Title Maxillary Protraction and Maxillary Advancement Osteotomy Have Similar Long Term Stability
Clinical Question In patients with Class III malocclusion, does maxillary protraction in growing patients provide similar stability compared to maxillary advancement osteotomy in adults?
Clinical Bottom Line There is general similarity between the protraction and the surgical groups at T3 (7 years 6 months postprotraction or 1 year 5 months postsurgery) and in the overall stability of both treatment modalities over time.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
17208098Pangrazio-Kulbersh/200717 children/17 adults with maxillary deficiencyRetrospective Study
Key resultsOne of the three aims of this retrospective cephalometric study was to compare the long-term stability of early protraction facemask treatment vs. surgical maxillary advancement. 34 patients with Class III malocclusions with maxillary deficiency were included: 17 children (protraction sample) and 17 adults (surgical sample). Means and standard deviations were calculated for descriptive cephalometric measurements. ANOVA was used to assess the differences between and within the protraction and surgery groups at T1, T2, and T3. There was a statistically significant (P≤.01) decrease in overjet in the protraction group between T2 and T3. The protraction group had a total increase in overjet from T1 to T3 of 1.11 mm. There were also significant improvements in molar relationships in both groups (SNpM). The surgical group had greater changes in ANB angle and the Wits appraisal from T1 to T3 than did the protraction sample. Therefore, 0.65° of total increase in the ANB angle and 1.8 mm of increase in the Wits appraisal of surgical group is clinically significant, since these measurements remained stable over the long term.
Evidence Search Long-term[Title] AND stability[Title] AND Class[Title] AND III[Title]AND facemask Mesh terms: Class III malocclusion
Comments on
The Evidence
This is the only paper available at this time comparing these two methods of treatment. This paper is a retrospective cephalometric study. 34 patients were divided into two groups of 17. Each group received one of the two treatments studied. There were also controls for each study group, but the author didn’t mention the number of patients in the control groups. The groups' cephalometric analyses were not similar at start (T1) because of the difference in age between the two groups. The authors evaluated the posttreatment stability of the surgical group after 1 year 5 months; in my opinion they need to evaluate stability after a longer period of time, as they did with the protraction group (7 years 6 months).
Applicability After reviewing this study, an orthodontist now can provide information about how the treatment of Class III malocclusion in the early mixed dentition by maxillary protraction can have same stability over time as the treatment after growth is complete by maxillary advancement osteotomy. Also, they can explain to the patient about the risks and benefits of treatment as the cost of the treatment and the general surgical complications.
Specialty (Oral Surgery) (Orthodontics)
Keywords facemask, class III malocclusion, long term stability
ID# 2788
Date of submission 11/28/2014
E-mail alsaigh@livemail.uthscsa.edu
Author Hesham Al Saigh
Co-author(s) e-mail
Faculty mentor Ravikumar Anthony, BDS, MDS, MS
Faculty mentor e-mail ANTHONYR@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available