Osseointegrated implants as an adjunct to facemask therapy: A case report

Branemark Implants were placed in the zygomatic buttresses of the maxilla i n a 12-year and 1-month-old female patient with a Class III malocclusion ca used by maxillary growth retardation secondary to repair of a unilateral cl eft lip and palate defect. The implants were left to integrate for 6 months followed by placement of customized abutments that projected into the bucc al sulcus. Elastic traction (400 g per side) was applied from a facemask to the implants at 30 degrees to the occlusal plane for 14 hours per day for 8 months (ages 12 years and 10 months to 13 years and 6 months). The maxill a moved downward and forward 4 mm rotating anteriorly as it was displaced. The change in the maxillary occlusal plane resulted in a secondary opening of the mandible. There was a 2 degrees increase in the SN-mandibular plane angle and an increase in nasion to menton distance of 9 mm. Clinically, thi s resulted in an increase in fullness of the infraorbital region and correc tion of the pretreatment mandibular prognathism. There was an increase in n asal prominence as the maxilla advanced. This contributed to the increase i n facial convexity. The secondary dental change frequently seen in standard facemask therapy was avoided. The displacement of the maxilla was stable 1 year beyond cessation of facemask therapy. The patient's midface profile w as improved by age of 13 years and 6 months. Details of the clinical proced ure and treatment changes are presented.