case series. J Craniomaxillofac Surg. 2012;40:e350-4.
34. 34. Cha BK, Ngan PW. Skeletal Anchorage for Orthopedic Correction of Growing Class III Patients. Semin Orthod. 2011;17:124-37.