Early treatment of growth deviations of the maxilla – interceptive treatment possibilities in combination with orthographhic surgery
Hypoplastic growth of the maxilla often causes class III malocclusion that may necessitate orthodontic treatment. It is desirable to perform an early treatment in order to modify the growth of the jaws and the position of the teeth to obtain a result without need for later correction with orthognathic surgery. The aim of this paper is to provide an overview of the treatment options and to give recommendations for choice of therapy for growth deviations of the maxilla.
A posterior cross bite is often seen in presence of a maxillary hypoplasia and the recommended treatment is to perform a rapid palatal expansion before the pubertal growth spurt. If there is a concomitant tendency for development of a class III relation, the palatal suture expansion can be combined with protraction by use of a face-mask, which is done at the age of 8-10 years. An alternative to face-mask for class III malocclusions is the use of four skeletally anchored hooks (bone anchors) on which elastic traction is applied to stimulate an anterior growth of the maxilla and a restriction of the mandibular growth. Bone anchors should be inserted around the age of 11 years and the aim would be to avoid a later orthognathic surgical treatment.
In young persons with a very narrow maxilla a surgically assisted rapid maxillary expansion (SARME) is a treatment option. This implies a Le Fort I osteotomy and a midline osteotomy with insertion of a dentally or bone anchored device to expand the maxilla transversally. The purpose of this procedure is to obtain a widening of the basal maxillary skeleton, which may also have beneficial effect on nasal respiration.
Finally, a sagittal correction of severe maxillary hypoplasias can be performed distraction osteogenesis in which the maxilla is gradually advanced 1 mm per day with formation of bone and soft tissue.
In conclusion, early diagnosis of maxillary growth disturbances is important in order to initiate an effective interceptive treatment, which in high proportion of the patients can eliminate the need for later orthognathic surgery.