Deformation of the zygomaticomaxillary and nasofrontal sutures during bone-anchored maxillary protraction and reverse-pull headgear treatments: An ex-vivo study

Bone-anchored maxillary protraction (BAMP) is an emerging treatment that involves applying a protraction load to the maxillary bone. Although it is believed that such an approach results in better sutural separation, this has not been investigated. This study aimed to assess and compare the deformation of 1 circumaxillary suture (zygomaticomaxillary suture [ZMS]) and 1 facial suture (nasofrontal suture [NFS]) during BAMP and reverse-pull headgear (RPHG) treatment. The study was performed ex vivo on 15 pig heads. Miniplates were placed in the maxillary bone and the body of the mandible. A molar tube was bonded to the maxillary first molars. Six single-element strain gauges and 3 differential variable reluctance transducers were installed across the ZMS and NFS bilaterally. Each head underwent BAMP and RPHG unilaterally and bilaterally. In unilateral experiments, both BAMP and RPHG resulted in tension on the ipsilateral ZMS and NFS and compression on the contralateral side, with higher magnitude in the BAMP group. In bilateral experiments, both modalities resulted in tension at the ZMS, with higher magnitude in the BAMP group. Deformation of the NFS was different between the 2 groups: tension in majority of the BAMP and compression in most of the RPHG heads. Our study shows a higher magnitude of sutural separation in BAMP than in RPHG. The pattern of sutural deformation is consistent with a forward displacement of the midface in BAMP compared with an upward and backward rotation in the RPHG. Rotation of the maxilla was also present in some of the subjects who underwent BAMP. •Bone-anchored maxillary protraction (BAMP) and reverse-pull headgear (RPHG) resulted in tension at the zygomatico-maxillary suture (ZMS), with higher magnitude observed in the BAMP group.•BAMP caused mostly tension at the nasofrontal suture (NFS), while compression was the major outcome in the RPHG group.•NFS deformation pattern suggest that BAMP results in a horizontal translation while RPHG caused upward and backward rotation of the midface.•Compression at the NFS in some of the BAMP subjects suggests that anatomic variations might affect the outcome of the treatment.