Protocolo BAMP: Reporte de Caso Clínico

El presente reporte tiene como objetivo presentar de manera secuencial y visual la protracción maxilar de un paciente clase III esqueletal, utilizando el protocolo BAMP. Una vez realizado el análisis clínico del caso se decidió realiza un tratamiento ortopédico a través del uso de miniplacas de titanio con elásticos intermaxilares de clase III siguiendo el protocolo BAMP, junto a un tratamiento ortodóncico dento alveolar con aparatología fija bimaxilar prescripción Roth 0.22" Mini sprint forestadent. Se observa el éxito del enfoque interceptivo utilizando el protocolo BAMP. Este enfoque logró reducir tanto el tiempo como la complejidad del tratamiento ortodóncico, y también disminuyó la necesidad de someterse a una cirugía ortognática en la edad adulta. El tratamiento BAMP, diseñado para ciertas edades y crecimiento, se demostró exitoso en un paciente de 12 años sin potencial de crecimiento. Las miniplacas como anclaje son efectivas para protracción maxilar en varios casos, aunque se necesita seguimiento y educación postquirúrgica. Se recomienda retirar las miniplacas cuando no sean necesarias, adaptando el protocolo a cada paciente. En resumen, el tratamiento con miniplacas es eficaz para corregir anomalías Clase III esqueléticas.

The present report aims to sequentially and visually present the maxillary protraction of a Class III skeletal patient using the BAMP protocol. After conducting a clinical analysis of the case, it was decided to perform orthopedic treatment using titanium miniplates with Class III intermaxillary elastics following the BAMP protocol, in conjunction with dentoalveolar orthodontic treatment using fixed bimaxillary appliances with Roth prescription 0.022" Mini Sprint Forestadent. The success of the interceptive approach using the BAMP protocol is observed. This approach managed to reduce both the time and complexity of orthodontic treatment and also decreased the need for orthognathic surgery in adulthood. The BAMP treatment, designed for specific ages and growth stages, proved successful in a 12-year-old patient without growth potential. Miniplates as anchorage are effective for maxillary protraction in various cases, although post-surgical follow-up and education are required. It is recommended to remove the miniplates when they are no longer necessary, adapting the protocol to each patient. In summary, miniplate treatment is effective in correcting Class III skeletal anomalies.

Evaluation of Head and Cervical Spine Posture after Therapy with Maxillary Protraction Appliances / Evaluación de la Postura de la Cabeza y la Columna Cervical Después de la Terapia con Aparatos de Protracción Maxilar

SUMMARY: The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements.A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture.

El objetivo de este estudio fue evaluar los cambios en la postura de la cabeza y la columna cervical debido a la maloclusión clase esquelética en adolescentes con protracción maxilar. Treinta casos de maloclusión de clase esquelética fueron seleccionados al azar del Hospital Estomatológico de la Universidad Médica de Shanxi. Se recogieron cefalogramas laterales de alta calidad, incluidos el tratamiento previo y posterior, para comparar los cambios en la postura de la cabeza y la columna cervical. Los datos se procesaron con el software estadístico SPSS 26.0. Se utilizó la prueba t pareada para comparar las medidas angulares medias antes y después del tratamiento. Una diferencia significativa en SNA (p <0,001), SNB (p <0,01) y ANB (p <0,001) entre T1 y T2 mostró una mejora en las relaciones sagitales. Se observó un cambio significativo en la postura de la columna cervical media, mientras que las variables de postura de la columna cervical superior no mostraron diferencias significativas después del tratamiento. La clase esquelética con aparato de protracción maxilar no solo condujo a la mejora de la relación sagital, sino que también cambió la postura de la columna cervical media.

Corrección de una clase III esqueletal con anclaje óseo en paciente en crecimiento: Reporte de caso / Skeletal class III correction in growing patient with bone anchorage: CaseReport

Antecedentes: La clase III esqueletal, es una deformidad dentofacial donde el tercio inferior de la cara es más prominente, el tratamiento se decide según la etiología y la edad del paciente; si se encuentra en crecimiento la malformación puede ser tratada con un protocolo interceptivo y si es posible evitar la cirugía ortognática a futuro. Objetivo: Mejorar la clase esqueletal, descruzar la mordida u obtener mordida borde a borde, mejorar la posición del labio superior y evaluar el comparativo inicial-final de SNA y ANB. Reporte de caso:Paciente masculino de 13 años, sin antecedentes personales patológicos o familiares reportados; presenta clase III esqueletal responsiva bimaxilar, crecimiento vertical, clase molar I y canina III; fue tratado con el protocolo de mini placas BAMP (bone anchored maxillary protraction) por sus siglas en inglés, elásticos intermaxilares y un paladar con pistas planas. Resultados:La fase ortopédica duro cinco meses y se logró mordida borde a borde y clase I esqueletal. Discusión: Se obtuvieron resultados con el uso de mini implantes sin anclaje extraoral en menos tiempo a comparación de otros métodos que tienen que ser usados por 9-12 meses.Conclusión:El protocolo BAMP puede ser usado en pacientes en crecimiento sin máscara facial para corregir la clase III esqueletal.

Background: Skeletal class III is a dentofacial deformity where the lower third ofthe face is more prominent. The treatment is decided according to the etiology and age of the patient; If the patient is in growing, the malformation can be treated with an interceptive protocol and if possible, avoid a orthognathic surgery in the future. Objective: Improve the skeletal class, uncross the bite or obtain an edge-to-edge bite, improve the position of the upper lip and compare the initial-final relationship of ANS and ANB.Case report:13-year-old male patient, with no reported pathological or family history; presents skeletal class III, vertical growth, molar class I and canine III; he was treated with the protocol of mini BAMP (bone anchored maxillary protraction) plates, intermaxillary elastics and a palate with flat tracks. Results:The orthopedic phase lasted five months and an edge-to-edge bite and skeletal class I were achieved.Discussion:Results were obtained with the use of mini plates without extraoralanchorage in less time compared to other methods that have to be used for 9-12 months. Conclusion: The BAMP protocol can be used in growing patients without a face mask to correct skeletal class III.

Biomechanical behavior of an alveolar graft under maxillary therapies.

Cleft lip and palate is a congenital defect that affects the oral cavity. Depending on its severity, alveolar graft surgery and maxillary orthopedic therapies must be carried out as a part of the treatment. It is widely accepted that the therapies should be performed before grafting. Nevertheless, some authors have suggested that mechanical stimuli such as those from the maxillary therapies could improve the success rate of the graft. The aim of this study is to computationally determine the effect of maxillary therapies loads on the biomechanical response of an alveolar graft with different degrees of ossification. We also explore how the transverse width of the cleft affects the graft behavior and compare results with a non-cleft skull. Results suggest that stresses increase within the graft as it ossifies and are greater if maxillary expansion therapy is applied. This has consequences in the bone remodeling processes that are necessary for the graft osseointegration. Maxillary orthopedic therapies after graft surgery could be considered as a part of the treatment since they seem to act as a positive extra stimulus that can benefit the graft.

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Immediate and late follow-up effects of class III early correction in cleft lip and palate patients treated with maxillary protraction / Efeitos imediatos e a longo prazo da correção precoce da classe III em pacientes com fissura lábio palatal tratados com protração maxilar

Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient's age was determined by Pearson's chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.

Resumo Introdução Não há consenso sobre os efeitos imediatos e tardios da protração maxilar em pacientes com fissura lábio palatal. Objetivo avaliar a estabilidade do tratamento precoce da Classe III em pacientes com fissura labiopalatina por meio da expansão e protração maxilar. Material e método A amostra consistiu de 28 pacientes com fissura lábio palatal com (média de idade pré tratamento de 6.7±1.8) com fissura lábio palatal transforame unilateral, tratados com disjuntor maxilar e com máscara facial de Petit. Por meio de análise em telerradiografias laterais as grandezas angulares (SNA, SNB, ANB, SN.GoGn, FMA, Ângulo Z) e lineares (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) foram avaliadas, com o software Dolphin®, nos tempos: inicial (T0), após o tratamento (T1) e acompanhamento de 2 a 6 anos (T2). Os dados foram submetidos à ANOVA e teste Tukey-Kramer. A correlação entre as grandezas cefalométricas e a idade do paciente foi determinada pelo teste de Pearson. Todas as análises foram realizadas com nível de significância de 5%. Resultado SNA, ANB e AO-BO aumentaram significativamente (p<0,05) e após o período de acompanhamento voltaram a ser semelhantes às iniciais (p>0,05). O overjet aumentou significativamente após o tratamento e mesmo tendo diminuído com o tempo, ainda se apresentava maior quando comparado ao momento inicial (p<0,05). O ângulo Z apresentou melhora com o tratamento e se manteve estável no período de acompanhamento (p<0,05). Conclusão após o tratamento (disjunção associada à protração maxilar) houve melhora do padrão esquelético. No período de acompanhamento, verificou-se que essas melhoras voltaram a medidas próximas das iniciais. Houve melhora no padrão dentário e no perfil facial que se manteve no período de controle.

Correction of Class III malocclusion with alternate rapid maxillary expansions and constrictions using a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment: A case report.

In this report, we describe the successful use of alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for the management of severe Class III malocclusion due to maxillary hypoplasia in an 11-year-old girl. The devices were removed after 20 months of treatment, and the family was instructed about a careful control and retention program that should be followed in accordance with the patient's growth. The final result included the correction of Class III malocclusion with adequate function and excellent facial esthetics, which restored the patient's self-esteem and provided personal motivation. The outcomes showed good stability after 24 months of retention. The decrease in the duration of active treatment is the most important finding from the present case. Considering that facial esthetics in adolescence is a determining factor for the development of a personality and interpersonal relationships, we recommend the use of this protocol for growing patients, who will exhibit not only an improved physical appearance but also a better quality of life.

Bimax III – uma alternativa para o tratamento ou contenção ativa nos casos de Classe III precoce / Bimax III – an alternative for treatment or active retention in early Class III cases

A má oclusão de Classe III tem como aliada no tratamento precoce a protração maxilar por meio da máscara facial. Embora esse aparelho seja altamente efetivo, do ponto de vista esquelético e dentário, demanda colaboração total do paciente, o que nem sempre é atingido devido o aparelho ser externo e causar um problema estético, principalmente quando usado em público. Para ajudar no tratamento (às vezes até substituí-lo), é proposto um novo dispositivo, o Bimax III, aparelho dento-suportado utilizado em conjunto com elásticos de Classe III, que embora ainda não haja estudos comprovando sua eficácia esquelética, responde muito bem à movimentação dentária, pois é facilmente aceito pelo paciente. A proposta desse artigo é apresentar o referido aparelho e sugerir outras formas de tratamento para a correção da Classe III precoce.

The treatment of early Class III malocclusion has an ally in maxillary protraction through the facemask. Although this device is highly effective in terms of skeletal and dental outcomes, full compliance of the patient is needed. This is often hard to achieve since the device is external and cause an aesthetic problem, especial ly when used in public. To assist in the treatment (or sometimes even replace it) a new device is proposed, the Bimax III, a dental-supported device used in conjunction with Class III elastics. Although there are no studies proving its skeletal effectiveness, it responds very well to the tooth movement because it is readily accepted by the patient. The purpose of this paper is to present the mentioned appliance and suggest other forms of early Class III treatment.

Tração reversa da maxila associada à disjunção palatal / Maxillary protaction associated to palatal expansion

A tração anterior da maxila é parte do arsenal do ortodontista já há algum tempo no que se refere ao tratamento da má oclusão de Classe III de pacientes em crescimento. Paciente M.C. do sexo feminino, na época com 6 anos e 10 meses de idade, apresentou-se para tratamento ortodôntico. No exame extrabucal, apresentava sinais de hipoplasia de maxila: perfil côncavo e olheiras bem demarcadas. No exame intrabucal, possuía uma mordida cruzada anterior e posterior bilateral. A telerradiografia e o traçado cefalométrico confirmaram uma maxila retroposicionada (SNA=79º). Na radiografia panorâmica notava-se impacção do elemento 16 (em relação ao 55). Os objetivos do tratamento consistiram em aumentar a dimensão transversa da maxila para descruzar a mordida posterior e tracioná-la para uma posição mais anterior. A disjunção rápida da maxila associada à máscara facial de Petit foram utilizadas para alcançar estes objetivos. A mordida cruzada posterior bilateral foi corrigida completamente pela disjunção maxilar, assim como a posição da maxila foi melhorada pela força ortopédica anterior (SNA final=85º). A terapia teve de ser repetida aos 10 anos e 3 meses de idade. A terapia ortodôntica utilizada nesta paciente mostrou-se efetiva na correção da má oclusão inicial, além de mostrar-se estável após 33 meses de controle de contenção (após término da segunda fase do tratamento).

Introduction: Orthodontists have been using maxillary anterior traction on Class III patients that are going through their growth period. Description: A female patient M.C., 6 years and 10 months old, was taken to orthodontic treatment. The extra-oral examination presented signs of maxillary hypoplasia: concave facial profile and evident under eye dark circles. Intra-oral examination showed an anterior and bilateral posterior cross-bite. The teleradiography and cephalometric tracing confirmed posterior positioned maxilla (SNA=79º). In the panoramic radiograph an impaction of the element 16 on the 55 was easily noticed. Treatment plan: The treatment aimed at enhancing the maxilla’s transversal dimension to correct the bilateral posterior cross bite and to protract the maxilla anteriorly. The orthodontic devices utilized to address these objectives were the Haas palatal expander and Petit’s facial mask. Results: The posterior cross bite was fully corrected through the palatal expansion, as well as the maxillary sagittal position (SNA=85º) using anteriorly directed orthopedic force. The protraction therapy had to be repeated when the patient was aging 10 years and 3 months. Conclusion: The utilized therapies have proved to be effective in correcting the initial malocclusion. Furthermore, they have shown good stability 33 months after the removal of the fixed appliance (phase II).

Má oclusão Classe III de Angle, subdivisão direita, tratada sem exodontias e com controle de crescimento / Angle Class III malocclusion, subdivision right, treated without extractions and with growth control

A Classe III de Angle é uma má oclusão caracterizada por discrepâncias anteroposteriores dentárias e faciais, normalmente acompanhadas por alterações esqueléticas, com componente genético associado. O diagnóstico precoce e correto e o tratamento adequado são de suma importância para promover o controle do crescimento e evitar recidivas. Este artigo relata o tratamento, executado em duas fases, de uma paciente do sexo feminino de 12 anos de idade, apresentando uma má oclusão de Classe III de Angle, subdivisão direita, com mordida cruzada anterior em máxima intercuspidação habitual (MIH) e topo em relação cêntrica (RC), apresentando, ainda, falta de espaço na maxila, que foi tratada sem exodontias e com controle de crescimento. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), representando a categoria 1, ou seja, uma má oclusão Classe III de Angle, tratada sem exodontias e com controle de crescimento, como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.

Angle Class III malocclusion is characterized by anteroposterior dental and facial discrepancies usually accompanied by skeletal changes associated with a genetic component. Early, accurate diagnosis and appropriate treatment are of paramount importance to promote growth control and prevent relapse. This article reports the two-phase treatment of a female patient, aged 12 years, with an Angle Class III, subdivision right malocclusion with anterior crossbite in maximum intercuspation (MIC) and end-on bite in centric relation, further presenting with lack of maxillary space. The case was treated without extractions and with growth control. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as representative of Category 1, i.e., Angle Class III malocclusion treated without tooth extractions, as part of the requirements for obtaining the BBO Diploma.