Skeletal and dentoalveolar changes following the use of an occlusally bonded maxillary protraction headgear appliance in patients born with cleft lip and palate

Maxillary hypoplasia is a common finding in patients with cleft lip and palate (CLP). This study evaluated the skeletal and dentoalveolar changes in patients with CLP treated with an occlusally bonded maxillary protraction headgear (PHG) appliance.A total of 267 consecutive patients (1995-2012) treated with a PHG appliance were reviewed. In all, 40 patients with CLP (mean age 7.70 years) met the inclusion criteria. Mean treatment duration was 7.5 months with a mean force of 405 g per side. X- and Y-axis displacement for 38 lateral cephalometric landmarks was recorded at pretreatment (T0), following removal of PHG (T1), and at 1.5 years follow-up (T2).From T0 to T1, A-point advanced by +2.48 mm (p < 0.01), UIE advanced by +4.91 mm (p < 0.01) and B-point moved posteriorly by −2.03 mm (p < 0.01) and inferiorly by −3.86 mm (p < 0.01). During the same time interval, the ANB angle changed from 0.08° to 3.77° (p < 0.01). At 1.5 year follow-up, A-point moved posteriorly by −0.28 mm (p > 0.05), B-point moved anteriorly by 3.69 mm (p < 0.01) and the ANB angle decreased to 0.51° (p < 0.01).A PHG appliance with a mean 810 g of force resulted in 54.60% skeletal and 45.40% dentoalveolar advancement. At 1.5 years (T2), the maxillary position was stable with minimal anterior growth; however, the mandible showed significant anterior growth contributing to reduction of the ANB angle.