Skip Navigation


The European Journal of Orthodontics Advance Access originally published online on February 7, 2006
The European Journal of Orthodontics 2006 28(2):184-189; doi:10.1093/ejo/cji095
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/2/184    most recent
cji095v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (3)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Sayinsu, K.
Right arrow Articles by Arun, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sayinsu, K.
Right arrow Articles by Arun, T.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2006. Published by Oxford University Press on behalf of the European Orthodontics Society. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Sagittal airway dimensions following maxillary protraction: a pilot study

Korkmaz Sayinsu, Fulya Isik and Tülin Arun

Faculty of Dentistry, Yeditepe University, Istanbul, Turkey

Address for correspondence Dr Korkmaz Sayinsu, Yeditepe University, Faculty of Dentistry, Bagdat cad. No: 238 34730, Göztepe, Istanbul, 34730 Turkey, E-mail: drkorkmaz{at}yeditepe.edu.tr


   Summary
Top
 Summary
Introduction
 Materials and methods
 Results
 Discussion
 Conclusions
 References
 
The relationship between changes in the position of the maxillary structures caused by maxillary protraction therapy and airway dimensions have not been investigated as comprehensively as the accompanying skeletal changes. The purpose of this study was to examine the effects of rapid palatal expansion (RPE) used in conjunction with maxillary protraction headgear on the sagittal dimension of the airway.

The treatment sample consisted of 19 Class III patients (12 girls, 7 boys) with a mean age of 10.51 ± 1.15 years, presenting with maxillary retrognathism. A cap splint type rapid palatal expander that had hooks between the upper lateral and canine teeth was used intraorally, and a Petit type facemask device extraorally, for an average of 6.78 ± 0.93 months. Pre- and post-treatment cephalometric radiographs were evaluated.

The results of the study revealed that point A moved anteriorly. The palatal plane showed a counter-clockwise rotation matched by the clockwise rotation of the mandible and an accompanying decrease in SNB angle. The vertical parameters showed a statistically significant increase. The head was in a more extensive position in relation to the cervical vertebrae. The nasopharyngeal airway measurements (PNS–ad1, PNS–ad2) showed an increase of 2.71 ± 3.35 and 3.03 ± 2.37 mm, respectively. These results demonstrated that limited maxillary widening together with protraction of the maxilla, improve nasopharyngeal but not oropharyngeal airway dimensions in the short term.


   Introduction
Top
 Summary
 Introduction
Materials and methods
 Results
 Discussion
 Conclusions
 References
 
The skeletal and dentoalveolar effects of orthopaedic treatment in subjects with Class III malocclusions with maxillary retrognathia, have been well documented in the orthodontic literature. Maxillary skeletal protraction, forward movement of the maxillary dentition, counter-clockwise rotation of the palatal plane, labial tipping of the maxillary incisors, inhibition of anterior mandibular growth, augmentation of face height, clockwise rotation of the mandible and lingual tipping of the lower incisors have all been shown to take place when treating growing skeletal Class III patients with a facemask (Ishii et al., 1987Go; Mermigos et al., 1990Go; Delaire, 1997Go; Nartallo-Turley and Turley, 1998Go; Baccetti et al., 1998Go, 2000Go; da Silva Filho et al., 1998Go; Macdonald et al., 1999Go; Jäger et al., 2001Go; Turley, 2002Go).

Animal experiments have shown that the entire maxilla is displaced anteriorly, and not only point A. Furthermore, the significant effects of the facemask were seen as posteriorly as the zygomatico-temporal suture (Kambara, 1977Go; Nanda, 1978Go; Jackson et al., 1979Go). The use of rapid palatal expansion (RPE) is postulated to disarticulate the maxillary sutures and allow more efficient forward protraction of the maxilla (McNamara, 1987Go; Turley, 1988Go, 1996Go). The relationship between these extreme changes in the position of the maxillary structures and the airway dimensions has not been investigated as comprehensively as the skeletal changes. Severe maxillary hypoplasia seen in craniofacial anomalies has been suggested to constrict the upper airway, including the nasal cavity and velopharynx (Handler, 1985Go; Hui et al., 1998Go). The positive effect of midface distraction carried out to alleviate upper airway obstruction in midface hypoplasia seen with achondroplasia has recently been reported (Elwood et al., 2003Go). The change in respiratory function induced by RPE has also been documented (Basciftci et al., 2002Go; Doruk et al., 2004Go). The effects of a maxillary protraction appliance used in combination with a chin cap have been shown to alter the upper airway dimension during maxillary protraction (Hiyama et al., 2002Go). The purpose of this study was to examine the effect of RPE and maxillary protraction headgear on the sagittal dimensions of the upper airway.


   Materials and methods
Top
 Summary
 Introduction
 Materials and methods
Results
 Discussion
 Conclusions
 References
 
The material for this retrospective study consisted of 38 lateral cephalometric films obtained from 19 Class III patients with maxillary retrognathism from a university clinic. All the patients were between PP2 and MP3 cap developmental stages at the beginning of the treatment period. The mean ages for girls (n = 12) and boys (n = 7) were 10.50 ± 0.96 and 10.54 ± 1.51, respectively. The patients were included in the study based on the following criteria: (1) The presence of a skeletal Class III malocclusion with maxillary skeletal retrusion, (2) No other congenital anomalies or endocrine problems, (3) An anterior crossbite with a Class III molar relationship, and (4) No mandibular displacement.

An acrylic cap splint type rapid palatal expander (A0620–09, Leone, Firenze, Italy), that had hooks between the upper lateral incisors and canines, was fabricated for each patient and cemented with fluoride releasing glass ionomer cement (Unitek Multi-Cure Glass Ionomer Band Cement, 3M-Unitek, Monrovia, California, USA) (Figure 1). Treatment started with one week of palatal expansion for the purpose of sutural disarticulation. The palatal screw was activated twice a day for seven days. At the end of day 7 protraction therapy was commenced. The facemask utilized in the study was a Petit type device (Ormco Corp., Glendora, California, USA) with bilateral forces set to 600–800 g. The direction of the elastics was approximately 30 degrees below the occlusal plane, as recommended in the literature (Itoh et al., 1985Go; Roberts and Subtelny, 1988Go; Ngan et al., 1996Go) (Figure 2). The patients were instructed to wear the appliance for at least 16 hours per day. The mean and standard deviation of treatment time was 6.78 ± 0.93 months.


Figure 1
View larger version (115K):
[in this window]
[in a new window]
  		Figure 1  Intraoral view of the appliance.

 

Figure 2
View larger version (119K):
[in this window]
[in a new window]
  		Figure 2  Profile view of a patient wearing facemask.

 
Lateral cephalometric films, in natural head posture, were taken at the start and end of protraction. All the radiographs were taken with Trophy Ortho Slice 1000 C (Asahi Roentgen Ind. Co. Ltd, Kyoto, Japan) and were scanned at 300 dpi with an Epson Expression 1680 Pro scanner (Seiko Epson Corp., Nagano-Ken, Japan) into Dolphin Imaging Software 9.0 (Los Angeles, California, USA). The skeletal and dental parameters were calculated using the Dolphin Imaging software program, whereas head posture and sagittal airway measurements were traced, measured and registered by hand using conventional methods. The skeletal changes were assessed by SN–GoMe angle, ANSMe/NMe ratio, NP–A distance, maxillary depth angle, maxillary height angle, SNA angle, SNB angle and ANB angle. The dental changes were evaluated by U1–SN angle, L1–MP angle, SN–PP angle and SN–OP angle. The other parameters related to head posture and sagittal pharyngeal airway were NSL–OPT, NSL–CVT, NL–OPT, NL–CVT, and OPT–CVT angles, and PNS–ad1, PNS–ad2, OAW1, OAW2, OAW3, SPPS, MPS, and IPS distances, as defined by earlier research (Linder-Aronson and Henrikson, 1973Go; Solow and Tallgren, 1976Go; Hellsing, 1989Go; Figure 3).


Figure 3
View larger version (19K):
[in this window]
[in a new window]
  		Figure 3  Diagrammatic representation of cephalometric head posture and airway variables. ad1, the point where posterior nasal spine (PNS)–basion (Ba) line intersects the posterior pharyngeal wall; ad2, the point where a line perpendicular to sella (S)–Ba plane passing through PNS intersects the posterior pharyngeal wall; OAW1, the distance between the points where the functional occlusal plane intersects the anterior and posterior pharyngeal walls; OAW2, the distance between points where a line passing through hyoid (hy) and C2i intersects the anterior and posterior pharyngeal walls; OAW3, the distance between the points where a line passing through hy and C4i intersects the anterior and posterior pharyngeal walls; SPPS, anteroposterior width of the pharynx measured between the posterior pharyngeal wall and the dorsum of the soft palate on a line parallel to the Frankfort horizontal (FH) plane that runs through the middle of a line from PNS to pogonion (P); MPS, anteroposterior width of the pharynx measured between the posterior pharyngeal wall and the dorsum of the tongue on a line parallel to the FH plane that runs through P; IPS, anteroposterior width of the pharynx measured between the posterior pharyngeal wall and the dorsum of the tongue on a line parallel to the FH plane that runs through C2i.

 
Statistical calculations were performed with GraphPad Prisma Version 3.0 software (San Diego, California, USA) for Windows. In addition to standard descriptive statistical calculations (mean and standard deviation), the non-parametric Wilcoxon signed rank test was utilized for the comparison of pre- and post-treatment changes (Table 1). The results were evaluated within a 95 per cent confidence interval. The statistical significance level was established at P < 0.05.


View this table:
[in this window]
[in a new window]
  		Table 1 Comparison of intra-group changes (Wilcoxon sign rank test).

 
In order to assess the magnitude of the method error for each parameter, 20 randomly selected lateral cephalometric radiographs were retraced and remeasured by the same examiner (KS) with an interval of 20 days. Inter-rater correlation coefficients were found to be within 0.91 and 0.99.


   Results
Top
 Summary
 Introduction
 Materials and methods
 Results
Discussion
 Conclusions
 References
 
The changes which occurred during facemask therapy are shown in Table 1. Parameters regarding the sagittal maxillary position (NPer–A distance, maxillary depth angle, SNA angle) demonstrated that point A moved anteriorly. The palatal plane demonstrated a counter-clockwise rotation parallel to the clockwise rotation of the mandible, revealed by the decrease in SNB angle. The vertical parameters (SN–GoMe, ANSMe/NMe) showed a statistically significant increase.

The upper incisors tipped labially, a mean of 1.37 degrees with respect to the anterior cranial base, and the lower incisors tipped lingually. The amount of mean overjet increase was 8.06 mm.

The head was in a more extended position in relation to the cervical vertebrae, confirmed by the 2.38 degrees increase in NSL–CVT angle. NL–OPT and NL–CVT angles also showed an increase, slightly more than the NSL–CVT angle, supporting the counter-clockwise rotation of the maxillary complex. The mean increases in nasopharyngeal airway measurements (PNS–ad1 and PNS–ad2) were 2.71 and 3.03 mm, respectively.


   Discussion
Top
 Summary
 Introduction
 Materials and methods
 Results
 Discussion
Conclusions
 References
 
The present investigation analysed the treatment changes after orthopaedic therapy of Class III malocclusions by means of a bonded RPE used in conjunction with a facemask. An acrylic cap splint-type RPE was used as the anchorage appliance for the protraction therapy in order to obtain greater stability and skeletal effects (Kim et al., 1999Go; Turley, 1988Go, 1996Go).

A control group could not be established in the present study. There are studies in the literature where Class I control groups have been used; however, the dentoalveolar and skeletal growth trends in subjects with a Class III malocclusion may differ from those of normal subjects. The need to use a Class III adequately matched control sample to make valid comparisons is therefore essential. Furthermore, there are examples which show that Class I control groups are not suitable for comparing with Class III treatment groups (Tindlund, 1989Go; Takada et al., 1993Go; Shanker et al., 1996Go). As for airway measurements, Özbek et al. (1998)Go showed that only negligible changes occurred in the upper airway during their 1.8 year observation period. Another limitation of the present study is the two-dimensional airway measurements, meaning that the results for these parameters are for the sagittal section only, and should be interpreted with caution taking this fact into consideration.

The parameters regarding the sagittal maxillary position (NP–A distance, maxillary depth angle, SNA angle) show that point A moved anteriorly. These results are similar to previously published reports as far as the amount and nature of the protraction effects. Most other studies (Nanda, 1980Go; Mermigos et al., 1990Go; Gallagher et al., 1998Go) reported between 1 and 3 mm of maxillary protraction, in line with the current study. This skeletal movement was accomplished by a force below the centre of resistance of the maxilla and directed downward and forward, lowering the posterior maxilla more than the anterior. The amount of skeletal movement of the maxilla was limited by the amount of dental movement, because the patients were generally treated until a positive overjet was achieved (Gallagher et al., 1998Go). However, there is also a large range of responses reported in the literature, from significant maxillary advancement to minimal or no change with treatment (Turley, 2002Go). This inconsistency in response might be due to variations in treatment protocol including the design of appliances, the force level used, the number of hours worn per day, and the overall treatment time.

Maxillary height did not show any significant changes in the present study. Shanker et al. (1996)Go reported a 0.3 mm downward movement of the vertical position of point A in the treatment group, compared with a 1.0 mm downward movement in the control group. Those authors concluded that treatment appeared to inhibit normal downward movement of point A, which may be the result of the reported counter-clockwise rotation of the maxilla with protraction forces (Linder-Aronson and Henrikson, 1973Go; Ishii et al., 1987Go; Tindlund, 1989Go; Shanker et al., 1996Go). The palatal plane in this study showed a counter-clockwise rotation, resulting in a backward and downward displacement of the mandible. These findings are similar to the results of da Silva et al. (1998)Go and Ishii et al. (1987)Go, where the ratio between maxillary anterior displacement and mandibular retroposition was almost 1:1.

The accompanying decrease in SNB angle is not a reflection of a change in dimension (da Silva et al., 1998Go), but of a change in position, revealed by the vertical parameters (SN–GoMe, ANSMe/NMe) which showed a statistically significant increase. This downward and backward mandibular rotation results in point B moving backward, which then allows an increase in facial convexity and improvement in the profile.

Post-treatment, the head was in a more extended position in relation to the cervical vertebrae demonstrated, by a mean increase of 2.38 degrees in NSL–CVT angle. NL–OPT and NL–CVT angles also showed an increase, slightly more than that of NSL–CVT angle, supporting the counter-clockwise rotation of the maxillary complex.

Upper airway dimension and head posture were found to be strongly correlated with previous research (Spann and Hyatt, 1971Go; Thach and Stark, 1979Go; Hiyama et al., 2002Go). Nasopharyngeal airway measurements (PNS–ad1 and PNS–ad2) showed a mean increase of 2.71 and 3.03 mm, respectively in this study. The other airway parameters measured demonstrated no statistically significant differences. There are studies regarding the influence of functional appliances or RPE devices on the upper airway. In a recent review, oral devices were shown to be effective in approximately 50–70 per cent of patients with obstructive sleep apnoea (OSA; Verse et al., 2003Go). Mandibular distraction osteogenesis may also be of help in OSA in patients with mandibular hypoplasia and severe upper airway obstruction (Elwood et al., 2003Go; Mandell et al., 2004Go). Considering that mandibular growth has a definite influence on the upper airway dimension, it can be speculated that maxillary growth could also have beneficial effects on the upper airway (Hiyama et al., 2002Go).

Even though no significant changes between pre- and post-treatment airway parameters were found by Hiyama et al. (2002)Go, they carried out a multiple regression analysis which revealed that greater forward maxillary growth was associated with a greater increase in the superior upper airway dimension. A possible explanation as to why Hiyama et al. (2002)Go could not find any differences in the between the pre- and post-treatment airway parameters may be the lack of related parameters in their study. The upper airway measurements used (SPPS, MPS, IPS) were mainly at the back of the tongue and very minimally related to maxillary structures. The backward rotation of the mandible, although implicitly restricting the related sagittal airway dimensions, did not appear to cause any change.


   Conclusions
Top
 Summary
 Introduction
 Materials and methods
 Results
 Discussion
 Conclusions
References
 
This study evaluated the effect of using maxillary disarticulation and protraction on the sagittal dimension of the naso- and oropharyngeal airways in 19 growing patients with a skeletal Class III relationship. The results, however, should be interpreted with caution because of the small sample size and the lack of a control group. The findings showed:

  1. Point A moved anteriorly, the palatal plane showed a counter-clockwise rotation matching the clockwise rotation of the mandible as revealed by the decrease in SNB angle, and the vertical parameters showed a statistically significant increase.
  2. The head was in a more extended position in relation to the cervical vertebrae. Nasopharyngeal airway measurements (PNS–ad1, PNS–ad2) showed a mean increase of 2.71 and 3.03 mm, respectively.
  3. Maxillary disarticulation and protraction improved naso- but not oropharyngeal airways.

Further research may be needed to evaluate the functional status of the airway after maxillary protraction.


   References
Top
 Summary
 Introduction
 Materials and methods
 Results
 Discussion
 Conclusions
 References
 

    Baccetti T, McGill J S, Franchi L, McNamara Jr J A, Tollaro I 1998 Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy. American Journal of Orthodontics and Dentofacial Orthopedics 113: 333–343[CrossRef][Web of Science][Medline]

    Baccetti T, Franchi L, McNamara Jr J A 2000 Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics 118: 404–413[CrossRef][Web of Science][Medline]

    Basciftci F A, Mutlu N, Karaman A I, Malkoc S, Kucukkolbasi H 2002 Does the timing and method of rapid maxillary expansion have an effect on the changes in nasal dimensions? Angle Orthodontist 72: 118–123[Web of Science][Medline]

    da Silva Filho O G, Magro A C, Capelozza Filho L 1998 Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction. American Journal of Orthodontics and Dentofacial Orthopedics 113: 196–203[CrossRef][Web of Science][Medline]

    Delaire J 1997 Maxillary development revisited: relevance to the orthopaedic treatment of Class III malocclusions. European Journal of Orthodontics 19: 289–311[Abstract/Free Full Text]

    Doruk C, Sökücü O, Sezer H, Canbay E 2004 Evaluation of nasal airway resistance during rapid maxillary expansion using acoustic rhinometry. European Journal of Orthodontics 26: 397–403[Abstract/Free Full Text]

    Elwood E T, Burstein F D, Graham L, Williams J K, Paschal M 2003 Midface distraction to alleviate upper airway obstruction in achondroplastic dwarfs. Cleft Palate-Craniofacial Journal 40: 100–103

    Gallagher W, Miranda F, Buschang P H 1998 Maxillary protraction: treatment and posttreatment effects. American Journal of Orthodontics and Dentofacial Orthopedics 113: 612–619[CrossRef][Web of Science][Medline]

    Handler S D 1985 Upper airway obstruction in craniofacial anomalies: diagnosis and management. Birth Defects 21: 15–31

    Hellsing E 1989 Changes in the pharyngeal airway in relation to extension of the head. European Journal of Orthodontics 11: 359–365[Abstract/Free Full Text]

    Hiyama S et al. 2002 Effects of maxillary protraction on craniofacial structures and upper-airway dimension. Angle Orthodontist 72: 43–47[Web of Science][Medline]

    Hui S, Wing Y K, Kew J, Chan Y L, Abdullah V, Fok T F 1998 Obstructive sleep apnea syndrome in a family with Crouzon's syndrome. Sleep 21: 298–303[Web of Science][Medline]

    Ishii H, Morita S, Takeuchi Y, Nakamura S 1987 Treatment effect of combined maxillary protraction and chincap appliance in severe Class III cases. American Journal of Orthodontics and Dentofacial Orthopedics 92: 304–312[CrossRef][Web of Science][Medline]

    Itoh T, Chaconas S J, Caputo A A, Matyas J 1985 Photoelastic effects of maxillary protraction on the craniofacial complex.American Journal of Orthodontics 88: 117–124[CrossRef][Web of Science][Medline]

    Jackson G W, Kokich V G, Shapiro P A 1979 Experimental and postexperimental response to anteriorly directed extraoral force in young Macaca nemestrina. American Journal of Orthodontics 75: 318–333[CrossRef][Web of Science][Medline]

    Jäger A, Braumann B, Kim C, Wahner S 2001 Skeletal and dental effects of maxillary protraction in patients with Angle Class III malocclusion. A meta-analysis. Journal of Orofacial Orthopedics 62: 275–284

    Kambara T 1977 Dentofacial changes produced by extraoral forward force in the Macaca irus. American Journal of Orthodontics 71: 249–277[CrossRef][Web of Science][Medline]

    Kim J H, Viana M A, Graber T M, Omerza F F, BeGole E A 1999 The effectiveness of protraction face mask therapy: a meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics 115: 675–685.[CrossRef][Web of Science][Medline]

    Linder-Aronson S, Henrikson C O 1973 Radiocephalometric analysis of anteroposterior nasopharyngeal dimensions in 6- to 12-year-old mouth breathers compared with nose breathers. Journal for Oto-Rhino-Laryngology and Its Related Specialties 35: 19–29

    Macdonald K E, Kapust A J, Turley P K 1999 Cephalometric changes after the correction of Class III malocclusion with maxillary expansion/facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics 116: 13–24[CrossRef][Web of Science][Medline]

    Mandell D L, Yellon R F, Bradley J P, Izadi K, Gordon C B 2004 Mandibular distraction for micrognathia and severe upper airway obstruction. Archives of Otolaryngology-Head and Neck Surgery 130: 344–348[CrossRef]

    McNamara J A 1987 An orthopedic approach to the treatment of Class III malocclusion in young patients. Journal of Clinical Orthodontics 21: 598–608

    Mermigos J, Full C A, Andreasen G 1990 Protraction of the maxillofacial complex. American Journal of Orthodontics and Dentofacial Orthopedics 98: 47–55[Web of Science][Medline]

    Nanda R 1978 Protraction of maxilla in rhesus monkeys by controlled extraoral forces. American Journal of Orthodontics 74: 121–141[CrossRef][Web of Science][Medline]

    Nanda R 1980 Biomechanical and clinical considerations of a modified protraction headgear. American Journal of Orthodontics 78: 125–139[CrossRef][Web of Science][Medline]

    Nartallo-Turley P E, Turley P K 1998 Cephalometric effects of combined palatal expansion and facemask therapy on Class III malocclusion. Angle Orthodontist 68: 217–224[Web of Science][Medline]

    Ngan P, Hägg U, Yiu C, Merwin D, Wei S H 1996 Treatment response to maxillary expansion and protraction. European Journal of Orthodontics 18: 151–168[Abstract/Free Full Text]

    Özbek M M, Memikoglu T U, Gögen H, Lowe A A, Baspinar E 1998 Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. Angle Orthodontist 68: 327–336[Web of Science][Medline]

    Roberts C A, Subtelny J D 1988 Use of the face mask in the treatment of maxillary skeletal retrusion. American Journal of Orthodontics and Dentofacial Orthopedics 93: 388–394[CrossRef][Web of Science][Medline]

    Shanker S et al. 1996 Cephalometric A point changes during and after maxillary protraction and expansion. American Journal of Orthodontics and Dentofacial Orthopedics 110: 423–430[CrossRef][Web of Science][Medline]

    Solow B, Tallgren A 1976 Head posture and craniofacial morphology. American Journal of Physical Anthropology 44: 417–435[CrossRef][Web of Science][Medline]

    Spann R W, Hyatt R E 1971 Factors affecting upper airway resistance in conscious man. Journal of Applied Physiology 31: 708–712.[Free Full Text]

    Takada K, Petdachai S, Sakuda M 1993 Changes in dentofacial morphology in skeletal Class III children treated by a modified protraction headgear and a chin cup: a longitudinal cephalometric appraisal. European Journal of Orthodontics 15: 211–221[Abstract/Free Full Text]

    Thach B T, Stark A R 1979 Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants. Journal of Pediatrics 94: 275–281[CrossRef][Web of Science][Medline]

    Tindlund R S 1989 Orthopedic protraction of the midface in the deciduous dentition—results covering 3 years out of treatment. Journal of Cranio-Maxillofacial Surgery 17 (Suppl 1): 17–19

    Turley P K 1988 Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear. Journal of Clinical Orthodontics 22: 314–325

    Turley P K 1996 Orthopedic correction of Class III malocclusion: retention and phase II therapy. Journal of Clinical Orthodontics 30: 313–324

    Turley P K 2002 Managing the developing Class III malocclusion with palatal expansion and facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics 122: 349–352[CrossRef][Web of Science][Medline]

    Verse T, Pirsig W, Stuck B A, Hormann K, Maurer J T 2003 Recent developments in the treatment of obstructive sleep apnea. American Journal of Respiratory Medicine 2: 157–168


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur J OrthodHome page
A. S. Kilinc, S. G. Arslan, J. D. Kama, T. Ozer, and O. Dari
Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects
Eur J Orthod, February 1, 2008; 30(1): 61 - 66.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/2/184    most recent
cji095v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (3)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Sayinsu, K.
Right arrow Articles by Arun, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sayinsu, K.
Right arrow Articles by Arun, T.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?