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Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances.

Abstract

In this cephalometric investigation, we compared the long-term effects of an initial phase of rapid maxillary expansion and facemask (RME/FM) therapy followed by comprehensive edgewise therapy with the effects of growth in untreated, matched controls. The treated sample consisted of 34 patients who underwent RME/FM treatment before the pubertal growth spurt (average age, 8 years 3 months at the beginning of treatment). At the final observation period (average age, 14 years 10 months), all patients were in decelerative growth phases as determined by the cervical vertebral maturation (CVM) method. After the first 10 months of active treatment, significant favorable changes in both the maxillary and the mandibular skeletal components were noted. The forward movement of the maxilla was 1.8 mm greater than in the controls, mandibular projection was reduced by almost 3 mm, and the relative sagittal intermaxillary discrepancy improved by 4.3 mm, as measured by the Wits appraisal. During the posttreatment period, the treated and untreated Class III subjects generally grew similarly, although the skeletal relationship of the maxilla to the mandible remained unchanged in the RME/FM group, whereas the controls had an increased skeletal discrepancy of 3.0 mm. Over the long term, there was a slightly greater increase in midfacial length (1.6 mm) in the treatment group than in the controls. Similarly, the distance from Point A to nasion perpendicular decreased by 1.2 mm in the treated group. The overall increase in mandibular length was 2.4 mm less in the RME/FM group than in the controls, and mandibular projection relative to nasion perpendicular was 3.0 mm less in the treated group. The change in the Wits appraisal was substantial between groups (6.1 mm), with an improvement in the intermaxillary relationship in the treated group (3.4 mm); the Wits appraisal worsened (-2.7 mm) in the untreated controls. No clinically significant differences were observed between the groups in the vertical dimension. Overjet increased significantly in the treated group relative to the controls (4.4 mm), whereas the molar relationship decreased significantly (-3.9 mm). It appears that the favorable skeletal change observed over the long term is due almost entirely to the orthopedic correction achieved during the RME/FM protocol. During the posttreatment period that includes the pubertal growth spurt, craniofacial growth in RME/FM patients is similar to that of untreated Class III controls. Aggressive over-correction of the Class III skeletal malocclusion, even toward a Class II occlusal relationship, appears to be advisable, with the establishment of positive overbite and overjet relationships essential to the long-term stability of the treatment outcome.

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  • Authors+Show Affiliations

    ,

    Graduate orthodontic program, University of Michigan, Ann Arbor, 48109-1078, USA.

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    Source

    MeSH

    Age Factors
    Analysis of Variance
    Case-Control Studies
    Cephalometry
    Child
    Extraoral Traction Appliances
    Female
    Follow-Up Studies
    Humans
    Male
    Malocclusion, Angle Class III
    Maxillofacial Development
    Orthodontic Appliances
    Orthodontics, Corrective
    Palatal Expansion Technique
    Treatment Outcome
    Vertical Dimension

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    12637903

    Citation

    Westwood, Patricia Vetlesen, et al. "Long-term Effects of Class III Treatment With Rapid Maxillary Expansion and Facemask Therapy Followed By Fixed Appliances." American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, vol. 123, no. 3, 2003, pp. 306-20.
    Westwood PV, McNamara JA, Baccetti T, et al. Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop. 2003;123(3):306-20.
    Westwood, P. V., McNamara, J. A., Baccetti, T., Franchi, L., & Sarver, D. M. (2003). Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 123(3), pp. 306-20.
    Westwood PV, et al. Long-term Effects of Class III Treatment With Rapid Maxillary Expansion and Facemask Therapy Followed By Fixed Appliances. Am J Orthod Dentofacial Orthop. 2003;123(3):306-20. PubMed PMID: 12637903.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. AU - Westwood,Patricia Vetlesen, AU - McNamara,James A,Jr AU - Baccetti,Tiziano, AU - Franchi,Lorenzo, AU - Sarver,David M, PY - 2003/3/15/pubmed PY - 2003/4/4/medline PY - 2003/3/15/entrez SP - 306 EP - 20 JF - American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics JO - Am J Orthod Dentofacial Orthop VL - 123 IS - 3 N2 - In this cephalometric investigation, we compared the long-term effects of an initial phase of rapid maxillary expansion and facemask (RME/FM) therapy followed by comprehensive edgewise therapy with the effects of growth in untreated, matched controls. The treated sample consisted of 34 patients who underwent RME/FM treatment before the pubertal growth spurt (average age, 8 years 3 months at the beginning of treatment). At the final observation period (average age, 14 years 10 months), all patients were in decelerative growth phases as determined by the cervical vertebral maturation (CVM) method. After the first 10 months of active treatment, significant favorable changes in both the maxillary and the mandibular skeletal components were noted. The forward movement of the maxilla was 1.8 mm greater than in the controls, mandibular projection was reduced by almost 3 mm, and the relative sagittal intermaxillary discrepancy improved by 4.3 mm, as measured by the Wits appraisal. During the posttreatment period, the treated and untreated Class III subjects generally grew similarly, although the skeletal relationship of the maxilla to the mandible remained unchanged in the RME/FM group, whereas the controls had an increased skeletal discrepancy of 3.0 mm. Over the long term, there was a slightly greater increase in midfacial length (1.6 mm) in the treatment group than in the controls. Similarly, the distance from Point A to nasion perpendicular decreased by 1.2 mm in the treated group. The overall increase in mandibular length was 2.4 mm less in the RME/FM group than in the controls, and mandibular projection relative to nasion perpendicular was 3.0 mm less in the treated group. The change in the Wits appraisal was substantial between groups (6.1 mm), with an improvement in the intermaxillary relationship in the treated group (3.4 mm); the Wits appraisal worsened (-2.7 mm) in the untreated controls. No clinically significant differences were observed between the groups in the vertical dimension. Overjet increased significantly in the treated group relative to the controls (4.4 mm), whereas the molar relationship decreased significantly (-3.9 mm). It appears that the favorable skeletal change observed over the long term is due almost entirely to the orthopedic correction achieved during the RME/FM protocol. During the posttreatment period that includes the pubertal growth spurt, craniofacial growth in RME/FM patients is similar to that of untreated Class III controls. Aggressive over-correction of the Class III skeletal malocclusion, even toward a Class II occlusal relationship, appears to be advisable, with the establishment of positive overbite and overjet relationships essential to the long-term stability of the treatment outcome. SN - 0889-5406 UR - https://www.unboundmedicine.com/medline/citation/12637903/Long_term_effects_of_Class_III_treatment_with_rapid_maxillary_expansion_and_facemask_therapy_followed_by_fixed_appliances_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S088954060256964X DB - PRIME DP - Unbound Medicine ER -