Maxillary protraction at early ages. The revolution of new bone anchorage appliances

An update is provided on the different types of early treatment for class III malocclusions of maxillary origin. There is an increasing tendency to prescribe maxillary orthopedic treatment with skeletal anchorage, with the purpose of enhancing the skeletal and reducing the dentoalveolar effects--offering a management option for children with important deformations that otherwise would have to wait until adult age to receive surgical treatment.

A literature review has been made of maxillary bone orthopedic traction appliances in growing children with class III malocclusions. A Medline (PubMed) search was made using the following MeSH terms: Cephalometric, Child, Malocclusion class III/therapy, Extraoral traction appliances, Palatal expansion, Bone plates, Skeletal anchorage, Orthodontic anchorage.

Many articles show that the greatest maxillary advances are obtained at very early ages, though with a greater tendency towards relapse. However skeletal anchorage has been seen to afford a lesser relapse rate and greater dentofacial orthopedic efficiency due to its low dentoalveolar impact. In any case, further randomized clinical studies are needed to firmly establish the quantifiable differences in terms of maxillary advance, optimum traction age, optimum traction appliance and potential side effects. At present, the incorporation of surgically inserted bone anchorage appliances (miniplates and miniscrews) offers a purely orthopedic approach to treatment, with minimization of the undesirable side effects of traditional dentofacial orthopedic compensation based on dentoalveolar anchorage. Nevertheless, further studies are needed to consolidate the supporting scientific evidence in this field.