Cephalometric and occlusal changes following maxillary expansion and protraction

Abstract

A prospective clinical trial was conducted to determine the cephalometric and occlusal changes following maxillary expansion and protraction. Twenty Southern Chinese patients (eight males and 12 females with a mean age of 8.4 ± 1.8 years) with skeletal Class III malocclusions were treated consecutively with maxillary expansion and a protraction facemask. Growth adaptation of these patients was followed for 2 years after removal of the appliances and compared with a control group of subjects with no treatment. Lateral cephalometric radiographs were used to quantify the skeletal and dental changes before treatment (T1), immediately after treatment (T2) and 2 years after removal of appliances (T3). With 8 months of treatment (T2 - T1), overjet was overcorrected from a -2.0 to 3.5 mm. The maxilla moved forwards by an average of 2.1 mm and the molar relationship was improved to a Class I dental arch relationship. The palatal and occlusal planes were tilted upward 1.0 and 2.0 degrees, respectively. Two years following removal of the appliances (T3 - T2), a positive overjet was maintained in 18 out of 20 patients. The maxilla continued to move forwards in the treated subjects similar to the controls. The mandible outgrew the maxilla. In most instances, dental compensation with proclination of the maxillary incisors was observed. The palatal plane returned to pre-treatment value. The occlusal plane continued to tilt upward due to eruption of the molars and proclination of the incisors. Analysis of dental casts showed a significant increase in maxillary intercanine (2.2 mm) and intermolar widths (2.3 mm) with 7 days of rapid palatal expansion followed by maxillary protraction. The percentage relapse in maxillary intermolar widths was 30-45 per cent after 1 year, in most cases with minimal retention. In the mandibular arch, the concurrent increase in intermolar width (2.3 mm) was primarily due to buccal uprighting of the posterior molars when the maxilla was protracted into a Class I skeletal relationship and was stable after 1 year. The results of this study indicate stability of orthopaedic treatment of Class III malocclusions directed at the maxilla. Despite some relapse, a net improvement in maxillomandibular relationship and a positive overjet was maintained in 18 out of 20 patients at the end of the follow-up period.