Success rate of miniplate anchorage for bone anchored maxillary protraction

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Success Rate of Miniplate Anchorage for Bone Anchored

Maxillary Protraction Eline E. B. De Clercka ; Gwen R. J. Swennenb(Angle Orthodontist, Vol 81, No 6, 2011)

Dr. Saba BasitMCPS ResidentOrthodontics

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AIM and OBJECTIVE :

Aim of this prospective study was to evaluate

the success rate of Bollard miniplate anchorage for BAMP in growing children.

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What is a Miniplate?

Temporary skeletal anchorage device.

American Journal of Orthodontics and Dentofacial Orthopedics May 2014 Vol 145 Issue 5

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USES OF MINIPLATES:

1. Difficult cases with complex problems 2. Surgical orthodontics a) Class 3 patients after mandibular set back and

maxillary advancement. b) Distalization and intrusion of maxillary posteriors.3. Orthopedic treatment. 4. Backup system of miniscrews


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USES cont.

1. Difficult cases with complex problems

a) Bimaxillary posterior teeth distilization to avoid premolar extractions.

b) Skeletal open-bite with class II malocclusion requiring distalization plus intrusion of molars.


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Maxillary Posterior Teeth Distilization to Avoid Premolar Extractions


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Skeletal Open-bite with Class II Malocclusion Requiring DISTALIZATION & INTRUSION of Molars


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Uses cont.2. Surgical orthodontics

In Class III patients, immediately after mandibular setback or maxillary advancement miniplates are implanted at the zygomatic buttress and mandibular body during orthognathic surgery.

Miniplates are applied to distalize and intrude the maxillary posterior teeth and/or protract the mandibular dentition.


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Molar intrusion with miniplates

Miniplate in Zygomatic Arch

Mandibular setbackAmerican Journal of Orthodontics and Dentofacial Orthopedics May 2014 Vol 145 Issue 5

Surgical Orthodontics

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Molar Intrusion:


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4. Orthopedic Treatment

Skeletal class III patients with poor compliance with a face mask.


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Orthopedic Treatment


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Maxillary Protraction :

Why we need? In class III patients

Mandibular Prognathism Maxillary Retrognathism


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Maxillary Hypoplasia

Delaire in the 1970’s Delaire face mask

Disadvantages:• Noncompliance • Dentoalveolar compensation• Clockwise rotation of the mandible

Angle Orthodontist, Vol 81, No 6, 2011

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Materials And Method:

25 patients - 7 males & 18 females. - Mean age – 12 yrs

All had (BAMP) without corticotomy or osteotomy with the use of class III elastics between miniplate skeletal anchorage in the upper and lower jaw.


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Materials And Method cont.. Minimal invasive flap was raised.


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In the upper jaw, ‘‘Upper Bollards with hooks’’ were placed at the right

and left infrazygomatic crest.

In the lower jaw, ‘‘Lower Bollards with hooks’’ were placed on both sides between the lower canine and the lateral incisor.

Materials And Method cont..


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In all patients, the Bollard miniplates were fixed with monocortical Titamed Bollard Miniplate Screws .



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In the first six patients, self-tapping screws were used, and in the following 19 patients, self-drilling screws were applied.

A single dose of IV antibiotics (amoxicillin and clavulanic acid) was given

during surgery.

Postsurgical instructions were given to all patients



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Loading of Bollard modified miniplates with 150 g elastics was initiated 17 to 18days after

surgery .

Maintained for a period of 12 months.



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RESULTS:

In 25 consecutive patients, 99 Bollard modified miniplates could be placed with excellent primary stability under general anesthesia.

In the lower jaw, miniplates could be placed in all patients between the lateral incisor and the canine. No infections occurred.


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The overall success rate in terms of stability of Bollard miniplate anchorage was 97%.

Five different patients showed signs of mobility with small discomfort. In these cases, loading was interrupted for 2 months.

Two miniplates became stable again, and three miniplates needed to be removed and replaced under local anesthesia 3 months later.

In two patients, fracture of a hook of the miniplate occurred and was solved by insertion of a custom-made hook .

RESULTS cont.


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DISCUSSION:

BAMP is the most critical procedure regarding stability and patient morbidity in the use of miniplate anchorage in orthodontics.

Initial mechanical retention of is mainly influenced by the thickness and density of the external cortical bone and is reduced in growing children compared with adult patients.

In a prospective study on 200 miniplates, most failures occurred in the youngest patients.


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DISCUSSION cont..

All failures in our study occurred in the youngest patients.

No significant differences were observed in the stability of plates fixed by self-taping or self-drilling screws. Therefore The authors recommend self-drilling screws, which are easier to use.


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DISCUSSION cont..

Last but not least, good orthodontic follow-up consisting of oral hygiene instructions and evaluation of miniplate anchorage is essential for treatment outcome.


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DISCUSSION cont.

The high success rate in this study is related to:

(1) Presurgical counseling of the patient, (2) Minimal invasive surgery with decreased patient

morbidity and adequate postsurgical instructions (3) Good orthodontic follow-up.


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Postsurgical Instructions to the Patients:

Cooling during 48 hours light upright position during 48 hours Increase in blood pressure avoided during the first week Rinsing twice per day with chlorhexidine over 12 days Extensive rinsing with sparkling water (5–10 times/d) NSAID over 3 days Orthodontic loading of Bollard modified miniplates at approximately 14

days after surgery. Manipulation of Bollard modified miniplates with tongue or fingers

avoided. No antibiotics are prescribed after surgery. NSAID indicates nonsteroidal anti-inflammatory drug.


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LIMITATIONS:

Cross sectional study with no major statistical evaluation of results.

Failure was vaguely correlated with factors responsible.

Oral hygiene and compliance were either not monitored or recorded.


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Future Recommendations for Further Research Based on this Article:

We can explore:

1. Factors associated with failure. 2. Difference between skeletal changes with face mask

only and with Bollard miniplates. 3. Evaluation of comfort with face mask and Bollard

miniplates with class III elastics.


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AFID CASE:

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INTRA ORAL PICTURES

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DURING SURGERY

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CONCLUSION

1. Miniplate anchorage with Bollard modified miniplates is highly effective for bone anchored maxillary protraction (BAMP).

2. Success depends on proper presurgical patient counseling, minimal invasive surgery, good postsurgical instructions, and orthodontic follow-up.


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REFERENCES1. Delaire J. Manufacture of the ‘‘orthopedic mask.’’ RevStomatol Chir Maxillofac. 1971;72:579–582.2. Delaire J. Treatment of Class III with dentofacial orthopedicmask. Acta Odontol Venez. 1979;17:168–200.3. Baik HS. Clinical results of the maxillary protraction in Koreanchildren. Am J Orthod Dentofacial Orthop. 1995;108:583–592.

Success rate of miniplate anchorage for bone anchored maxillary protraction

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