Skeletal and Dentoalveolar Effects of Maximly Protraction Using Tooth- and Miniscrew-Anchored Devices in Patients with Class III Malocclusion with Maximly Deficiency: A Retrospective Follow-Up Study  
[PERSON]  
1 Department of Orthodontics, Dental Research Institute, Pusan National University,  
Yangsan 50612, Republic of Korea; [EMAIL_ADDRESS] (J.-C.B.); [EMAIL_ADDRESS] (S.-H.K.); [EMAIL_ADDRESS] (S.-S.K.); [EMAIL_ADDRESS] (S.-B.P)  
[PERSON]  
2 Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea  
extraoral facemask applies forward and downward forces on the maxilla. This protracts the maxilla after separating the maxillary tubercle posterior-superior suture [7] while limiting forward growth in the mandible and changing the direction of growth via clockwise rotation. Because force is indirectly transferred to the maxilla through a tooth-anchored appliance, undesirable changes in the maxillary teeth can reduce the effect of maxillary advancement [8]. Various methods have been proposed to reduce odontogenic side effects by directly applying force to bone using skeletal anchorage [9; 10; 11]. Miniplates have been positioned [9] in the maxillary buttress and anterior mandibular chin or on the infragyz-gomatic crest using various means to avoid influencing dentition development [10; 11]. However, these methods have disadvantages, such as a need for additional surgery and the possibility of loosening. Several approaches have been introduced to overcome these limitations, such as intraoral devices with reinforced skeletal anchorage devices on the palatal side that can be easily positioned under local anesthesia [12; 13]. These reports describe the effects of palatal-reinforced skeletal anchorage devices, facemasks, and intraoral devices such as mini-implant or miniscrew-assisted rapid palatal expander (MARPE). A forward movement of the maxilla is significantly more associated with bone-anchored than with tooth-anchored devices, which limits dentoalveolar bone effects [14]. Bone-anchored devices can reduce negative side effects such as a lingual inclination of the maxillary anterior teeth and maxillary molar extrusion, while directly delivering orthodontic forces to the maxillary complex [15]. Nevertheless, the effects of an orthodontic treatment of a skeletal Class III malocclusion might not be maintained during the subsequent growth spurt of the mandible. Therefore, long-term studies are needed to evaluate the effectiveness of such treatment. [PERSON] et al.'s study has found that the long-term results are more sustainable for miniplates than tooth-anchored devices [16]. However, there has been no study using palatal miniscrew-anchored devices, and the long-term effects of miniscrew-anchored devices have not been compared. In this study, we aimed to scrutinize skeletal and dental changes in growing Class III patients before and after treatment, as well as during the follow-up period, utilizing a maxillary protraction facemask anchored by teeth and miniscrews. The null hypothesis for this study could be formulated as follows: there is no significant difference in skeletal and dental measurements before and after treatment, as well as during the follow-up period, in growing Class III patients treated with a maxillary protraction facemask anchored by teeth and miniscrews.