Int J Stomatol

Int J Stomatol ›› 2026, Vol. 53 ›› Issue (1): 19-25.doi: 10.7518/gjkq.2026008

• Orthodontics • Previous Articles     Next Articles

Development of bone-anchored maxillary protraction for the orthopedic treatment of class Ⅲ malocclusion in growing patients

Ao Yu(),Guangli Han()   

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Dept. of Orthodontics Division Ⅱ, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2024-12-24 Revised:2025-03-07 Online:2026-01-01 Published:2025-12-31
  • Contact: Guangli Han E-mail:ya1999noora@163.com;guanglihan@whu.edu.cn

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Abstract:

The facemask is the common appliance for the treatment of skeletal class Ⅲ patients with maxillary retrusion. Bone-anchored maxillary protraction (BAMP) appliances have recently been used to overcome the limitations of tooth-borne appliances in the interceptive treatment of class Ⅲ malocclusions. BAMP has demonstrated promising initial results, attributed to its potential to offer great skeletal changes with less unwanted displacement of dentition during the late mixed dentition and early permanent dentition stages. BAMP therapy techniques significantly improve the soft tissue profile, which leads to an improvement of the concave profile. Moreover, BAMP protocol with class Ⅲ elastics has shown certain advantages in controlling vertical skeletal pattern. This work aims to review the research progress in the selection of BAMP protocol, necessity of combining transverse arch expansion, optimal treatment timing, and long-term treatment outcomes and explore its future development.

Key words: bone anchorage, maxillary protraction, maxillary hypoplasia, skeletal class Ⅲ malocclusion

CLC Number: 

  • R783.5

TrendMD: 
[1] Smyth RSD, Ryan FS. Early treatment of class Ⅲ malocclusion with facemask[J]. Evid Based Dent, 2017, 18(4): 107-108.
[2] Kamath A, Sudhakar SS, Kannan G, et al. Bone-anchored maxillary protraction (BAMP): a review[J]. J Orthod Sci, 2022, 11: 8.
[3] Owens D, Watkinson S, Harrison JE, et al. Ortho-dontic treatment for prominent lower front teeth (ClassⅢmalocclusion) in children[J]. Cochrane Database Syst Rev, 2024, 4(4): CD003451.
[4] Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results[J]. Am J Orthod Dentofacial Orthop, 2008, 133(3): 440-449.
[5] Sar C, Arman-Özçırpıcı A, Uçkan S, et al. Comparative evaluation of maxillary protraction with or without skeletal anchorage[J]. Am J Orthod Dentofacial Orthop, 2011, 139(5): 636-649.
[6] Jang YK, Chung DH, Lee JW, et al. A comparative evaluation of midfacial soft tissue and nasal bone changes with two maxillary protraction protocols: tooth-borne vs skeletal-anchored facemasks[J]. Orthod Craniofac Res, 2021, 24(): 5-12.
[7] Lee HJ, Choi DS, Jang I, et al. Comparison of facemask therapy effects using skeletal and tooth-borne anchorage[J]. Angle Orthod, 2022, 92(3): 307-314.
[8] Lee HJ, Jeong H, Park JH, et al. A comparison of maxillary posterior changes following facemask the-rapy: skeletal anchorage versus tooth-borne ancho-rage[J]. Orthod Craniofac Res, 2024, 27(2): 303-312.
[9] Jang JW, Lee MH, Chung DH, et al. Long-term effects of lateral nasal wall anchored facemasks compared with tooth-borne facemasks[J]. Am J Orthod Dentofacial Orthop, 2023, 164(4): 584-592.
[10] 王凡, 常荍, 梁舒然, 等. 个性化钛板与传统前方牵引治疗生长发育期骨性Ⅲ类错𬌗的疗效对比[J]. 中华口腔医学杂志, 2024, 59(9): 904-10.
Wang F, Chang Q, Liang SR, et al. A comparative study of the efficacy of customized titanium plates versus conventional maxillary protraction in the treatment of skeletal class Ⅲ patients[J]. Chin J Stomatol, 2024, 59(9): 904-910.
[11] Liu CM, Hou M, Liang LM, et al. Sutural distraction osteogenesis (SDO) versus osteotomy distraction osteogenesis (ODO) for midfacial advancement: a new technique and primary clinical report[J]. J Craniofac Surg, 2005, 16(4): 537-548.
[12] Tong HZ, Wang XG, Song T, et al. Trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate: clinical outcomes and analysis of skeletal changes[J]. Plast Reconstr Surg, 2015, 136(1): 144-155.
[13] Zhang PY, Tong HZ, Chen YJ, et al. Effect of bone-borne trans-sutural distraction osteogenesis therapy on the cranial base of children with midfacial hy-poplasia due to cleft lip and palate[J]. J Craniofac Surg, 2023, 34(2): 551-555.
[14] Cha BK, Choi DS, Ngan P, et al. Maxillary protraction with miniplates providing skeletal anchorage in a growing class Ⅲ patient[J]. Am J Orthod Dentofacial Orthop, 2011, 139(1): 99-112.
[15] Ge YS, Liu J, Chen L, et al. Dentofacial effects of two facemask therapies for maxillary protraction[J]. Angle Orthod, 2012, 82(6): 1083-1091.
[16] Choi YK, Park JJ, Jeon HH, et al. Comparison of the skeletodental effects of miniscrew-anchored and tooth-anchored facemask treatment in growing patients with skeletal classⅢmalocclusions[J]. Orthod Craniofac Res, 2023, 26(4): 695-703.
[17] Elsaharty MA, Ghobashi SA, El-Shorbagy E. Evalua-tion of maxillary protraction using a mini screw-retained palatal C-shaped plate and face mask[J]. Turk J Orthod, 2024, 37(3): 146-152.
[18] Wilmes B, Nienkemper M, Drescher D. Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid hyrax[J]. World J Orthod, 2010, 11(4): 323-330.
[19] Ngan P, Wilmes B, Drescher D, et al. Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment[J]. Prog Orthod, 2015, 16: 26.
[20] de Clerck H, Cevidanes L, Baccetti T. Dentofacial effects of bone-anchored maxillary protraction: a controlled study of consecutively treated class Ⅲ patients[J]. Am J Orthod Dentofacial Orthop, 2010, 138(5): 577-581.
[21] De Clerck HJ, Cornelis MA, Cevidanes LH, et al. Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency[J]. J Oral Maxillofac Surg, 2009, 67(10): 2123-2129.
[22] Manhães FR, Valdrighi HC, de Menezes CC, et al. Treatment with bone-anchored maxillary protraction for correcting growing classⅢskeletal malocclusion[J]. AJO DO Clin Companion, 2023, 3(1): 22-29.
[23] de Clerck H, Nguyen T, de Paula LK, et al. Three-dimensional assessment of mandibular and glenoid fossa changes after bone-anchored class Ⅲ interma-xillary traction[J]. Am J Orthod Dentofacial Orthop, 2012, 142(1): 25-31.
[24] Elnagar MH, Elshourbagy E, Ghobashy S, et al. Comparative evaluation of 2 skeletally anchored ma-xillary protraction protocols[J]. Am J Orthod Dentofacial Orthop, 2016, 150(5): 751-762.
[25] Willmann JH, Nienkemper M, Tarraf NE, et al. Early class Ⅲ treatment with Hybrid-Hyrax-Facemask in comparison to Hybrid-Hyrax-Mentoplate-skeletal and dental outcomes[J]. Prog Orthod, 2018, 19(1): 42.
[26] Hu SS, An K, Peng YR. Comparative efficacy of the bone-anchored maxillary protraction protocols for orthopaedic treatment in skeletal class Ⅲ malocclusion: a Bayesian network meta-analysis[J]. Orthod Craniofac Res, 2022, 25(2): 243-250.
[27] Tanne K, Hiraga J, Sakuda M. Effects of directions of maxillary protraction forces on biomechanical changes in craniofacial complex[J]. Eur J Orthod, 1989, 11(4): 382-391.
[28] Lee NK, Baek SH. Stress and displacement between maxillary protraction with miniplates placed at the infrazygomatic crest and the lateral nasal wall: a 3-dimensional finite element analysis[J]. Am J Orthod Dentofacial Orthop, 2012, 141(3): 345-351.
[29] Yan XL, He WJ, Lin T, et al. Three-dimensional finite element analysis of the craniomaxillary complex during maxillary protraction with bone ancho-rage vs conventional dental anchorage[J]. Am J Orthod Dentofacial Orthop, 2013, 143(2): 197-205.
[30] Kim KY, Bayome M, Park JH, et al. Displacement and stress distribution of the maxillofacial complex during maxillary protraction with buccal versus pala-tal plates: finite element analysis[J]. Eur J Orthod, 2015, 37(3): 275-283.
[31] Wang F, Chang Q, Liang SR, et al. Three-dimensional finite element analysis on the effects of maxillary protraction with an individual titanium plate at multiple directions and locations[J]. Korean J Orthod, 2024, 54(2): 108-116.
[32] Shyagali TR, Patidar R, Gupta A, et al. Evaluation of stresses and displacement in the craniofacial region as a reaction to bone-anchored maxillary protraction in conjugation with posterior bite plane and rapid maxillary expansion in patients with class Ⅲ malocclusion: a finite element analysis study[J]. Am J Orthod Dentofacial Orthop, 2023, 164(2): 253-264.
[33] Rai P, Garg D, Tripathi T, et al. Biomechanical effects of Skeletally anchored class Ⅲ elastics on the maxillofacial complex: a 3D finite element analysis[J]. Prog Orthod, 2021, 22(1): 36.
[34] Vaughn GA, Mason B, Moon HB, et al. The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial[J]. Am J Orthod Dentofacial Orthop, 2005, 128(3): 299-309.
[35] Foersch M, Jacobs C, Wriedt S, et al. Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis[J]. Clin Oral Investig, 2015, 19(6): 1181-1192.
[36] Miranda F, Garib D, Silva I, et al. Maxillary protraction anchored on miniplates versus miniscrews: th-ree-dimensional dentoskeletal comparison[J]. Eur J Orthod, 2024, 47(1): cjae071.
[37] Park JH, Bayome M, Zahrowski JJ, et al. Displacement and stress distribution by different bone-borne palatal expanders with facemask: a 3-dimensional finite element analysis[J]. Am J Orthod Dentofacial Orthop, 2017, 151(1): 105-117.
[38] Liou EJW. Effective maxillary orthopedic protraction for growing class Ⅲ patients: a clinical application simulates distraction osteogenesis[J]. Prog Orthod, 2005, 6(2): 154-171.
[39] Liou EJW, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions[J]. Cleft Palate Craniofac J, 2005, 42(2): 121-127.
[40] Wu ZP, Zhang X, Li ZX, et al. A Bayesian network meta-analysis of orthopaedic treatment in class Ⅲmalocclusion: maxillary protraction with skeletal anchorage or a rapid maxillary expander[J]. Orthod Craniofac Res, 2020, 23(1): 1-15.
[41] Kathem SJ, Matras RC, Abbas SOM. Class Ⅲ ma-locclusion treated with a 3D-printed hybrid hyrax distalizer combined with mentoplate using Alt-RAMEC protocol: a case report[J]. J Orthod, 2024, 51(2): 183-191.
[42] Ergul T, Gulec A. Comparison of the effectiveness of skeletal and tooth-borne protraction methods with or without alternate rapid maxillary expansion and constriction protocol in patients with class Ⅲ malocclusion[J]. Am J Orthod Dentofacial Orthop, 2025, 167(3): 282-295.
[43] Major MP, Wong JK, Saltaji H, et al. Skeletal anchored maxillary protraction for midface deficiency in children and early adolescents with class Ⅲ ma-locclusion: a systematic review and meta-analysis[J]. J World Fed Orthod, 2012, 1(2): e47-e54.
[44] Lim G, Kim KD, Park W, et al. Endodontic and surgical treatment of root damage caused by orthodontic miniscrew placement[J]. J Endod, 2013, 39(8): 1073-1077.
[45] Papageorgiou SN, Zogakis IP, Papadopoulos MA. Failure rates and associated risk factors of orthodontic miniscrew implants: a meta-analysis[J]. Am J Orthod Dentofacial Orthop, 2012, 142(5): 577-595.e7.
[46] Tarraf NE, Dalci O, Dalci K, et al. A retrospective comparison of two protocols for correction of skeletal class Ⅲ malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask[J]. Prog Orthod, 2023, 24(1): 3.
[47] Facio-Umaña JA, Chaurand J, Gonzalez-Luna P. Early class Ⅲ treatment with maxillary protraction-miniscrew-assisted rapid palatal expansion (MAR-PE) and mandibular miniplates[J]. Adv Oral Maxillofac Surg, 2021, 4: 100151.
[48] Tabellion M, Lisson JA. Dentofacial and skeletal effects of two orthodontic maxillary protraction protocols: bone anchors versus facemask[J]. Head Face Med, 2024, 20(1): 60.
[49] Büyükçavuş MH, Sari ÖF, Findik Y. Correction of late adolescent skeletal class Ⅲ using the Alt-RAMEC protocol and skeletal anchorage[J]. Korean J Orthod, 2023, 53(1): 54-64.
[50] Papadopoulou AK, Koletsi D, Masucci C, et al. A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, Alt-RAMEC and miniscrew-supported intraoral elastics in gro-wing class Ⅲ patients[J]. Int Orthod, 2022, 20(1): 100603.
[51] Meazzini MC, Torre C, Cappello A, et al. Long-term follow-up of late maxillary orthopedic advancement with the Liou-Alternate rapid maxillary expansion-constriction technique in patients with skeletal class Ⅲ malocclusion[J]. Am J Orthod Dentofacial Orthop, 2021, 160(2): 221-230.
[52] Lin YF, Guo RZ, Hou LY, et al. Stability of maxillary protraction therapy in children with class Ⅲmalocclusion: a systematic review and meta-analysis[J]. Clin Oral Investig, 2018, 22(7): 2639-2652.
[53] Lee SH, Koh SD, Chung DH, et al. Comparison of skeletal anchorage and tooth-borne maxillary protraction followed by fixed appliance in class Ⅲ ma-locclusion[J]. Eur J Orthod, 2020, 42(2): 193-199.
[54] Zere E, Chaudhari PK, Sharan J, et al. Developing class Ⅲ malocclusions: challenges and solutions[J]. Clin Cosmet Investig Dent, 2018, 10: 99-116.
[55] Raghupathy Y, Ananthanarayanan V, Kailasam V, et al. Posttreatment stability following facemask therapy in patients with skeletal class Ⅲ malocclusion: a systematic review[J]. Int J Clin Pediatr Dent, 2023, 16(6): 897-907.
[56] Xu SK, Liu Y, Hou Y, et al. Maxillofacial growth changes after maxillary protraction therapy in children with classⅢmalocclusion: a dual control group retrospective study[J]. BMC Oral Health, 2024, 24(1): 7.
[57] Cornelis MA, Tepedino M, Riis NV, et al. Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis[J]. Eur J Orthod, 2021, 43(1): 51-68.
[58] Hodecker LD, Kühle R, Weichel F, et al. Concept for the treatment of class Ⅲ anomalies with a skeletally anchored appliance fabricated in the CAD/CAM process-the MIRA appliance[J]. Bioenginee-ring, 2023, 10(5): 616.
[59] Kim M, Li JW, Kim S, et al. Individualized 3D-printed bone-anchored maxillary protraction device for growth modification in skeletal class Ⅲ malocclusion[J]. J Pers Med, 2021, 11(11): 1087.
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