title: Non-compliant maxillary protraction by  orthodontic micro-implants.
abstract: OBJECTIVE
  Delaire-type facemask is still the appliance of choice for non surgical paediatric Class III treatment. However, it entails great aesthetical problems and is totally dependent on patient compliance. A new modified maxillary protractor was then designed: it is monomaxillary, fixed, implant-supported, aesthetically pleasing and it does not require patient compliance. The aims of this study were to evaluate the clinical use and analyse the effects of a new appliance called Fixed Maxillary Protractor. The device aims at obtaining a forward movement of the maxillary dento-alveolar component in non-compliant paediatric patients, when mandible retrusion cannot be pursued.
  
  
  METHODS
  A non-compliant patient aged 4 years 11 months with mild skeletal and predominant dento-alveolar Class III malocclusion with maxillary deficiency, anterior crossbite and complete deciduous dentition was treated for 10 months. The appliance, anchored by 2 micro-implants in the posterior palatal region, consisted of an acrylic plate, a lingual splint, 2 TMA springs that delivered a posterior-anterior force, 2 anterior security devices and 2 occlusal bite raising splints on the deciduous molars. The treatment yielded a slightly overcorrected Class I incisal relationship. Increase in SNA angle (2°) and a decrease in SNB angle (1°) resulted in an increase in ANB angle (3°). Increases in Wits appraisal of 4 mm and in overjet of 7 mm were obtained. A correction of the anterior crossbite the a posterior sliding of the mandible due to the crossbite correction were observed. An anticlockwise rotation of the maxilla and a mild increase in the anterior facial height were achieved: the treatment effects are similar to those obtained with the Delaire-type facemask, but the amount of postero-anterior correction is lower.
  
  
  CONCLUSIONS
  The Fixed Maxillary Protractor is effective for the treatment of mild-moderate Class III malocclusion with maxillary deficiency in non-compliant paediatric patients.
authors.affiliation: University of Padova, Italy. lorenzo.favero@unipd.it
authors.forename: L
authors.initials: L
authors.lastname: Favero
authors.forename: A
authors.initials: A
authors.lastname: Winkler
authors.forename: V
authors.initials: V
authors.lastname: Favero
mesh_terms: D002508:Cephalometry; D002675:Child, Preschool; D015921:Dental Implants; D005260:Female; D006801:Humans; D008313:Malocclusion, Angle Class III / Q000628:therapy*; D008437:Maxilla / Q000254:growth & development*; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation*; D016382:Orthodontic Appliance Design; D010159:Palate / Q000601:surgery; D010349:Patient Compliance
chemical_list: D015921:Dental Implants