Comparative Analysis of Bone vs. Tooth Anchored Maxillary Protraction in Cleft Lip and Palate Patients—A Systematic Review and Meta-Analysis

Vaibhav Gandhi¹ | Amine Fattal² | Gina Genova³ | Sumit Yadav¹ | Nandakumar Janakiraman⁴

¹Department of Growth and Development, University of Nebraska Medical Center, Lincoln, Nebraska, USA | ²Private Practice, Elkhart, Indiana, USA | ³University of Louisville, Louisville, Kentucky, USA | ⁴Georgia School of Orthodontics, Atlanta, Georgia, USA

Correspondence: Vaibhav Gandhi (drvaibhavgandhi88@gmail.com)

Received: 10 April 2025 | Revised: 28 June 2025 | Accepted: 1 September 2025

Keywords: bone-anchored

maxillary protraction | class III | cleft lip and palate | facemask therapy | tooth-anchored maxillary protraction

ABSTRACT
Management of class III malocclusion in patients with cleft is geared toward improving the maxillary position with maxillary protraction therapy with or without bone anchorage. This study aims at evaluating the effects of bone-anchored maxillary protraction (BAMP) and tooth-anchored maxillary protraction (TAMP) appliances in patients with cleft lip and palate (CLP). A search of PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertations and Theses Global, and Clini calTr ials. gov registry was performed. Prospective studies that evaluated the effect of BAMP and/or TAMP therapy in patients with CLP were screened. A meta-analysis was performed for the cephalometric parameters evaluating sagittal (SNA, SNB, ANB and Wits appraisal), vertical (mandibular plane angle), and dentoalveolar (U1 to PP, IMPA, overjet and overbite) effects following the BAMP or TAMP. Database research, elimination of duplicate studies, data extraction and risk of bias (RoB) assessment were performed by authors independently and in duplication. A random-effect
meta-analysis was performed to evaluate the sagittal, vertical and dentoalveolar effects. BAMP increased SNA angle by 1.76 degrees (95% CI: 1.03 to 2.49), ANB angle by 2.08 (95% CI: 0.99 to 3.18), Wits appraisal by 2.17 mm (95% CI: 1.05 to 3.28), and overjet reduction by 2.03 mm (95% CI: 0.98 to 3.08). TAMP increased SNA by 2.56° (95% CI: 1.58 to 3.54), ANB angle by 4.40° (95% CI: 3.61 to 5.18), Wits appraisal by 5.53 mm (95% CI: 4.27 to 6.79). However, TAMP decreased SNB by 2.00° (95% CI: −2.61 to −1.39) and increased mandibular plane angle by 2.75 (95% CI: 1.73, 3.76). Sagittal correction is expected with BAMP and TAMP therapy in children with CLP. However, pronounced vertical or dentoalveolar side effects are expected with TAMP compared to BAMP therapy. Trial Registration: This systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0, was registered at the PROSPERO database (CRD42021247529), and reported according to the PRISMA statement.

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