Tratamento ortopédico de expansão rápida da maxila e protração maxilar com máscara facial em paciente com fissura labiopalatina unilateral completa – Caso clínico / Orthopedic treatment of rapid maxillary expansion and maxillary protraction with facial mask in patient with complete unilateral cleft lip - Clinical case

The aim of this study was to compare the efficacy of early treatment of Class III malocclusions with rapid maxillary expansion (RME) and facial mask (FM) versus the removable mandibular retractor (RMR) re-evaluated at a postpubertal observation on lateral cephalograms. All prepubertal patients with Class III malocclusion treated consecutively from 1986 to 2013 by means of RME/FM or RMR were analyzed. Twenty-nine patients treated with RME/FM therapy and 23 patients treated with RMR were selected. Lateral cephalograms were available at 3 time points, before treatment (T1), at the end of active treatment (T2), and at a postpubertal observation (T3). Statistical comparisons were performed with independent sample t tests or Mann–Whitney tests. During the T1–T3 interval, a significantly greater maxillary protraction (SNA +1.5 mm, p = 0.031) and significantly greater improvements in ANB and Wits appraisal (+1.9 degrees, p = 0.002, and +2.2 mm, p = 0.012, respectively) were recorded in the RME/FM group. No statistically significant changes could be found in vertical skeletal measurements. In the dentoalveolar region, the RME/FM group showed a significantly greater correction of the molar relationship (−1.5 mm, p = 0.021). Early treatment of Class III malocclusion with RME/FM protocol in comparison with RMR protocol showed a greater maxillary advancement and greater improvements in sagittal skeletal Class III relationships.

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A New Protocol for Maxillary Protraction in Cleft Patients: Repetitive Weekly Protocol of Alternate Rapid Maxillary Expansions and Constrictions

The Cleft Palate-Craniofacial Journal ◽

10.1597/03-107.1 ◽

2005 ◽

Vol 42 (2) ◽

pp. 121-127 ◽

Cited By ~ 68

Author(s):

Eric Jein-Wein Liou ◽

Wen-Ching Tsai

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Rapid Maxillary Expansion ◽

Mixed Dentition ◽

Prospective Clinical Study ◽

Maxillary Expansion ◽

Treatment Results ◽

Maxillary Protraction ◽

Maxillary Advancement

Objective It was hypothesized that, through a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC), the maxilla in cleft patients could be protracted more effectively than with a single course of rapid maxillary expansion (RME). Methods Twenty-six consecutive unilateral cleft lip and palate patients at the age of mixed dentition were included in this prospective clinical study. The rapid maxillary expansion group included the first 16 consecutive patients undergoing 1 week of rapid maxillary expansion (1 mm/day) followed by 5 months, 3 weeks of maxillary protraction. The Alternate Rapid Maxillary Expansions and Constrictions group included the next 10 consecutive patients undergoing 9 weeks of Alternate Rapid Maxillary Expansions and Constrictions followed by 3 months, 3 weeks of maxillary protraction. Daily activation of the weekly expansion or constriction was 1.0 mm. Two-hinged expanders and intraoral maxillary protraction springs were used in both groups. Treatment results were evaluated cephalometrically. Results The amount of maxillary anterior displacement by the 2-hinged expander in the Alternate Rapid Maxillary Expansions and Constrictions group was 3.0 ± 0.9 mm at A point, significantly greater than the 1.6 ± 1.0 mm in the rapid maxillary expansion group. The amount of maxillary advancement with intraoral protraction springs in the Alternate Rapid Maxillary Expansions and Constrictions group was 2.9 ± 1.9 mm at A point, significantly greater than the 0.9 ± 1.1 mm in the rapid maxillary expansion group. The overall amount of maxillary advancement in the Alternate Rapid Maxillary Expansions and Constrictions group was 5.8 ± 2.3 mm at A point. This result remained stable, without significant relapse after 2 years. Conclusions Maxillary protraction using the 2-hinged expander, a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions, and intraoral protraction springs is most effective, with stable results at 2-year follow-up.

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Dentoskeletal Effects of Maxillary Protraction in Cleft Patients with Repetitive Weekly Protocol of Alternate Rapid Maxillary Expansions and Constrictions

The Cleft Palate-Craniofacial Journal ◽

10.1597/07-144.1 ◽

2009 ◽

Vol 46 (4) ◽

pp. 391-398 ◽

Cited By ~ 16

Author(s):

Gustavoda Luz Vieira ◽

Luciane Macedo de Menezes ◽

Eduardo Martinelli S. de Lima ◽

Susana Rizzatto

Keyword(s):

Repeated Measures ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Covariance Structure ◽

Face Mask ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Maxillary Protraction ◽

Significant Difference ◽

Group 2

Objective: To evaluate the amount of maxillary protraction with face mask in complete unilateral cleft lip and palate patients submitted to two distinct rapid maxillary expansion (RME) protocols. Material and Methods: The sample consisted of 20 individuals (nine boys and 11 girls; mean age of 10.4 ± 2.62 years) with unilateral complete cleft lip and palate who had a constricted maxilla in the vertical and transverse dimensions. Ten patients underwent 1 week of RME with screw activation of one complete turn per day, followed by 23 weeks of maxillary protraction (group 1). The other 10 patients underwent 7 weeks of alternate rapid maxillary expansion and constriction, with one complete turn per day, followed by 17 weeks of maxillary protraction (group 2); both groups underwent a total of 6 months of treatment. Cephalometric measurements were taken at different times: pretreatment (T1), soon after RME (T2), and after 6 months of treatment (T3). Each measurement was analyzed with mixed models for repeated measures, and the covariance structure chosen was compound symmetry. Results: The maxilla displaced slightly forward and downward with a counterclockwise rotation; the mandible rotated downward and backward, resulting in an increase in anterior facial height; the sagittal maxillomandibular relationship was improved; the maxillary molars and incisors were protruded and extruded; and the mandibular incisors were retroclined. Conclusion: There was no significant difference between the groups in evaluation time.

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Efficacy of Rapid Maxillary Expansion Associated With Maxillary Protraction in Patients With Unilateral Complete Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619896675 ◽

2020 ◽

Vol 57 (7) ◽

pp. 872-876

Author(s):

Okada Terumi Ozawa ◽

Costa Daniela Salzedas ◽

de Lima Beatriz Oliveira ◽

Renata Sathler ◽

Gleisieli Baessa ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Control Sample ◽

Face Mask ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Maxillary Protraction ◽

The Stability ◽

In The Beginning ◽

Dental Casts

Objective: To evaluate the efficacy of rapid maxillary expansion (RME) and maxillary protraction (MP) in patients with unilateral complete cleft lip and palate (UCLP) using the Goslon yardstick index. Design: Retrospective study. Patients: Dental casts of 34 Goslon 3 (G3) and Goslon 4 (G4) patients treated with RME and MP were evaluated which composed the treated sample (S1). The dental cast were taken before the RME (T1) and immediately after the use of face mask for MP was suspended (T2). In order to verify the stability of the treatment, dental casts of 17 of these patients were evaluated 1 year after the treatment was finished (T3). For the control sample (S2), dental casts of 20 untreated G3 and G4 patients were evaluated. Results: At T2, 85.7% of study sample patients initially G3 and 70% of patients initially G4 obtained improvement in occlusal index. At T3, the majority of patients initially classified as G3 and G4 returned to the same classification as in the beginning of the treatment. The evaluation of the control sample showed that patients initially classified as G3, 55.6% continued at this initial index, and 44.4% had it worsened. Those initially G4, 100%, continued at this initial index. Conclusion: The immediate result of RME and MP was satisfactory, and despite the instability of these results, the outcome of this treatment option was better than the untreated sample.

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Treatment of Unilateral Cleft Lip and Palate Patient With Intraoral Tooth Tissue Borne Distractor and Facemask Therapy: A Case Report

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621993366 ◽

2021 ◽

pp. 105566562199336

Author(s):

Akansha Bansal Agrawal ◽

Harshavardhan Kidiyoor ◽

Anand K. Patil Morth

Keyword(s):

Case Report ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Face Mask ◽

Rapid Maxillary Expansion ◽

Growth Potential ◽

Maxillary Expansion ◽

Long Term Stability ◽

Tooth Tissue

This case report demonstrates the successful use of intraoral distractor/hygenic rapid expander (HYRAX) for rapid maxillary expansion in anteroposterior direction with an adjunctive use of face mask therapy for anterior orthopedic traction of maxillary complex in a cleft patient with concave profile. The patient was a 13-year-old girl who reported with a chief complaint of backwardly positioned upper jaw and a severely forward positioned lower jaw. Therefore, a treatment was chosen in which acrylic bonded rapid maxillary expansion was done with tooth tissue borne intraoral distractor/HYRAX having a different activation schedule along with Dr Henri Petit facemask to treat maxillary retrognathism. As a result, crossbite got corrected and attained a positive jet with no bone loss in cleft area over a period of 5 months which was followed by fixed mechanotherapy achieving a well settled occlusion in 1 year. After completion of expansion and fixed mechanotherapy, ANB became +1 post-treatment which was −4 pretreatment. The prognathic profile was markedly improved by expansion and taking advantage of the remaining growth potential, thus minimizing the chances of surgery later in life. This provided a viable alternative to orthognathic surgery with good long-term stability.

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Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.2016-001.aop ◽

2016 ◽

Vol 21 (6) ◽

pp. 82-90 ◽

Cited By ~ 1

Author(s):

Daniel Santos Fonseca Figueiredo ◽

Lucas Cardinal ◽

Flávia Uchôa Costa Bartolomeo ◽

Juan Martin Palomo ◽

Martinho Campolina Rebello Horta ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Rapid Maxillary Expansion ◽

Cone Beam ◽

Tomographic Image ◽

Maxillary Expansion ◽

Downward Movement ◽

Computed Tomographic ◽

Significant Difference ◽

Maxillary Region

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.

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Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate:

The Angle Orthodontist ◽

10.2319/091919-598.1 ◽

2020 ◽

Vol 90 (4) ◽

pp. 539-547 ◽

Cited By ~ 1

Author(s):

Eman H. Elabbassy ◽

Noha E. Sabet ◽

Islam T. Hassan ◽

Dina H. Elghoul ◽

Marwa A. Elkassaby

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensions ◽

Class Iii ◽

Maxillary Expansion ◽

Forward Movement ◽

Maxillary Protraction ◽

Computed Tomography Images ◽

Group I ◽

Effective Treatment Modality

ABSTRACT Objectives To assess the effectiveness of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate (UCLP) and whether it was enhanced when preceded by maxillary expansion. Materials and Methods The sample consisted of 28 growing children (9–13 years old) with UCLP and Class III malocclusion. They were divided into two equal groups. In group I, patients were treated with BAMP not preceded by maxillary expansion. In group II, patients were treated with BAMP preceded by maxillary expansion. To assess treatment changes in three dimensions, Cone-beam computed tomography images were taken 1 week after surgical placement of the miniplates (T1) and after 9 months of treatment (T2). Results BAMP produced forward movement of the maxilla in both groups (3.17 mm) and (3.37 mm) respectively, without significant differences between the two groups except for clockwise rotation of the palatal plane in group I (1.60). Conclusions BAMP is an effective treatment modality for correcting midface deficiency in patients with UCLP whether or not maxillary expansion was carried out.

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