Does surgically assisted maxillary protraction with skeletal anchorage and Class III elastics affect the pharyngeal airway? A retrospective, long-term study.

Objective: Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods: The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results: The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions: No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.

Occlusal plane rotation and orthodontic decompensation: influence on the outcome of surgical correction of class III malocclusion.

PURPOSE: The aim of this retrospective multicenter study is to evaluate the influence of surgical manipulation of the upper occlusal plane (UOP) and orthodontic decompensation on the outcome of class III orthognathic surgery. METHODS: Incisor inclinations, occlusal plane inclination as well as skeletal and soft tissue changes were assessed in lateral cephalograms of 85 class III patients who had previously undergone orthognathic surgery. Fourteen linear and eight angular measurements were performed on each radiograph at the beginning of treatment (T0), before surgery (T1) and at the end of treatment (T2) using imaging software. After measurement of variables, Mann-Whitney U­test, repeated-measures analysis of variance (ANOVA) with Bonferroni multiple comparison test, and Spearman's correlation analysis were performed. RESULTS: A statistically significant improvement was observed in both sagittal skeletal and soft tissue measurements (p < 0.05). Surgical change in UOP was significantly correlated with changes in overbite, upper lip strain and soft tissue B­point change in the sagittal direction (p < 0.05). Overjet change was significantly correlated with changes in the soft tissue and all sagittal skeletal parameters except for SNA. Changes in the incisor inclinations was significantly correlated with changes in the sagittal skeletal parameters and lower facial height. Significant differences were also observed between the groups with induced clockwise or counterclockwise rotation of the mandible in terms of IMPA (long axis of LI to mandibular plane), overbite, upper lip strain and position of soft tissue B­point (p < 0.05). CONCLUSION: Sufficient dental decompensation is crucial for controlling the sagittal as well as the vertical relationship during surgery. Counterclockwise rotation provides an increase in sagittal projection of the mandibular body at the soft tissue B­point.

Changes in the Mandible Following Rapid Maxillary Expansion in Children with Class II Malocclusion: A Systematic Review.

OBJECTIVE: The aim of this systematic review was to determine whether rapid maxillary expansion (RME) allows favorable changes in the mandible during the treatment of class II malocclusion before the growth spurt. METHODS: A search of Pubmed/Medline, the Science Direct, and the Google Scholar database was performed. The keywords used were: orthodontics, rapid maxillary expansion, class II, and growing patients. Relevant articles were assessed for quality according to Cochrane guidelines, and then changes in SNA, SNB, ANB, NL-NSL (or SN-SNP.SNA), and ML-NSL (or SN-Go-Gn) relationships were analyzed. RESULTS: The selection process brought forth five articles, including 162 patients (91 females, 71 males) for detailed analysis. The quality of the evidence (GRADE) for comparisons and outcomes was assessed as moderate for SNB and ANB and as low or very low for other variables. CONCLUSIONS: The results of this systematic review showed that there is a small body of moderate-quality evidence for statistically and clinically favorable changes in SNB and ANB angles and a small body of low-quality evidence for changes in vertical parameters after RME.

The Effects of Occlusal Plane Inclination and Dental Decompensation on the Overall Result of Surgical Correction of Class II Malocclusion.

PURPOSE: To evaluate the effects of upper occlusal plane (UOP) inclination and incisor decompensations on the outcome of surgical Class II patients. MATERIALS AND METHODS: Pretreatment (T0), preoperative (T1), and posttreatment (T2) cephalograms of 30 surgical Class II patients were included. Cephalometric measurements were performed using the Dolphin Imaging Software in this retrospective study. The differences between time points were analyzed with repeated measures ANOVA. Spearman correlation test was used to determine any correlations between either the UOP alterations or incisor decompensations and the cephalometric variables. RESULTS: A significant improvement was obtained in the sagittal skeletal, dental variables, and soft tissue B point. Significant correlations were found between the decompensation achievement ratio and the change of the convexity angle. The relative percentage ratio (RPR) of the lower incisor was correlated with Wits appraisal, ANB, and Convexity Angle at the T2 stage. The RPR of the upper incisor was found to be correlated with lip strain. The relative surgical correction ratio of the UOP angle was found to be correlated with the surgical change of Wits appraisal and convexity angle. The RPR of the UOP angle was correlated with the SNB, ANB, and SN-GOGN angles at the T2 stage. CONCLUSIONS: Significant improvement in the incisor inclinations was achieved, but the incisors were inadequately decompensated at the preoperative phase. Surgical correction was limited by the inadequate presurgical decompensation. The surgical alteration of the UOP should be taken into consideration for the surgical planning to obtain better outcomes for Class II patients.

Do we pay for maxillary protraction? Evaluation of the effects of Alt-RAMEC protocol and face mask treatment on root development.

OBJECTIVES: To evaluate root development of pediatric patients treated with Alt-RAMEC + Face mask therapy. MATERIAL AND METHODS: The 19 subjects (9 girls, 10 boys; mean age: 8.6 ± 1.1 years) treated with Alt-RAMEC and a Petit-type face mask were included to the study. The cone-beam tomography (CBCT) records of these patients were used to quantify the root length. The root length measurements of 456 permanent teeth (maxillary-mandibular incisors, canines, premolars, and first molars) were performed at the beginning of the treatment (T0), after the Alt-RAMEC protocol (T1), and at the end of the face mask treatment (T2) using Planmeca Romexis software. RESULTS: Tooth length values increased significantly in the maxillary teeth except the central incisors, left lateral incisor, the palatal root of the right first molar, and distal and palatinal roots of the left first molar (p < 0.05). Mandibular teeth also showed significant increase in the root length except mandibular central incisors and the distal root of left first molar (p < 0.05). The change in tooth lengths from T0 to T1 showed positive delta values. The comparison of the change in tooth lengths after the Alt-RAMEC protocol and after the face mask therapy showed that ∆T2-T1 was statistically significantly higher compared with ∆T1-T0 (p < 0.05). CONCLUSIONS: Alt-RAMEC + Face mask therapy seem not to inhibit root development of maxillary and mandibular teeth in the mixed dentition. CLINICAL RELEVANCE: These findings suggest that early Alt-RAMEC + Face mask interventions have not played a negative role in root development. However, further studies involving a control group need to be performed.

Maturity evaluation of orthodontically important anatomic structures with computed tomography.

BACKGROUND/OBJECTIVES: The success of the orthopaedic treatment is closely related to the patient's skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified. SUBJECTS/METHODS: The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient's age: 7-10, 11-13, 14-16, 17-20, 21-25, and 26-30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0. RESULTS: A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS-ZMS: r = 0.816, MPS-SOS: r = 0.736, ZMS-SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS-palatal thickness: r = 0.405, MPS-palatal length: r = 0.387, P = 0.000). CONCLUSIONS: A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS-PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.

Effect of piezocision on molar intrusion in open-bite treatment using a modified MEAW technique.

PURPOSE: The aim of this retrospective study was to investigate whether a piezocision technique influences molar intrusion in open-bite cases. METHODS: In all, 30 patients with open-bite malocclusion were assigned to one of two groups: the piezocision group comprised 15 patients who were treated using curved arches and anterior elastics with the simultaneous combination of piezocision which was performed interdentally in the upper posterior region, while the control group comprised 15 patients who were treated with the same treatment mechanics without piezocision. In both groups, after leveling and aligning, upper 0.017â€¯× 0.025 accentuated curve and lower 0.017â€¯× 0.025 reversed curve of Spee NiTi archwires were placed. Anterior vertical elastics were applied between laterals and the canines on both sides. The effects of treatments were investigated on cone-beam computed tomography images acquired before use of elastics and after correction of open-bite. RESULTS: Open-bite closure was achieved in 2.85 ± 0.85 and 4.1 ± 1.58 months in the piezocision and control groups, respectively, while total treatment lasted 1.4 ± 0.42 and 1.7 ± 0.43 years, respectively. Extrusion of lower posterior teeth (p < 0.05) was observed together with extrusion of incisors and canines (p < 0.001) in the piezocision group, while only incisors and canines were extruded in the control group (p < 0.001). There were no significant differences between the groups (p > 0.05) except significant lower incisor extrusion (p < 0.05) and counter-clockwise rotation of the lower occlusal plane in the piezocision group (p < 0.001). CONCLUSION: The duration of open-bite correction was significantly shorter in the piezocision group. No molar intrusion was observed in either group. Open bite correction was achieved mainly by extrusion and retrusion of the incisors while maintaining upper molar positions.

In-vitro evaluation of the effects of insertion and sterilization procedures on the mechanical and surface characteristics of mini screws.

PURPOSE: The aim of the present study was to investigate the effects of insertion and sterilization on primary stability and to examine the mechanical and surface characteristics of mini screws. MATERIALS AND METHODS: 140 miniscrews (70 Dual-Top; 70 Ortho-Easy) were divided into 3 groups. Group 1: control group, 10 miniscrews of each brand, evaluated without any primary procedure. Group 2: 30 miniscrews of each brand, each inserted into the sawbone once, then sterilized and tested. Group 3: 30 miniscrews of each brand, each inserted into the sawbone twice, sterilized after each insertion and then tested. The miniscrews were evaluated for changes in primary stability, mechanical and surface characteristics with scanning electron microscopy (SEM) analysis, torsion tests, maximum insertion-removal torques and vertical-horizontal pull out strength tests. RESULTS: The maximum insertion torque values of the unused miniscrews (Group 1) were found to be significantly higher than those of the reused (Groups 2, 3) mini screws (p<0.05). Removal torque, vertical-horizontal pull-out strength and torsional strength value changes were found to be statistically insignificant. In SEM analysis, wear and atrophy were seen on the threads of used miniscrews especially in the apical region and the oxide layer was seen to have disappeared from some regions of the coated miniscrews. CONCLUSION: Although wear and atrophy were detected in SEM analysis of used miniscrews, the overall primary stability and fracture torque resistance tests did not show any significant changes after the first and second insertion and sterilization procedures.

Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy.

OBJECTIVE: The aim of this retrospective study was to evaluate and compare the changes in the pharyngeal airway (PA), maxillary sinus volume, and skeletal parameters after rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy. METHODS: The records of 40 patients with skeletal Class III malocclusion due to maxillary retrognathism were collected, and the patients were assigned into two groups. The first group comprised 8 male and 12 female patients (mean age, 10.0 ± 1.1 years) treated using RME/FM for an average of 10 months. The second group comprised 10 male and 10 female patients (mean age, 9.64 ± 1.3 years) treated using Alt-RAMEC/FM for an average of 12 months. Cone-beam computed tomography images acquired before (T0) and after treatment (T1) were evaluated. RESULTS: Regarding the skeletal effects, significant differences between the groups were the increase in ANS-HRP (perpendicular distance of ANS to the horizontal reference plane, 0.99 mm, p <0.05) in the Alt-RAMEC/FM group and the decrease in PP-SN (palatal plane to Sella-Nasion plane, 0.93°, p < 0.05) in the RME/FM group. Maxillary sinus volumes increased significantly in both the groups, and the increase was statistically significantly higher in the Alt-RAMEC/FM group. Although no significant intergroup differences were observed in PA volumes, both lower (1,011.19 mm3) and total (1,601.21 mm3), PA volume increased significantly in the Alt-RAMEC/FM group. CONCLUSIONS: The different expansion devices and protocols used with FM therapy do not seem to affect the forward movement of the maxilla and PA volumes. In contrast, the increase in maxillary sinus volume was greater in the Alt-RAMEC/FM protocol.

Three-dimensional evaluation of open-bite patients treated with anterior elastics and curved archwires.

INTRODUCTION: One nonsurgical treatment method for a patient with open bite is to use curved nickel-titanium arches and anterior elastics. The aim of this study was to investigate the effects of this technique with cone-beam computed tomography. METHODS: Eighteen open-bite patients' treatment records were used for this retrospective study. The treatment methods were identical for all patients, beginning with the levelling and alignment of the teeth and the placement of maxillary accentuated and mandibular reverse curved archwires with anterior elastics. Cone-beam tomography images were taken and analyzed 3 dimensionally. The paired-samples t test statistical analysis was performed. RESULTS: A-point moved anteriorly (0.33 mm) and the SN-MP angle increased slightly (1.17°). Maxillary and mandibular incisors were extruded by 2.16 and 1.49 mm, respectively. Overbite increased (4.38 mm). There were no significant changes in the vertical parameters of the premolars and molars. CONCLUSIONS: The open bite was eliminated by retraction and extrusion of the anterior teeth while maintaining the vertical positions of the molars.

Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study.

Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal-dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm(3); P < 0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P < 0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P > 0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P > 0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient's age.

Corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics.

OBJECTIVE: To analyze the treatment effects of corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics in patients with Class III malocclusions. MATERIALS AND METHODS: The study group consisted of 19 patients with a mean age of 13.12 ± 1.28 years. Initially, patients were monitored for 5 months before treatment to evaluate growth changes. Changes during control, protraction and fixed orthodontic treatment periods were compared with the cephalometric radiographs taken initially, before protraction, after protraction, and after fixed orthodontic treatment. Treatment outcomes also were compared with the growth effects. RESULTS: Sagittal measurements of maxilla showed significant improvements (3.59 ± 1.32 mm) during the protraction period (3.85 ± 1.12 months) whereas no significant changes were seen during the control period. Upper and lower incisor inclinations were increased, and the upper occlusal plane angle showed significant counterclockwise rotation during protraction. Significant soft-tissue changes also reflected the underlying skeletal changes. Maxillary advancement was stable during fixed orthodontic treatment. CONCLUSION: Compared with control period of the patients, this protocol produced significant improvements in skeletal and soft-tissue structures.

Long-term results of surgically-assisted maxillary protraction.

OBJECTIVE: The long-term treatment results of surgically-assisted facemask therapy were assessed by a comparison of the immediate protraction effects with those seen at five years review. MATERIALS AND METHODS: Nine patients treated with a corticotomy-assisted maxillary protraction protocol were recalled five years following protraction. Cephalometric films taken before treatment (T0), immediately after maxillary protraction (T1) and five years after treatment (T2) were compared. RESULTS: The short-term results of surgically-assisted facemask therapy showed significant skeletal and soft tissue changes. After five years, the profile and dental relationships were well maintained and a cephalometric analysis revealed a stable vertical increase but only partially maintained soft tissue changes with loss of sagittal advancement. There was significant upper incisor proclination providing dental camouflage. CONCLUSION: Patients who are treated with corticotomy-assisted maxillary advancement should be very carefully selected. Assessment criteria include a low mandibular plane angle Class III patients who have severe maxillary retrognathism unable to be treated by conventional orthopaedic correction alone; patients who have almost completed growth and missed the chance of earlier orthopaedic correction, as well as patients who are not willing to accept bimaxillary orthognathic surgery, may be successfully treated.

Long-term results of surgically assisted maxillary protraction vs regular facemask.

OBJECTIVE: To evaluate the short- and long-term treatment results of rapid maxillary expansion (RME) and surgical assistance during maxillary protraction with a facemask (FM). MATERIALS AND METHODS: This study was carried out in 28 patients (12 male, 16 female) with maxillary retrognathism, anterior crossbite, and Class III skeletal and dental malocclusion characteristics. Seventeen patients (9 male, 8 female) with mild maxillary retrognathism were treated by RME and FM. The other 11 patients (8 female, 3 male), who had moderate to severe maxillary retrognathism, were treated with surgically assisted FM treatment. Patients treated with RME and FM were recalled after 5.64 years, and the surgically assisted FM group was recalled after 6.08 years. Cephalometric films taken before treatment (T0), right after maxillary protraction (T1), and at recall (T2) were used to evaluate and compare the results. RESULTS: In the short term, good maxillary advancement and a shorter treatment period were achieved with surgically assisted FM therapy. However, in the long term, maxillary advancement and some soft tissue improvements were lost. On the other hand, in the RME and FM protraction group, maxillary advancement and soft tissue improvement were well maintained. CONCLUSION: In the short term, statistically significant maxillary advancement was achieved with surgically assisted maxillary protraction. However, in the long term, these sagittal changes were not stable, whereas RME and FM provided stability.

Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol.

OBJECTIVE: To evaluate the skeletal, soft tissue, and airway effects of the alternate maxillary expansions and constrictions (Alt-RAMEC) protocol in prepubertal patients. MATERIALS AND METHODS: The appliance containing a double-hinged expansion screw was applied to 20 patients with Class III skeletal malocclusion characterized by maxillary retrognathia. The mean age of the study group was 9 years and 8 months. The patients' parents were instructed to open the screw by 1 mm per day during the first week and to close it by 1 mm per day the week after. This alternate opening and closing was repeated for 9 consecutive weeks. Cone beam computed tomography records and three-dimensional photographs were taken before treatment and after 9 week of the Alt-RAMEC protocol. RESULTS: Point A moved slightly forward (0.89 mm) and downward (0.92 mm) (P < .05). The average amount of expansion achieved at the level of point A was 5.54 mm (P < .05). Besides the maxilla, the expansive forces also affected the nasal bone, the zygomaticomaxillary and zygomaticotemporal sutures (P < .05). The soft tissue nasal width increased significantly. The airway volume of the anterior nasal compartment and the nasal cavity also increased (P < .05). CONCLUSIONS: Slight forward movement of point A occurred with the Alt-RAMEC protocol. The expansion affected not only the maxilla but also other structures of the face. Significant cutaneous changes occurred in the paranasal area. Some significant increase in the upper airway volume was obtained.

Three-dimensional alterations in pharyngeal airway and maxillary sinus volumes in Class III maxillary deficiency subjects undergoing orthopedic facemask treatment.

OBJECTIVE: To assess short-term alterations in the volume of pharyngeal airway space and maxillary sinuses associated with rapid maxillary expansion (RME) and facemask (FM) use in growing Class III maxillary-deficient patients. MATERIALS AND METHODS: Twenty-two patients (14 girls, eight boys) treated with the RME/FM and having pretreatment and posttreatment cone beam-computed tomographic scans were identified from the archives of the Marmara University, Department of Orthodontics. According to the protraction force that was used, they were divided into two groups: a group with 400 g protraction force (12 subjects) and a group with 800 g protraction force (10 subjects). Mean age for the study group was 10 years. All patients were diagnosed with normal/low vertical growth pattern, maxillary deficiency, and normal mandible. No control group was available for this study. For each patient, a hyrax expansion screw with acrylic cap splint was constructed and RME was performed for 10 days. On the seventh day, protraction with a FM started. RESULTS: The results showed a statistically significant increase in the volume of maxillary sinuses after treatment, which was related to the growth. On the other hand, the increase in the volume of pharyngeal airway was not statistically significant. CONCLUSIONS: RME/FM treatment did not affect at all the volume of maxillary sinuses and actually inhibited the normal expected increase of the volume of the pharynx when compared with a control group comprising normal individuals.

Long-term stability of intra-oral maxillary distraction in unilateral cleft lip and palate: a case report.

OBJECTIVE: This case report presents short and long-term treatment results of a unilateral cleft lip and palate patient treated with a modified intra-oral tooth-bone borne distraction appliance. MATERIALS AND METHODS: The chief complaints of a 16 year-old, unilateral cleft lip and palate patient were poor facial aesthetics, crowding and a fistula. Severe maxillary retrognathism was treated via distraction osteogenesis of the maxilla and performed using an intra-oral tooth-bone borne appliance. Treatment continued to completion with a multibracket system. At an eight-year review following the distraction procedure, the short and long-term results were determined cephalometrically. RESULTS: Following the distraction, A-point advanced 7 mm, 2 mm of which relapsed during fixed appliance treatment. At the end of the active treatment, the patient's skeletal and dental Class III relationship improved to Class I, which was preserved at the long-term review. The profile was markedly improved by the distraction osteogenesis. CONCLUSION: In cases of severe maxillary retrognathism as a result of a cleft lip and palate, maxillary distraction osteogenesis provides a viable alternative to orthognathic surgery.

Sagittal airway changes: rapid palatal expansion versus Le Fort I osteotomy during maxillary protraction.

The purpose of the present study was to evaluate upper airway changes related to craniofacial changes induced by a facemask (FM) combined with Le Fort I osteotomy without down-fracture in Class III maxillary retrusion subjects (group 1) when compared with a similar group of subjects treated with traditional rapid palatal expansion and FM therapy. Pre- (T1) and post- (T2) protraction cephalometric radiographs of group 1 (10 females and 6 males; mean age 12.75 ± 1.91 years) and group 2 (7 females and 9 males; mean age 12 ± 1.7 years) were traced. The treatment duration was 149 ± 14 days (approximately 5 months) and 270 ± 46 days (approximately 9 months) for groups 1 and 2, respectively. A paired t-test for intergroup comparisons of values at T1, an independent samples t-test for intragroup comparisons of values at T1 and T2, and a non-parametric Mann-Whitney U-test for intergroup comparisons were used. To evaluate the relationship between changes in upper airway dimension and craniofacial morphology, a multiple-regression analysis was performed. Significant maxillary protraction along with clockwise rotation of the mandible was achieved in both groups. Counter-clockwise maxillary rotation was significant in group 1 (P < 0.05) but not in group 2. While nasopharyngeal measurements (PNS-ad1, PNS-ad2) showed significant increases (P < 0.05) as a result of treatment in both groups, oropharyngeal measurements did not change. Maxillary protraction, which was achieved in both groups but in a shorter period of time in group 2, improved nasopharyngeal but not oropharyngeal airway dimensions.

Rapid maxillary expansion compared to surgery for assistance in maxillary face mask protraction.

OBJECTIVE: To compare the treatment outcomes of rapid maxillary expansion (RME) plus face mask (FM) and LeFort 1 osteotomy + FM during maxillary protraction. MATERIALS AND METHODS: This study was carried on 34 patients all having maxillary retrognathic, anterior cross-bite, Class III skeletal and dental malocclusion characteristics and a concave profile. Eighteen patients with milder maxillary retrognathism were treated with RME + FM. Sixteen other patients with moderate to severe maxillary retrognathism were treated with an incomplete LeFort 1 osteotomy + FM therapy. Cephalometric data were evaluated statistically. RESULTS: Significantly higher values of maxillary advancement and reduced treatment time were achieved with surgically assisted FM therapy. CONCLUSIONS: The surgically assisted FM treatment was more rapid and effective in maxillary protraction compared to the RME + FM treatment.