ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Maxillary Bone Anchored Maxillary Protraction Achieves Greater Maxillary Advancement Compared to Facemask/RME Therapy
Clinical Question Is there a difference in maxillary advancement when maxillary deficiency is treated with a facemask/RME therapy versus bone anchored maxillary protraction?
Clinical Bottom Line For adolescent patients with maxillary deficiency, bone anchored maxillary protraction (BAMP) is more effective in advancing the maxilla compared to facemask/RME therapy. This is supported by two comparative clinical studies where BAMP produced significantly larger maxillary advancement. These findings are based on the difference in timing of treatment. Facemask therapy is best applied during early mixed dentition and BAMP is more successful during late mixed dentition or early permanent dentition.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24182587Hino/201321 patients treated with RME/facemask; 25 patients treated with BAMPProspective Cohort Study
Key resultsUsing CBCT scans, 3D models were generated from measurements taken before treatment and 1 year post-treatment. This study showed that both treatment methods provided effective orthopedic changes. Treatment with BAMP showed significantly greater displacement of the midface by approximately 1mm. The maxilla protracted with means of 2.6mm in the facemask group and 3.7 in the BAMP group. The level of significance for this study was set at p=0.05.
#2) 20578848Cevidanes/201021 patients treated with RME/facemask; 34 patients treated with BAMPProspective Cohort Study
Key resultsThis study used lateral cephalograms to make 2D measurements of the changes from the start of treatment to the end of treatment in a facemask/RME therapy sample and BAMP sample. According to this study, the BAMP treatment produced significantly larger maxillary advancement than the facemask/RME therapy. The horizontal displacement of point A measured from the lateral cephalogram was a mean of 5.2mm in the BAMP group, and 2.9mm in the facemask group. There was a significant difference in the measurements of 2.5mm with a p value of 0.05.
Evidence Search "Extraoral Traction Appliances"[Mesh]) AND "Humans"[Mesh]) AND "Incisor/pathology"[Mesh]) AND "Malocclusion, Angle Class III/therapy"[Mesh]) AND "Maxilla/pathology"[Mesh]) AND "Orthodontic Anchorage Procedures/instrumentation"[Mesh]) AND "Orthodontic Appliance Design"[Mesh]) AND "Palatal Expansion Technique"[Mesh]
Comments on
The Evidence
These studies only evaluated the results directly after treatment and didn’t take into account the long-term results or the stability. Although the BAMP procedure showed better results, it would be beneficial to compare the outcomes of both therapies at a postpubertal point in time.
Applicability These two therapies are applied at different stages of dental development. Facemask/RME therapy is best applied during the early mixed dentition and the BAMP therapy is optimal for late mixed dentition or early permanent dentition. The later age of treatment for the BAMP protocol allows the orthodontist to treat patients who were not seen early enough for the facemask therapy. Since the BAMP is applied later, there is a shorter time interval between phase I and phase II treatment. Some clinical aspects of each therapy show that although the facemask requires fewer hours to be worn than the class III elastics associated with BAMP, the facemask appliance is not well tolerated. On the other hand BAMP therapy requires surgical procedures to place bone plates and to remove them.
Specialty/Discipline (Oral Surgery) (Orthodontics)
Keywords Orthodontics Maxillary expansion appliance Malocclusion
ID# 2791
Date of submission: 11/26/2014spacer
E-mail saunderskg@livemail.uthscsa.edu
Author Kristin Saunders
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail gakunga@uthscsa.edu
Basic Science Rationale
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