ORIGINAL ARTICLE
Treatment effects of maxillary
protraction with palatal plates vs
conventional tooth-borne anchorage in
growing patients with Class III
malocclusion
You-sun Lee,a Jae Hyun Park,b Jaehyun Kim,c Nam-Ki Lee,d Yoonji Kim,c and Yoon-Ah Kookc
Seoul and Seongnam, South Korea, and Mesa, Ariz
Introduction: Evaluate the treatment effects of maxillary protraction using palatal plates and compare them to
those with conventional tooth-borne anchorage in growing patients with Class III malocclusion. Methods: Forty
patients were divided into 2 groups according to the type of anchorage used: group 1 (n 5 20; mean age, 10.5 6
1.6 years; palatal plates) and group 2 (n 5 20; mean age, 10.0 6 1.2 years; tooth-borne appliances). Lateral
cephalograms were taken before and after maxillary protraction. Skeletal, dental, and soft-tissue variables
were measured. For statistical analysis, paired and independent t tests were performed. Results: Group 1
showed maxilla advancement by 2.3 6 1.0 mm compared with group 2 by 0.9 6 0.6 mm, and group 2 indicated
clockwise rotation of the mandible, but there was no such clockwise rotation in group 1 (P \0.001). Group 1 had
a less lingual inclination of the mandibular incisors than group 2 (IMPA, 1.0 6 3.8 vs 3.8 6 2.8 ; P \0.05).
There was no difference in soft-tissue changes between the 2 groups. Conclusions: A facemask with palatal
plate induced maxillary advancement with less mandibular clockwise rotation and dental movement than con-
ventional tooth-borne anchorage. This modality can be used efficiently for maxillary protraction in growing
patients with Class III malocclusion. (Am J Orthod Dentofacial Orthop 2022;162:520-8)
M
axillary protraction with tooth-borne appli- Bone-borne temporary skeletal anchorage devices
ances has the standard treatment for skeletal (TSADs) have been applied to avoid such drawbacks.4-12
Class III malocclusion patients with a retro- When a facemask or Class III elastics are to be used,
gnathic maxilla. However, this conventional method miniplates are placed on the lateral nasal wall,4,9 the infra-
may cause undesirable side effects, including extrusion zygomatic area,5,7,8 and the mandibular anterior area.6,10
of the molars, proclination of the maxillary incisors, In contrast, miniscrews are used in the buccal or
and increased lower anterior facial height.1-3 palatal areas because they are less invasive than mini-
plates.13,14 de Souza et al15 reported using 4 buccal
a
Graduate School of Clinical Dental Science, Catholic University of Korea, Seoul, screws on the maxilla and mandible with elastics to treat
South Korea.
b
patients with Class III malocclusion. The palate has been
Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health,
A.T. Still University, Mesa, Ariz; International Scholar, Graduate School of
considered a safe area for miniscrew application because
Dentistry, Kyung Hee University, Seoul, South Korea. of sufficient bone thickness and density.16,17 Using
c
Department of Orthodontics, Seoul St. Mary’s Hospital, College of Medicine, TSADs for maxillary protraction, a couple of studies
Catholic University of Korea, Seoul, South Korea.
d
Department of Orthodontics, Section of Dentistry, Seoul National University
have applied the hybrid hyrax device using miniscrews
Bundang Hospital, Seongnam, South Korea. or onplants on the palatal bone as anchorage with a
All authors have completed and submitted the ICMJE Form for Disclosure of Po- facemask.18-20 Al-Mozany et al14 used paramedian-
tential Conflicts of Interest, and none were reported.
Address correspondence to: Yoon-Ah Kook, Department of Orthodontics, Seoul
palatal and mandibular anterior miniscrews with elastics.
St. Mary’s Hospital, College of Medicine, Catholic University of Korea, 222 These studies incorporated palatal TSADs indirectly to
Banpo-daero, Seocho-Gu, Seoul 06591, South Korea; e-mail, kook2002@ enhance the anchorage of tooth-borne appliances.
catholic.ac.kr.
Submitted, March 2021; revised and accepted, May 2021.
For direct palatal anchorage, Kook et al21 reported
0889-5406/$36.00 that a modified palatal plate with a facemask was applied
Ó 2022 by the American Association of Orthodontists. All rights reserved. for maxillary protraction without a flap operation in a
https://doi.org/10.1016/j.ajodo.2021.05.014
520
Lee et al 521
Fig 1. Palatal plate and tooth-borne anchorage: A, Palatal plate; B, Tooth-borne anchorage.
(B-2010645-105), and informed consent was provided ac-
Table I. Baseline characteristics of subjects in the
cording to the Declaration of Helsinki.
palatal plate and tooth-borne anchorage groups
The samples were divided into 2 groups according to
Characteristics Group 1y Group 2z P value the type of anchorage device used in Figure 1 and Table
Patients (n) 20 20 I: Group 1 (n 5 20; mean age, 10.5 6 1.6 years; face-
Age (y) 10.5 6 1.6 10.0 6 1.2 0.301 mask with a palatal plate in the midpalatal area) and
Gender
group 2 (n 5 20; mean age, 10.0 6 1.2 years; facemask
Male 7 9
Female 13 11 with a tooth-borne appliance).
Treatment duration (mo) 7.8 6 3.4 9.6 6 3.2 0.126 The patients were selected on the basis of the
Note. Values are presented as mean 6 standard deviation. following inclusion criteria: (1) skeletal and dental Class
y
Facemask with palatal plate; zFacemask with the tooth-borne III malocclusion with retrognathic maxilla with mixed
appliance. dentition (ANB, \1.0 ; A to Nperp \1.0 mm), (2) ante-
rior crossbite to edge-to-edge bite, (3) no cleft and other
patient with Class III malocclusion. There was wider stress craniofacial syndromes, and (4) no significant skeletal
distribution and more forward displacement of the asymmetry (\2 mm of chin point deviation). Both
maxilla when maxillary protraction was accomplished groups were overcorrected until the Class II canine and
with palatal plates than with a miniplate at the infrazygo- molar relationship was achieved.
matic crest.22 In group 1, a palatal plate was customized on the
So far, there have been a significant amount of patient’s cast model, and a jig was fabricated, which
studies on maxillary protraction with buccal miniplates allowed the palatal plates to be applied easily and accu-
or miniscrews.4-10 Cornelis et al23 reported a systematic rately (Fig 2).21 The plate was placed in the paramedian-
review with meta-analysis in which they found little dif- palatal area with 3 self-drilling miniscrews (2.0 mm in
ference in the sagittal correction with TSADs vs tradi- diameter and 10.0 mm in length; Shinhung, Seoul,
tional facemask therapy for maxillary protraction. Korea) with a torque driver (Jeil Medical Corporation,
However, few clinical studies have considered maxillary Seoul, South Korea) at 30 rpm using \30 Ncm. Prophy-
protraction using palatal plates. lactic antibiotics (cefpodoxime proxetil for 3 days) were
Therefore, this study aimed to evaluate the treatment prescribed when the screws were likely to project into the
effects of maxillary protraction using palatal plates and nasal cavity. Elastics and a facemask were connected to
compare them to those with conventional tooth-borne the hooks on the palatal plate with forces at approxi-
anchorage in growing patients with Class III malocclusion. mately 30 downward and forward from the occlusal
plane for 12-14 hours daily to deliver 400-500 g of force
MATERIAL AND METHODS per side (Fig 3).
The study sample included 40 patients with Class III In group 2, a conventional tooth-borne appliance
malocclusion aged 8-13 years showing a retrognathic was used with a facemask for maxillary protraction. Elas-
maxilla with mixed dentition who visited the Depart- tics were connected to 2 hooks of a tooth-borne appli-
ment of Orthodontics at Seoul St. Mary’s Hospital and ance with forces at approximately 30 downward and
Seoul National University Bundang Hospital from forward from the occlusal plane for 12-14 hours daily
January 2011 to August 2020. to deliver 400-500 g of force per side.
Approval was obtained from the Institutional Review Lateral cephalograms were taken before (T0) and
Board of the Catholic University of Korea (KC20RIDI0641) after maxillary protraction treatment (T1). The mean
and Seoul National University Bundang Hospital treatment duration was 7.8 6 3.5 months in group 1
American Journal of Orthodontics and Dentofacial Orthopedics October 2022 Vol 162 Issue 4
522 Lee et al
Fig 2. Design of palatal plate and jig: A, Palatal plate; B, Customized palatal plate; C, Jig for palatal
plate placement.
and 9.4 6 3.5 months in group 2. Cephalometric tracing (A-Nperp) and 2.8 6 1.4 (SNA) compared with group
and measurements were made by 1 investigator (Y.-S.L.) 2 by 0.9 6 0.6 mm and 0.9 6 0.8 (P \0.001). There
using V-Ceph software (CyberMed, Seoul, South Korea) was no significant difference in the backward movement
at units of 0.05 and 0.05 mm, respectively (Figs 4 and of the mandible between the groups, but group 1 showed
5). The cephalometric variables are listed in Table II. improved intermaxillary relationships of 3.6 6 1.0
The sample size calculation is based on a previous (ANB) compared with 1.6 6 0.9 in group 2
study using bone-anchored maxillary protraction6 that (P \0.001). For the vertical changes, group 2 showed a
at least 12 samples were required to identify an effect 1.7 6 0.7 significant increase in mandibular plane angle
size of 1.83 units, with an a of 0.05 and b of 0.2. (FMA) compared with 0.4 6 1.5 in group 1. In addition,
One examiner (Y.-S.L.) took measurements of the there was no significant difference in the anterior rota-
landmarks. The same observer repeated measurements tion of the palatal plane between the groups.
after 1 week to calculate the intraclass correlation coef- Group 2 had a 4.5 6 2.1 mm increase in overjet
ficient, and the intraclass correlation coefficient value compared with 2.5 6 1.6 mm in group 1 (P \0.01).
ranged from 0.991 to 0.999 for intraobserver reliability. Group 1 showed no significant change in U1-FH (1.2
6 5.6 ), whereas group 2 showed a substantial
Statistical analysis increase in U1-FH (2.3 6 3.9 ), but there was no differ-
All statistical analyses were performed using SPSS ence between the 2 groups. Group 2 had a 3.8 6 2.8
Statistics (version IBM Corp, Armonk, NY), and statistical decrease in IMPA compared with a 1.0 6 3.8 in group
significance was set at P \0.05. The Kolmogorov- 1 (P \0.01). In addition, there was no difference in in-
Smirnova test was used to confirm the normal distribu- terincisal angle changes between the 2 groups (0.7
tion of measurements. All measurements showed normal 6 5.9 and 0.1 6 4.5 , respectively).
distribution. To evaluate the differences between the Changes in the upper lip and facial convexity were
groups, an independent t test was performed. To assess similar in the 2 groups (UL/E-plane, 0.8 6 1.5 mm
the differences between T0 and T1 in each group, a and 1.4 6 1.2 mm; G-Sn-Pog, 3.1 6 3.0 ; and 3.8 6
paired t test was used. 2.8 , respectively), without an intergroup difference.
The lower lip and nasolabial angle did not change.
RESULTS
As shown in Table I, there was no significant differ-
ence in age between the groups, indicating that the sam- DISCUSSION
ples were matched in age. The mean duration of Maxillary protraction using TSADs is an efficient mo-
treatment was 7.8 6 3.4 months and 9.6 6 3.2 months, dality for growing patients with Class III malocclusion
respectively. with maxillary deficiency. Palatal plates can provide
Before treatment, the cephalometric variables of both anchorage for maxillary protraction. They require single
groups were measured. There was no significant differ- and flapless placement compared with bilateral buccal
ence in the cephalometric variables between the pre- plates and achieve the most desirable dentoskeletal ef-
treatment groups except for nasolabial angle, as seen fects compared with other appliances.21,24 Our study
in Table III. Figure 6 and Table IV compare the treatment evaluated the treatment effects of maxillary protraction
effects on cephalometric variables. using palatal plates.
For the sagittal changes, group 1 showed a significant Group 1 showed 2.3 6 1.0 mm maxillary protraction
forward movement of the A-point by 2.3 6 1.0 mm in 7.8 6 3.4 months. Some studies4,5,25 reported the
October 2022 Vol 162 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al 523
Fig 3. Photograph and radiographic image after placement: A, Application facemask with palatal plate
using elastics; B, Lateral cephalogram image.
Fig 4. Linear measurements (mm) used in this study. 1, A-N perp; 2, Pog-N perp; 3, Wits appraisal; 4,
Overjet; 5, Overbite; 6, UL/E-plane; 7, LL/E-plane.
A-point moved 4.8 6 2.0 mm in 10.8 6 2.4 months us- The palatal plane did not show changes in both
ing lateral nasal wall plates,4 3.4 6 1.8 mm in 9.2 6 2.4 groups in our study. A study reported decreases in the
months using infrazygomatic plates with a facemask.5 In palatal plane of 0.7 6 1.1 in the miniplate groups
contrast, Nguyen et al25 demonstrated 3.7 6 1.7 mm of and 0.6 6 1.5 in the conventional groups, but there
the maxilla’s forward movement in 1.2 6 1.0 years using were no differences.5 This angle was reduced by 1.1
miniplates with elastics. The amount of maxillary pro- with a bone-tooth-borne hybrid and facemask.18 This
traction was around 0.3 mm/mo. This means that ortho- suggests that rotation of the palatal plane did not occur
pedic treatment using different TSADs produced similar during facemask therapy with the palatal plate.
maxillary protraction. In a finite element study22 with palatal plates and
Regarding the angular change of the maxilla, our infrazygomatic miniplates, ANS moved forward and up-
study showed a 2.8 6 1.4 increase of SNA in group 1. ward, and PNS had forward and downward displace-
Other studies using miniplates reported that SNA ment. Lee et al26 showed the infrazygomatic plate had
increased by 3.7 6 1.5 and 3.3 6 1.7 .4,5 A bone- forward and upward displacements of ANS. However,
tooth-borne hybrid appliance produced a 2.0 6 1.5 in- in our clinical study, the group using palatal plates
crease in SNA.20 showed less rotation of the palatal plane than group 2.
American Journal of Orthodontics and Dentofacial Orthopedics October 2022 Vol 162 Issue 4
524 Lee et al
Fig 5. Angular measurements ( ) used in this study. 1, SNA; 2, SNB; 3, ANB; 4, AB-MP; 5, Palatal
plane angle; 6, FMA; 7, SN-GoMe; 8, Gonial angle; 9, U1-FH; 10, U1-SN; 11, IMPA; 12, Interincisal
angle; 13, Nasolabial angle; 14, G-Sn-Pog.
Table II. Definitions of the cephalometric variables
Cephalometric variables Definition
Sagittal relationships
SNA ( ) The angle between the anterior cranial base (sella to nasion) and the NA (nasion to point A) line
SNB ( ) The angle between the anterior cranial base (sella to nasion) and the NB (nasion to point B) line
ANB ( ) The angle between NA and NB lines
A-Nperp (mm) The perpendicular distance from point A to the nasion perpendicular line to the Frankfort horizontal (FH) plane
Pog-Nperp (mm) The perpendicular distance from the pogonion to the nasion perpendicular line to the Frankfort horizontal (FH) plane
Wits appraisal (mm) The distance between AO and BO, the projection of points A and B perpendicularly to the occlusal plane
AB-MP ( ) The angle between the A-B line and the Go-Me line
Overjet (mm) Incisor overjet
Vertical relationships
Palatal plane angle ( ) The angle between the FH plane and ANS-PNS line
FMA ( ) The angle between the FH plane and Go-Me line
SN-GoMe ( ) The angle between the anterior cranial base (Sella to nasion) and the Go-Me line
Gonial angle ( ) The angle between the Me-Go line and the Go-Ar line
Overbite (mm) Incisor Overbite
Dental relationships
U1-FH ( ) The angle between the maxillary incisor axis line and the FH plane
SN-U1 ( ) The angle between the maxillary incisor axis line and the SN line
IMPA ( ) The angle between the mandibular incisor axis line and the mandibular plane
Interincisal angle ( ) The angle between the maxillary and mandibular incisor axis lines
Soft-tissue relationships
UL/E-plane (mm) The distance between the upper lip and the esthetic plane extending from the nose tip to the soft-tissue pogonion
LL/E-plane (mm) The distance between the lower lip and the esthetic plane
Nasolabial angle ( ) The angle between the line drawn through the midpoint of the nostril aperture and a line drawn
perpendicular to the Frankfurt horizontal while intersecting subnasale
G-Sn-Pog ( ) The angle between the line G-Sn and line Sn-Pog
This means maxillary advancement, including palatal Regarding horizontal and vertical mandibular posi-
plane changes, must be evaluated when selecting the tions, previous TSAD studies4,5 reported the SNB signif-
type of TSAD in orthopedic therapy. icantly decreased by 2.3 6 0.7 and 1.1 6 1.2 with the
October 2022 Vol 162 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al 525
Table III. Comparison between cephalometric variables of the palatal plate and tooth-borne anchorage groups at pre-
treatment
Variables Group 1y Group 2z P value
Sagittal relationships
SNA ( ) 79.16 6 2.68 79.25 6 2.95 0.926
SNB ( ) 80.29 6 3.07 80.13 6 2.95 0.880
ANB ( ) 1.13 6 1.15 0.88 6 1.49 0.589
A-Nperp (mm) 1.11 6 1.80 1.66 6 4.13 0.622
Pog-Nperp (mm) 0.87 6 4.53 1.24 6 6.60 0.853
Wits appraisal (mm) 9.24 6 2.50 8.73 6 1.83 0.508
AB-MP ( ) 59.92 6 4.32 62.23 6 3.88 0.116
Overjet (mm) 0.10 6 1.82 0.46 6 1.83 0.384
Vertical relationships
Palatal plane angle ( ) 0.99 6 3.61 0.23 6 2.81 0.506
FMA ( ) 28.49 6 4.80 27.01 6 4.70 0.376
SN-GoMe ( ) 38.11 6 4.18 36.31 6 4.28 0.232
Gonial angle ( ) 126.75 6 6.21 126.75 6 5.93 1.000
Overbite (mm) 0.11 6 1.43 0.46 6 1.63 0.290
Dental relationships
U1-FH ( ) 117.06 6 7.32 116.86 6 6.48 0.935
SN-U1 ( ) 107.47 6 7.77 107.57 6 5.76 0.966
IMPA ( ) 86.14 6 4.57 86.98 6 6.78 0.677
Interincisal angle ( ) 128.31 6 8.99 129.15 6 8.81 0.788
Soft-tissue relationships
UL/E-plane (mm) 0.61 6 1.96 1.25 6 2.26 0.390
LL/E-plane (mm) 1.02 6 2.36 1.59 6 2.53 0.507
Nasolabial angle ( ) 89.40 6 12.54 103.79 6 14.03 0.002
G-Sn-Pog ( ) 3.62 6 4.48 5.32 6 3.92 0.263
Note. Values are presented as mean 6 standard deviation. An independent t test was performed.
y
Facemask with palatal plate; zFacemask with the tooth-borne appliance.
facemask, but not with the Class III elastics.13 In our palatal plates and facemask, and it is useful for patients
study, SNB decreased by 0.8 6 1.3 and 0.8 6 0.9 in with hyperdivergent Class III malocclusion.
groups 1 and 2, respectively. Vertically, the mandibular Regarding dental changes, group 1 showed no signif-
plane angle was significantly increased by 1.2 6 0.7 icant proclination of maxillary incisors (U1-FH)
and 1.0 6 1.6 using a facemask,4,5 but De Clerck compared with 2.3 6 3.9 in group 2. However, Cha
et al6 showed no significant changes with Class III elas- and Ngan5 reported it increased by 1.6 6 4.4 in a mini-
tics. Elnagar et al27 demonstrated Class III elastics to plate group and 3.2 6 4.1 in a conventional group.
miniplates provided more significant vertical closing of Nienkemper et al20 demonstrated that maxillary incisors
the mandibular plane than facemask anchored with increased by 0.6 6 7.4 with bone-tooth-borne hybrid
miniplates. Cornelis et al,23 in their systematic review, and facemask. Therefore, maxillary incisor position
showed that mandibular incisor retroclination and facial with protraction using TSADs showed less protrusion
height seemed to be better controlled with bone- tendency than conventional appliances. In addition, ret-
anchored Class III elastics compared with the bone- roclination of the mandibular incisors because of the
anchored facemask. In our study, the mandibular plane chincup effect in conventional facemask treatment has
angle in group 1 did not change. However, group 2 been reported in several studies.1,29,30 Group 2 showed
showed a clockwise rotation of the mandible, which ac- significantly less advancement of the maxilla and more
cording to Baccetti et al28 means backward rotation. retroclination of mandibular incisors than group 1.
Ngan et al1 demonstrated side effects such as extrusion These results were similar to the other studies.5,31 In
of the molars in tooth-borne appliances. It seems to addition, because the overjet increased more in group
rotate the mandible clockwise. In contrast, group 1 mini- 2 (4.5 6 2.1 mm) than in group 1 (2.5 6 1.6 mm)
mized these side effects by using bone-borne appliances because of excessive proclination of the maxillary inci-
for maxillary protraction. Sar et al29 showed results sors, the lower lip could interpose between the maxillary
inconsistent with our study. This suggests that the verti- and mandibular incisors. It might cause retroclination of
cal position of the mandible does not change with mandibular incisors.
American Journal of Orthodontics and Dentofacial Orthopedics October 2022 Vol 162 Issue 4
526 Lee et al
Fig 6. Intraoral photographs and lateral cephalograms at pretreatment and posttreatment using a
palatal plate: A and C, Pretreatment; B and D, Posttreatment.
Soft-tissue measurements showed maxillary protru- bearing areas compared with other TSADs, which require
sion. Cha et al32 demonstrated in their case report that bilateral invasive installation.
upper and lower lips to E-line increased by 2.8 mm Our study was limited because it was a short-term
and 0.7 mm, respectively. Kircelli and Pektas4 showed study of Asian patients. Long-term results and a com-
facial convexity decreased by 8.9 6 1.9 , and upper lip parison of different ethnic groups need to be evaluated.
to E-line increased by 3.3 6 1.8 mm, but lower lip to
E-line did not change significantly. In group 1, the upper CONCLUSIONS
lip to E-line increased by 0.8 6 1.5 mm, but the lower lip This study compared the treatment effects of maxil-
to E-line and nasolabial angle did not change signifi- lary protraction with the palatal plate (group 1) vs con-
cantly. Facial convexity increased, but the groups had ventional maxillary protraction with tooth-borne
no significant differences in soft-tissue changes. appliances (group 2) for patients with Class III malocclu-
In our study, the improved design was placed on all sion with mixed dentition. We concluded the following;
patients. In addition, the improved design of palatal
plates allowed for a better fit of individual palatal shapes 1. Group 1 had a maxilla advancement of 2.3 6 1.0
and made it easier to apply elastics than the old design.21 mm compared with 0.9 6 0.6 mm in group 2.
After the canine eruption, the arms were bent shorter 2. Group 2 showed a clockwise rotation of the
and away from the erupting canines (Fig 1, B). To pre- mandible, but group 1 had no such rotation.
vent the failure of palatal plates because of inflamma- 3. Group 1 had less retroclination of the mandibular
tion, the patients were instructed to maintain good incisors than group 2.
hygiene. Our palatal plates had advantages such as flap- Therefore, these results suggest that facemasks with
less and single application and placement in nontooth palatal plates can be used as an efficient modality for
October 2022 Vol 162 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al 527
Table IV. Comparison of treatment effects between cephalometric variables of the palatal plate and tooth-borne
anchorage groups
Group 1y Group 2z
DT1 T0 Mean 6 SD P value Mean 6 SD P value P value
Sagittal relationships
SNA ( ) 2.84 6 1.41 \0.001 0.89 6 0.76 \0.001 \0.001
SNB ( ) 0.79 6 1.32 0.025 0.75 6 0.91 0.005 0.918
ANB ( ) 3.64 6 1.00 \0.001 1.64 6 0.85 \0.001 \0.001
A-N perp (mm) 2.32 6 1.02 \0.001 0.89 6 0.62 \0.001 \0.001
Pog-N perp (mm) 1.23 6 2.46 0.055 1.51 6 1.88 0.006 0.718
Wits appraisal (mm) 3.97 6 2.35 \0.001 1.53 6 2.45 0.025 0.007
AB-MP ( ) 6.21 6 1.96 \0.001 1.66 6 1.67 0.001 \0.001
Overjet (mm) 2.54 6 1.63 \0.001 4.52 6 2.08 \0.001 0.005
Vertical relationships
Palatal plane angle ( ) 0.05 6 1.45 0.894 0.41 6 1.34 0.242 0.463
FMA ( ) 0.43 6 1.45 0.244 1.65 6 0.74 \0.001 0.005
SN-GoMe ( ) 0.00 6 1.40 0.989 1.64 6 0.96 \0.001 \0.001
Gonial angle ( ) 0.51 6 2.10 0.333 1.13 6 1.12 0.001 0.009
Overbite (mm) 0.10 6 1.43 0.771 0.56 6 1.55 0.168 0.384
Dental relationships
U1-FH ( ) 1.21 6 5.61 0.390 2.26 6 3.91 0.036 0.540
SN-U1 ( ) 1.63 6 5.77 0.262 2.27 6 3.91 0.035 0.711
IMPA ( ) 0.96 6 3.78 0.311 3.77 6 2.83 \0.001 0.023
Interincisal angle ( ) 0.67 6 5.90 0.645 0.13 6 4.45 0.907 0.770
Soft-tissue relationships
UL/E-plane (mm) 0.78 6 1.46 0.042 1.37 6 1.20 \0.001 0.214
LL/E-plane (mm) 0.21 6 1.17 0.477 0.46 6 1.12 0.122 0.530
Nasolabial angle ( ) 1.16 6 9.30 0.605 3.11 6 7.73 0.096 0.490
G-Sn-Pog ( ) 3.13 6 3.00 \0.001 3.76 6 2.79 \0.001 0.548
Note. Paired t and Independent t tests were performed.
SD, standard deviation.
y
Facemask with palatal plate; zFacemask with the tooth-borne appliance.
maxillary protraction in growing patients with Class III 2. Kim JH, Viana MA, Graber TM, Omerza FF, BeGole EA. The effec-
malocclusion. tiveness of protraction face mask therapy: a meta-analysis. Am J
Orthod Dentofacial Orthop 1999;115:675-85.
3. Da Silva Filho OG, Magro AC, Capelozza Filho L. Early treatment of
AUTHOR CREDIT STATEMENT the Class III malocclusion with rapid maxillary expansion and
You-sun Lee contributed to data collection and orig- maxillary protraction. Am J Orthod Dentofacial Orthop 1998;
113:196-203.
inal draft preparation, Jae Hyun Park contributed to
4. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally
conceptualization and manuscript review and editing, anchored face mask therapy: a novel approach and prelimi-
Jaehyun Kim contributed to data curation and manu- nary results. Am J Orthod Dentofacial Orthop 2008;133:
script review and editing, Nam-Ki Lee contributed to 440-9.
visualization and manuscript review and editing, Yoonji 5. Cha BK, Ngan PW. Skeletal anchorage for orthopedic correction of
growing Class III patients. Semin Orthod 2011;17:124-37.
Kim contributed to manuscript review and editing, and
6. De Clerck H, Cevidanes L, Baccetti T. Dentofacial effects of bone-
Yoon-Ah Kook contributed to supervision. anchored maxillary protraction: a controlled study of consecu-
tively treated Class III patients. Am J Orthod Dentofacial Orthop
SUPPLEMENTARY DATA 2010;138:577-81.
7. Lee NK, Yang IH, Baek SH. The short-term treatment effects of face
Supplementary data associated with this article can mask therapy in Class III patients based on the anchorage device:
be found, in the online version, at https://doi.org/10. miniplates vs rapid maxillary expansion. Angle Orthod 2012;82:
1016/j.ajodo.2021.05.014. 846-52.
8. Ahn HW, Kim KW, Yang IH, Choi JY, Baek SH. Comparison of the
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October 2022 Vol 162 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
