Bone- and tooth-borne maxillary protraction with miniscrews and class III elastics: A pilot case-control study

Abstract Background Bone-Anchored Class III Elastics (BAC3E) with miniplates offer better skeletal outcomes but require invasive surgical placement and removal. This pilot study explores a minimally invasive alternative by assessing the dental, skeletal, and soft tissue effects of miniscrew-assisted maxillary protraction (MAMP) combined with computer-aided design/manufacturing (CAD/CAM) in skeletal Class III patients. Methods Eleven pre-peak subjects (seven females, four males) with a retrusive maxilla were treated with MAMP and compared with two retrospective control groups (BAC3E and untreated Class III controls). Subjects were matched for age, gender, and vertical skeletal pattern. Pre- and post-treatment lateral cephalograms were taken. The MAMP protocol involved custom CAD/CAM frameworks with four miniscrews, with Class III elastics worn full-time. Paired t-tests and ANOVA were employed for statistical comparisons. Results The MAMP group showed significant maxillary skeletal improvements (SNA, +2.5°; Co-A, +2.4 mm), reduced SNML angle (−0.6°), maxillary incisors retroclination (U1-PP, −4.7 °), mandibular incisors proclination (L1-ML, +1.6°), and improved overjet (+3.8 mm). Compared to BAC3E, the MAMP group had significantly smaller midfacial advancement but significantly greater maxillomandibular outcomes than untreated controls. No significant differences in mandibular sagittal position were found between the MAMP and BAC3E groups, but the MAMP group exhibited significant Co-Gn changes compared to untreated controls. No significant vertical changes were observed among the three groups. Conclusions MAMP with CAD/CAM frameworks offers an effective, minimally invasive approach for early Class III intervention, with favourable skeletal improvements and vertical control.