Publication: Evaluation of the effectiveness of the removable mandibular retractor with slow maxillary expansion compared to the bone-anchored intermaxillary traction with rapid maxillary expansion in the correction of skeletal class iii malocclusion associated with maxillary constriction in growing patients: a randomized controlled trial
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Date
2025-08
Authors
Zakaria, Ahmad Salim
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Abstract
This randomized controlled trial aimed to evaluate the effectiveness and acceptability of the bone-anchored intermaxillary traction (BAIMT) with rapid maxillary expansion (RME) in comparison with removable mandibular retractor (RMR) with slow maxillary expansion (SME) in the correction of skeletal class III malocclusion associated with a maxillary constriction in terms of treatment time. Moreover, sagittal and transverse skeletal changes, dento-alveolar and soft tissue changes, and Patient-Reported Outcome Measures (PROMs) were also assessed. The final sample consisted of 26 patients (13 males, 13 females), ages ranging 12-15 years who were assigned to two groups randomly: BAIMT with RME group (14 patients, mean age 14.09±1.12 years) and RMR with SME group (12 patients, mean age 13.04±1.46 years). After correction of malocclusion in the sagittal and transverse planes, patients underwent a 3-month retention phase. Lateral and anteroposterior cephalograms and dental casts were taken of all patients participating at two assessment times: before the beginning of the treatment, and at the end of the retention phase. Furthermore, the levels of pain, discomfort, functional impairment, and shyness were evaluated using a standardized questionnaire that was distributed to the patients at five assessment times: (T1) after one day of the beginning of the active treatment, (T2) after one week (T3) after four weeks, (T4) after 3 months, and (T5) after 6 months. Intraclass correlation coefficients (ICCs) were applied to determine the reproducibility of the employed method, i.e. intra-observer reliability (or random error), whereas paired t-tests were applied to determine any systematic error. The data distribution for all study variables was initially tested using the Shapiro-Wilk normality test. Thereafter, Two-sample t-test, or its nonparametric counterpart, the Mann-Whitney U test, was used to detect the significance of the differences between the two groups regarding treatment duration, cephalogram data, and dental cast. For PROM questionnaire data, the Chi-square test was used. For all variables, Intraclass correlation coefficients values were in the range of excellent correlation. The results showed that the duration of both expansion and active treatment phase was significantly lower in BAIMT group compared to the RMR group (p<0.001). Sagittal skeletal and soft tissue analysis showed a significant difference between the two groups only regarding Co-Gn (p=0.039) and ANS-Me (p=0.008) in favor of RMR with SME. However, no significant differences were found between the two groups regarding the variables studied on both the anteroposterior cephalograms and dental casts (p>0.05). Regarding Patient-Reported Outcome Measures assessment, the speech difficulties level was significantly greater in the RMR group compared to the other one only at T1 (p=0.006). In contrast, mandibular movement restriction was significantly greater in the BAIMT with RME group compared to the other one only at T2 (p=0.042). Both BAIMT with RME and RMR with SME are capable of correcting Class III malocclusion associated with a maxillary constriction in growing patients with permanent dentition by making similar skeletal, dental, and soft tissue changes
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