interceptive non-surgical maxillary advancement in clp children: long term results of late orthopaedic advancement of the maxilla
An anterior cross bite, related to an inadequate development in a postero-anterior direction of the maxillary bone, is very frequent in patients affected by cleft lip and palate. One of the most traditional treatment methods is the use of an external device for maxillary protraction at an early age. While the literature is in agreement on the fact that a Delaire Mask is more efficient when applied early, within three years after the completion of active treatment the original skeletal pattern of growth gradually reappears (Tinlund, 1994). Although in the early mixed dentition there is often an indication for maxillary orthopaedic protraction, such as occlusal trauma, generally at the level of the central incisors, the orthodontist should never be too enthusiastic in terms of prognosis in the long term.Generally, a horizontal hypoplasia of the maxilla is associated to a transversal and a vertical hypoplasia. In the literature rapid palatal expansion has been shown to facilitate sagittal advancement of the maxilla by mobilizing circum-maxillary sutures (Ngan et al, 1998).A relatively new technique developed by Liou, (Liou et al, 2005), allows for the orthopaedic advancement of the maxillary arch after having it effectively mobilized through alternative movements of opening and closure of the maxillary sutures with a double fan rapid palatal expander. It includes the use of intraoral springs which allow to apply continuous propulsive forces to the maxillary bone instead of non-continuous forces as utilized with a protraction face mask. This system allows to start treatment at a later stage of facial growth, around 11 to 12 years of age (around the II stage of cervical vertebral maturation) and it allows to obtain a clinically significant overcorrection (the average advancement obtained by the author was of 6 mm when compared to the amount of 2 to 3 mm which is obtainable from way Delaire mask treatment). Furthermore, there are very few dental compensations with this method. This allows the orthodontists to feel more confident about a better prognosis at the end of growth. In this study we present short and long-term results of the application of the Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) technique, a late orthopaedic maxillary protraction with intraoral anchorage in cleft patients.
A total of 96 patients were treated with Alt-Ramec. In this study only CLP patients were included:35 patients affected by Unilateral Cleft Lip and Palate (UCLP) and affected by Bilateral Cleft Lip and Palate (BCLP) were included. The treatment was started when the vertebral stage of maturation was V2-V3.The advancement of A-point, after the application of the technique, was 5.7±3 mm.Our results showed a satisfactory maxillary protraction, with stable long-term result.