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Published on: May 23, 2020
Personalized 3-dimensional-printed titanium plate bone-anchored maxillary protraction and 3-dimensional mandibular
Shukui Xu1, Linna Wang1, Weiwei Chang1
1Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, China.
Background:
This study presents an assessment of the 3-dimensional (3D) morphologic and volumetric changes in the mandible and condyle after the use of a novel intraoral bone-anchored maxillary protraction (BAMP) device, specifically personalized with 3D-printed titanium plates, in adolescents with skeletal Class III malocclusion. Through the integration of a medical-industrial collaborative approach in the design and fabrication of patient-specific implants, the aim of this research is to establish an innovative treatment model that enhances the efficacy and precision of orthopedic interventions.
Methods:
This retrospective cohort study included 33 patients aged 11-13 years who were divided into a treatment group (TG; n = 15) that received BAMP and an untreated control group (CG; n = 18). Pretreatment and posttreatment cone-beam computed tomography scans were analyzed via MIMICS software (Materialise, Leuven, Belgium: http://biomedical.materialise.com/mimics) for 3D reconstruction and morphometric evaluation of the condylar volume, surface area, diameter, mandibular ramus dimensions, and axial angle.
Results:
The TG exhibited a significant reduction in condylar anteroposterior diameter (0.16 ± 0.09 mm compared with 1.86 ± 1.05 mm in the CG; P = 0.001; 95% confidence interval [CI] = 0.1574-0.1654 mm) and a significant increase in condylar mediolateral diameter (2.02 ± 1.06 mm compared with 0.64 ± 1.08 mm in the CG; P = 0.001; 95% CI = 1.6214-2.7692 mm). The increase in condylar surface area in the TG was smaller than that in the CG (70.51 ± 88.30 mm2 compared with 196.83 ± 259.50 mm2 in the CG; P = 0.042; 95% CI = -390.2642 to 2937.8041 mm2). In addition, there was a notable decrease in the mandibular axial angle within the TG (-3.61° ± 3.25° compared with 0.19° ± 1.84° in the CG; P = 0.001; 95% CI = -5.1079° to 0.1478°). No statistically significant differences were observed in the variations of condylar volume (P = 0.182), condylar height (P = 0.627), mandibular ramus volume (P = 0.301), and mandibular ramus height (P = 0.611).
Conclusions:
BAMP facilitated the directional remodeling of condylar growth and mandibular morphology, promoting mediolateral expansion and counterclockwise rotation. These findings indicate the potential of BAMP to influence the progression of skeletal Class III malocclusion. However, several limitations exist: the technology is still in clinical trials, limiting its scope, sample size, and follow-up duration for assessing long-term outcomes. The impact on long-term mandibular growth is unclear. Larger studies with longer follow-ups and multicenter efforts are needed to determine BAMP's long-term efficacy and clinical limitations.
