Three-dimensional finite element analysis of maxillary protraction with labiolingual arches and implants

• A 3-dimensional finite element model of the maxillofacial bones was constructed.
• Two protraction methods were simulated.
• Changes in the sutures were quantified to assess growth of the maxillofacial bones.
• This research supports orthopedic treatment of skeletal Class III malocclusions.
• It is important to properly evaluate a problem before orthopedic treatment.

IntroductionIn this study, we aimed to evaluate the effects of maxillary protraction using traditional labiolingual arches and implant-type protraction devices before orthopedic treatment of patients with skeletal Class III malocclusion.MethodsA 3-dimensional finite element model of the maxillofacial bones with high biologic similarity and including the sutures was constructed. Through stress and displacement calculations, a biomechanical study was performed for the maxillofacial bones, mandible, and sutures.ResultsWe quantified detailed changes in the sutures with 2 protraction methods to analyze their effects on the growth of the maxillofacial bones.Conclusions(1) The labiolingual arch is suitable for skeletal Class III patients with crossbite and deep overbite. The frontomaxillary and zygomaticomaxillary sutures played major roles in the forward displacement and counterclockwise rotation of the maxilla. The temporozygomatic and pterygopalatine sutures did not change significantly. (2) The implant type of protraction device is suitable for skeletal Class III patients with crossbite and open bite. Both the frontomaxillary and zygomaticomaxillary sutures played decisive roles in the forward displacement and clockwise rotation of maxilla. The temporozygomatic and pterygopalatine sutures showed small changes. (3) The labiolingual arch caused less stimulatory growth on the maxilla, whereas the implant caused greater stimulatory growth on the maxilla. Protraction with the labiolingual arch is more suitable for early skeletal Class III patients at a younger age; protraction with an implant is applicable to skeletal Class III patients in the late mixed dentition or early permanent dentition.