Impact of bone-anchored maxillary protraction on the quality of life of subjects with complete unilateral cleft lip and palate.

INTRODUCTION: This study aimed to evaluate the influence of bone-anchored maxillary protraction (BAMP) on the oral health-related quality of life (OHRQOL) in subjects with complete unilateral cleft lip and palate (UCLP) and moderate-to-severe maxillary deficiency. METHODS: A longitudinal observational study was conducted with a sample of 20 patients (13 males, 7 females) aged 10-14 years (mean age, 11.8 years) with Goslon 3, 4, and 5. To assess the patient's perception of their OHRQOL, the Quality of Life Questionnaire for Orthosurgical Patients was administered in 2 stages: after the installation of the protraction plates (T1) and 18 months after the protraction therapy started (T2). The questionnaire was composed of 4 domains, distributed over 22 questions: social aspects, facial esthetics, oral function, and awareness of facial deformity. RESULTS: The treatment protocol improved the OHRQOL in 75% of the patients who presented UCLP. The domain social aspects of the deformity were the only one that showed a significant difference from T1 to T2 and indicated an improvement in self-esteem. The girls had worse OHRQOL than boys at T1, which was statistically significant only for the domains of social aspects of deformity and awareness of deformity. After BAMP therapy, the effect size indicated a larger change in OHRQOL in girls than in boys. CONCLUSIONS: BAMP therapy positively impacted the OHRQOL and self-esteem of patients with UCLP during adolescence.

Influence of bone-anchored maxillary protraction on secondary alveolar bone graft status in unilateral complete cleft lip and palate.

INTRODUCTION: Our objective was to evaluate the effects of bone-anchored maxillary protraction (BAMP) on the status of the secondary alveolar bone graft in patients with unilateral complete cleft lip and palate (UCLP). METHODS: The experimental group (EG) comprised 26 patients with UCLP, mean age of 11.9 years, submitted to secondary alveolar bone grafting (SABG) with recombinant bone morphogenetic protein, and BAMP therapy, using miniplate-borne Class III intermaxillary elastics. Cone beam computed tomography (CBCT) examinations were taken 6 months after SABG and before BAMP (T1) and after 18 months of BAMP therapy (T2). The control group (CG) was composed of 24 patients with UCLP submitted only to SABG with recombinant bone morphogenetic protein or autogenous bone from iliac crest without BAMP therapy, matched by initial age and sex with the EG. In the CG, CBCT examinations were performed 6 months (T1) and 12 months (T2) after SABG surgery. CBCT axial sections were analyzed using Garib scores in both time points. Intra- and intergroup comparisons were performed using Wilcoxon and Mann-Whitney tests, respectively (P <0.05). RESULTS: No intergroup differences were found at T1 and T2. The EG showed significant improvement of graft status from T1 to T2 at the cervical and middle levels of the alveolar cleft. No significant interphase differences were found for graft scores in the CG. CONCLUSIONS: Despite loads of intermaxillary elastics applied to the maxilla, no harm to the grafted alveolar bone was observed after BAMP therapy in patients with UCLP.

Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal.

OBJECTIVES: The aim of this study was to evaluate the cephalometric outcome of bone-anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). MATERIAL AND METHODS: The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P < 0.05). RESULTS: BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. CONCLUSIONS: BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.

Bone-anchored maxillary protraction long-term outcomes in UCLP.

This case report presents a 12-year-old boy with unilateral complete cleft lip and palate and severe maxillary retrusion treated with bone-anchored maxillary protraction (BAMP) therapy followed by fixed appliances. The follow-up period extended until the end of growth. Initially, the patient demonstrated a Goslon 4 interarch relationship with an overjet of -3.5 mm and a Wits appraisal of -7.9 mm. Six months after the secondary alveolar bone graft, Bollard miniplates were fixed bilaterally at the infrazygomatic region in the maxilla and between the canines and lateral incisors in the mandible. Class III elastics were used bilaterally full time for 12 months. After treatment, the overjet increased 5.9 mm. Significant maxillary advancement (SNA +3.2°) and skeletal convexity improvement (NA-APo +12.4°) were observed. Retrusion of the anteroposterior position of the mandible was observed (SNB -2.1°). Comprehensive orthodontic treatment was performed after BAMP therapy with nighttime bone-anchored Class III elastics as active retention until the end of growth. Occlusion and facial esthetics were satisfactory at the end of orthodontic treatment and growth. Le Fort I surgery for maxillary advancement was not required. BAMP therapy demonstrated an adequate orthopedic outcome, preventing the need for orthognathic surgery in unilateral complete cleft lip and palate.

Protração maxilar ancorada em miniplacas na fissura labiopalatina ­ do diagnóstico à maturidade esquelética / Cleft lip and palate bone anchored maxillary protraction in miniplates ­ from diagnosis to skeletal maturity

Resumo O propósito deste trabalho consiste em descrever um caso com fissura transforame unilateral tratado com o protocolo de protração maxilar ancorado em miniplacas (BAMP) e acompanhado até o término do crescimento facial. Uma paciente do sexo feminino com fissura completa de lábio e palato unilateral esquerda iniciou o tratamento ortodôntico em um centro de reabilitação aos 7 anos de idade. Apresentava Padrão facial III por deficiência maxilar, relação interarcos GOSLON 4, trespasse horizontal negativo de 1,5mm e agenesia do incisivo lateral superior esquerdo. Na dentadura mista, foi submetida à expansão rápida da maxila seguida pelo procedimento de enxerto ósseo alveolar secundário. Aos 12 anos e 3 meses de idade, foram instaladas duas miniplacas na maxila e duas na mandíbula para terapia BAMP. A paciente foi orientada a usar os elásticos de Classe III em período integral, com força de 250g/lado, em conjunto com uma placa de levantamento de mordida no arco superior. A terapêutica ortopédica de protração maxilar durou 19 meses com obtenção de trespasse horizontal positivo e relação interarcos GOSLON 1. A análise cefalométrica demonstrou um suave avanço ortopédico da maxila. Os elásticos de Classe III passaram a ser utilizados somente no período noturno, como contenção ativa, concomitantemente à Fase 2 do tratamento ortodôntico. O tratamento ortodôntico corretivo compensatório estabeleceu uma oclusão adequada entre os arcos dentários, com melhora significativa da estética facial após a intervenção. O avanço cirúrgico da maxila não foi necessário.(AU)

Abstract The purpose of this study was to report a case with complete unilateral cleft lip and palate (CLP) treated with bone anchored maxillary protraction (BAMP) in miniplates followed up until the end of facial growth. A 7-year-old girl with complete left side CLP started the orthodontic treatment in a rehabilitation center. She presented a Class III skeletal pattern due to maxillary deficiency, a GOSLON 4 sagittal interarch relationship, a negative overjet of 1.5mm and agenesis of left upper lateral incisor. In the mixed dentition, the patient was submitted to rapid maxillary expansion followed by the secondary alveolar bone grafting procedure. At 12y 3m two miniplates were installed in the maxilla and two in the mandible with BAMP therapy. The patient was instructed to use full time Class III elastics with force of 250g/side together with a bite lifting plate in the upper arch. BAMP therapy duration was 19 months leading to a positive overjet and GOSLON 1 sagittal interarch relationship. The cephalometric analysis demonstrated a mild maxilla advancement. Class III elastics started to be used only at night as an active retention concomitantly with Phase II orthodontic treatment. Compensatory corrective orthodontic treatment established adequate occlusion between the dental arches with significant improvement of facial aesthetics after the intervention. Le Fort 1 surgery with maxillary advancement was not necessary. (AU)