Efeitos da protração maxilar em pacientes em crescimento com fissuras labiopalatinas: uma revisão de escopo

Abstract

Background: Growing individuals with cleft lip and palate rehabilitated in childhood often have skeletal Class III malocclusion due to the tensile forces that limit anteroposterior maxillary growth. Objectives: To conduct a scoping review to map the short- and long-term effects of different maxillary protraction modalities in growing patients with complete cleft lip and palate and skeletal Class III malocclusion. Methods: Two reviewers independently and blindly performed an electronic search of the Medline/PubMed, Latin American and Caribbean Health Sciences Literature Resources (LILACS), Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, OpenGrey, and Google Scholar databases. Articles were selected by title and abstract, by full-text reading and manual search of the reference list. Results: A total of 542 articles were found, but twenty-seven were selected for this review. The maxillary protraction with facemask, maxillary protraction associated with Alt-RAMEC with a facemask or intraoral springs, and bone-supported maxillary protraction appear to treat Class III by means of the combination of skeletal and dental effects, with positive consequences in the soft tissue. The cleft type, the maxillary protraction modality, the type of maxillary expansion and the alveolar bone graft seem to influence on the effects. Some of the dentoskeletal effects obtained appear to be unstable in the long-term. Conclusion: Skeletal Class III malocclusion is treated in growing patients with complete cleft lip and palate by means of skeletal, dental and soft tissue effects that seem to vary according to the maxillary protraction modality and along the follow-up period.