Journal of AdvancedMedical and Dental Sciences Research

Background: Class III malocclusion in growing individuals is common in our daily practice. Protraction headgear is the most common appliance used in Class III patients. Headgear does not have a positive feedback aesthetically by young adults. The use of temporary anchorage devices (TADs) in orthodontics has increased over recent years. One type of temporary anchorage device, a modification of the titanium miniplate has been used successfully as a skeletal anchorage device for various orthodontic applications. This new Bone Anchored Maxillary Protraction method may be preferable as it does not involve an extra oral appliance during treatment, compliance requirements are limited to the use of elastics, maintenance of oral hygiene and ability to apply orthopedic force for a longer period without causing root resorption. Aim: To assess the efficacy of modified maxillary protraction appliance in treating Class III growing patients with maxillary deficiency using lateral cephalogram and Cone Beam Computed Tomography.  Methodology: 10 individuals, in the age group 10-15 years with Class III skeletal pattern were selected as per inclusion criteria. Lateral cephalograms and Cone Beam Computed Tomography were obtained before and after the study to assess the degree of maxillary protraction. Bonded rapid maxillary expansion appliance was placed on to the maxilla and was activated for 2 weeks. Titanium miniplates were placed in the anterior region of the mandible. Rapid maxillary expansion (RME) appliance and the miniplates were attached with intermaxillary elastics, force of 200-250 gms was applied on each side. The data obtained was statistically evaluated using paired t test to compare the pre and post- treatment values. Results: On comparison of pre- treatment and post- treatment values obtained from lateral cephalogram and Cone Beam Computed Tomography, significant forward positioning of maxilla was noted, with counter clockwise rotation of the mandible, which is beneficial in high angle Class III cases.
Conclusion: Significant sagittal and vertical changes were encountered on comparison of the pre and post study Cone Beam Computed Tomography and lateral cephalograms. The post study values showed forward movement of the maxilla in all the 10 cases and a significant increase in SNA angle. There was a significant decrease in the SNB angle, due to the counter clockwise rotation of the mandible, resulting in an improvement in facial profile. Further controlled trials are required to substantiate this finding.
Key words: Class III malocclusion, Maxillary protraction, Miniplates, RME, Lateral cephalogram, CBCT.