• The korean journal of orthodontics
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• v.54 no.2
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• pp.108-116
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• 2024

Objective: A three-dimensional-printed individual titanium plate was applied for maxillary protraction to eliminate side effects and obtain the maximum skeletal effect. This study aimed to explore the stress distribution characteristics of sutures during maxillary protraction using individual titanium plates in various directions and locations. Methods: A protraction force of 500 g per side was applied at forward and downward angles between 0° and 60° with respect to the Frankfort horizontal plane, after which the titanium plate was moved 2 and 4 mm upward and downward, respectively. Changes in sutures with multiple protraction directions and various miniplate heights were quantified to analyze their impact on the maxillofacial bone. Results: Protraction angle of 0-30° with respect to the Frankfort horizontal plane exhibited a tendency for counterclockwise rotation in the maxilla. At a 40° protraction angle, translational motion was observed in the maxilla, whereas protraction angles of 50-60° tended to induce clockwise rotation in the maxilla. Enhanced protraction efficiency at the lower edge of the pyriform aperture was associated with increased height of individual titanium plates. Conclusions: Various protraction directions are suitable for patients with different types of vertical bone surfaces. Furthermore, when the titanium plate was positioned lower, the protraction force exhibited an increase.

• The korean journal of orthodontics
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• v.18 no.2
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• pp.367-385
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• 1988

In case of skeletal Class III malocclusion with underdeveloped maxilla, the extraoral orthopedic force for the stimulation of maxillary growth or anterior reposition of the maxilla has been used clinically for the improvement of facial skeletal relationship. The purpose of this investigation was to examine the initial reaction of maxillofacial complex to the maxillary protraction by using extraoral orthopedic force. The dried human skull was used and this investigation was done by means of double exposure holographic interferometry. The protraction forces placed on the canine or the first molar were parallel, $10^{\circ}$ downward, $20^{\circ}$ downward to the occlusal plane. Fringe pattern of each protraction condition was compared and analized. The results were as follows: 1. Each maxillofacial bone displaced saparately. 2. More displacement was shown at the area of the teeth and the alveolar bone. 3. A counterclockwise rotation of the maxilla wa decreased by downward protraction and especially 20 degree downward protraction from the canine showed least rotation. 4. On the zygomatic arch, outward bend was observed and this effect was decreased by downward protraction. 5. On the zygomatic bone, the counter clockwise rotation was increased by the downward protraction. 6. When maxillary expansion was applied at the same time, outward and upward displacement with counterclockwise rotation was observed on the maxilla. 7. The lateral pterygoid plate of sphenoid bone was affected by maxillary protraction.

• The korean journal of orthodontics
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• v.53 no.1
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• pp.35-44
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• 2023

Objective: Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods: The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results: The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions: No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.

• The korean journal of orthodontics
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• v.22 no.3 s.38
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• pp.531-556
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• 1992

The majority of the commonly used protraction headgears for the protraction of small and/or retropositioned maxilla not allow a change in the point of force application or direction of the force delivery to attain predictable results because of the position of the upper and lower lips to avoid discomfort to the patient. The purpose of this study was to investigate the initial reaction of maxillofacial complex according to the change of force variables such as direction and point of force application with designing an antenna type-modified protraction head gear. A macerated human skull with well aligned upper teeth was used to experimental model and the investigation was done by double exposure holographic interferometry. Fringe patterns of each protraction conditions were compared and analized. The results were as follows. (Frontal view) 1. The Counterclockwise rotation of the maxilla was showed by parallel protraction to occlusal plane and the fringe was decreased in number as higher point of force application. 2. Generally, the number of fringe was increased in 500gm of protraction force than in 300gm. 3. When apply the protraction force to the maxilla with rapid palatal expansion, the direction of fringe patterns was differed from the protraction without expansion. 4. In most of cases, the counterclockwise rotation was decreased in case of the direction of the force is $20^{\circ}$ downward to occlusal plane compared to the parallel direction. 5. At the point of force application is 15mm above and the direction of force is 20 downward to occlusal plane , the translation of the maxillary complex was showed. (Lateral view) 6. The direction of fringe patterns of the facial bones were differed each other by the sutures, and showed almost parallel when apply the 300gm and 500gm of protraction force. 7. In case of rapid palatal expansion with protraction of the maxilla, the fringe patterns between the maxillary area and the area from the posterior of the maxillary first molar to the pterygomaxillary fissure were differed. In case without rapid palatal expansion, the changes of direction and point of the force application did not affect to the direction and the number of the fringe patterns.

• Korean Journal of Cleft Lip And Palate
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• v.16 no.1
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• pp.19-23
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• 2013

Maxilla protraction, orthopedic correction of deficient maxilla is necessary for treatment of most Class III growing patients. Protraction method has evolved from tooth-born appliance to miniplates on the maxilla, and from face mask to miniplates on the chin. By placing miniplates on the maxilla and the mandible and running elastics between them, we can minimize dentoalveolar relapse and maximize orthopedic change.

• The korean journal of orthodontics
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• v.48 no.5
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• pp.304-315
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• 2018

Objective: The purpose of this study was to analyze initial displacement and stress distribution of the maxillofacial complex during dentoskeletal maxillary protraction with various appliance designs placed on the palatal region by using three-dimensional finite element analysis. Methods: Six models of maxillary protraction were developed: conventional facemask (Type A), facemask with dentoskeletal hybrid anchorage (Type B), facemask with a palatal plate (Type C), intraoral traction using a Class III palatal plate (Type D), facemask with a palatal plate combined with rapid maxillary expansion (RME; Type E), and Class III palatal plate intraoral traction with RME (Type F). In Types A, B, C, and D, maxillary protraction alone was performed, whereas in Types E and F, transverse expansion was performed simultaneously with maxillary protraction. Results: Type C displayed the greatest amount of anterior dentoskeletal displacement in the sagittal plane. Types A and B resulted in similar amounts of anterior displacement of all the maxillofacial landmarks. Type D showed little movement, but Type E with expansion and the palatal plate displayed a larger range of movement of the maxillofacial landmarks in all directions. Conclusions: The palatal plate served as an effective skeletal anchor for use with the facemask in maxillary protraction. In contrast, the intraoral use of Class III palatal plates showed minimal skeletal and dental effects in maxillary protraction. In addition, palatal expansion with the protraction force showed minimal effect on the forward movement of the maxillary complex.

• The Journal of the Korean dental association
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• v.57 no.11
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• pp.654-663
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• 2019

This case report describes the management of a 30-year-old woman with hopeless mandibular first molars and right maxillary second premolar. The treatment plan included mandibular second and third molar protraction after extraction of mandibular first molars. Mini-implants were placed between roots of first and second premolar. Sliding mechanics with lever arm was used to prevent inclination of molars. A good functional occlusion was achieved in 38 months without clinically significant side effects. Most of the extraction space of mandibular first molar was closed by protraction of second and third molars. The skeletal Class II pattern was improved by counterclockwise rotation of mandible through reduction of wedge effect. Mandibular molar protraction with orthodontic mini-implants in adequate cases would be a great alternative to prosthetic implant and reduce the financial and surgical burden of patients.

• The korean journal of orthodontics
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• v.32 no.6 s.95
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• pp.425-434
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• 2002

The purpose of this investigation was to study the spatial changes of the maxillofacial complex following maxillary protraction transmitted to the center of resistance of a dry juvenile human skull by a modified maxillary protraction appliance. Four dry juvenile human skulls (without mandible) with well aligned upper deciduous dentition and early mixed dentition were used as experimental samples. A modified protraction headgear was fabricated from a Delare's facemask, and following an alginate impression, an orthodontic resin maxillary splint was made for each dry skull. Protraction force level was maintained at approximately 1000gm per side for 6 hours. Cephalometric radiographs were taken pre- and post- protraction, and nine reference markers with 1.5 mm length of $.017\times.025$ TMA wire were placed on the right side of the skull for an accurate superimposition of serial cephalometric radiographs. The present investigation demonstrated that vertical changes associated with an anterior displacement of the maxillary complex was observed, and the most prominent effect of protraction headgear was a counterclockwise rotation of the maxilla, that is, a forward and downward tipping around the palatomaxillary region.

• The korean journal of orthodontics
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• v.37 no.1 s.120
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• pp.73-84
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• 2007

The maxillary protraction headgear has been widely used in the treatment of skeletal Class III children with maxillary deficiency. A variety of treatment objectives which allow dentoalveolar movements may be established, but when only maxillary protraction without dentoalveolar movement is needed, one of the limitations in maxillary protraction with conventional tooth-borne anchorage is the loss of dental anchorage. This is because a bone remodeling occurs not only at circummaxillary sutures but also within the periodontal tissues. During protraction treatment in the mixed dentition phase, in older children or for the patient with multiple congenitally missing teeth, it is not uncommon to observe undesirable mesial movement of maxillary teeth. Such a side effect can be eliminated or minimized using absolute anchorage such as skeletal anchorage. The purpose of this case report is to introduce a new technique of the maxillary protraction headgear treatment using surgical miniplates.

• Korean Journal of Applied Biomechanics
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• v.22 no.2
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• pp.193-199
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• 2012

The purpose of this study was to investigate the activities of the serratus anterior (SA) and upper trapezius (UT) muscles during scapular protraction exercise with a dumbbell. Twenty-one healthy subjects with no medial history of shoulder pain or upper extremity disorders were recruited for this study. Subjects performed scapular protraction at $90^{\circ}$ and $130^{\circ}$ shoulder flexion with a dumbbell in supine and standing positions. The activities of the SA and UT were measured via surface electromyography (EMG) during 4 scapular protraction exercises. A 2 (angle) ${\times}$ 2 (position) repeated-measures analysis of variance (ANOVA) was used to compare the normalized activities of the SA and UT and the UT/SA ratio. The results showed that activities of both the SA and UT were the highest for the scapular protraction exercise at $130^{\circ}$ shoulder flexion in the standing position. However, the UT/SA ratio was the lowest for the exercise at $90^{\circ}$ shoulder flexion in supine position. Therefore, for selective activation of the SA muscle, we recommend performing the scapular protraction exercise with a dumbbell in the supine position at $90^{\circ}$ shoulder flexion.