Clinical Considerations in the Use of Maxillary Protraction Appliance in Cleft Lip and/or Palate Patients with Particular Emphasis on the Timing and Type of Protraction

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The effects of maxillary protraction with face mask on dentofacial morphology were studied in fifteen patients with cleft lip and/or palate. Maxillary traction was initiated at the age of 4 to 10 years (mean age 7.5 years). Traction term ranged from 9 to 24 months (average 17.2 months). Average force magnitude was 250-400 g on each side. Traction forces were used from one of the following sites; 1 : The molar's hook, 2 : an overlay palatal plate and 3 : buccal hooks from the main lingual arch on the premolar area. A control group of 15 untreated patients with similar anomaly and age was observed for one year. Changes in the dentofacial morphology in both groups were compared. Forward traction and correction of anterior crossbite were achieved in 6 cases (40 %) while traction failed to correct the crossbite in the remaining 9 patients. However, the orthopedic effects on palatal depth, S-N-ANS angle and upper lip improvement were observed in all subjects. In general, younger subjects showed more skeletal and dental improvement than older subjects. Moderate clockwise rotation of the mandible was observed in the overlay type. The results of this study suggested that using protractor appliance in the deciduous and early mixed dentitions is indicated as an early treatment of maxillary retrusion and anterior crossbite, especially in patients with cleft lip and/or palate.
昭和大学・昭和歯学会の論文