Dentoskeletal effects of facemask therapy in skeletal Class III cleft patients with or without bone graft.

INTRODUCTION: The association between maxillary protraction and bone graft in patients with cleft lip and palate remains unclear. The purpose of this study was to investigate whether a secondary alveolar bone graft influences dentoskeletal effects of facemask therapy in unilateral cleft lip and palate patients with a skeletal Class III relationship. METHODS: In this prospective nonrandomized clinical trial, 61 consecutive boys with unilateral cleft lip and palate and skeletal Class III malocclusion were divided into 3 groups: grafted facemask group (n = 21), ungrafted facemask group (n = 20), and untreated control group (n = 20). Sixteen dentoskeletal measurements on lateral cephalometric radiographs were compared before and after therapy or observation with 1-way analysis of variance or the Mann-Whitney U test. RESULTS: After facemask therapy, the grafted group showed a statistically significantly greater advancement of Point A (S-Vert-A, 4.18 +/- 1.94 mm; SNA, 3.51 degrees +/- 2.21 degrees ) than did the ungrafted group (S-Vert-A, 2.64 +/- 1.58 mm; SNA, 1.92 degrees +/- 1.05 degrees ). Furthermore, significant SNB changes were found in the grafted group when compared with those in the ungrafted group (-0.38 degrees +/- 1.77 degrees vs -1.69 degrees +/- 1.34 degrees ; P <0.05). The changes in the mandibular plane angle (MP-SN, MP-FH) in the grafted group were less pronounced than in the ungrafted group by approximately 2 degrees (P <0.05). Flaring of the maxillary incisors was more pronounced in treated subjects than in untreated subjects. The mandibular incisors proclined in both grafted (1.54 degrees +/- 4.21 degrees ) and control (0.97 degrees +/- 3.71 degrees ) patients, and were retroclined in the ungrafted group (-2.13 degrees +/- 3.68 degrees ). CONCLUSIONS: Facemask therapy performed after an alveolar bone graft produced more anterior maxillary migration (90%) and less pronounced mandibular clockwise rotation (10%) than those in the ungrafted group (50%, 50%, respectively).