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Long-term evaluation of class 3 orthopedics using skeletal anchorage. Tung Nguyen. AAO June 2021. Episode 98

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Farooq Ahmed

Long-term evaluation of class 3 orthopedics using skeletal anchorage. Tung Nguyen

 

Envelope of discrepancy – advent of skeletal anchorage has enlarged the envelope of orthopaedic change possible

 

Bone Anchored Maxillary Protraction

·      4 plates

o   2 infrazygomatic crest

o   2 between mandibular lateral and canine

·      Treatment age 11-14

·      250g force

·      Overcorrect

 

How does it work?

 

Midface and maxillary protraction DeClerck 2010

·      58% (3.9mm) maxillary protraction

·      Midface protraction 2.9mm (Orbitale)

·      42% (2.7mm) mandibular retrained

 

 

What took place for correction

 

·      Maxillary protraction via distraction at the maxillary sutures

·      Closure of the mandibular angle 2.1 De Clerck

·      Distalisation of ramus (3.6mm) )and condyles (2.5mm)

o   = bending the condylar angle

 

Retention protocol

·      Wear class 3 elastics to anchors 250 g

·      Monitor every 6 months

·      Anchors removed same time as 8s removed

 

Long term BAMP study by Nguyen (not published)

 

·      15 year follow up of 25 patients

·      Outcome CBCT follow up from pre, post and long term

·      A point 0.6mm change, vertical 2.1mm

·      B point 1.1mm advance, vertical 2.

·      Issues

o   Mandibular prognathic cases relapsed

 

16 years of experience

BAMP most effective for:

·      Maxillary deficient

·      Mild to moderate skeleltal deficiency

·      Most effective in younger

·      After 15 years of age only retraining effect on mandibible

·      12% failure

 

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