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Bone‑anchored maxillary
protraction (BAMP): A review
Apoorva Kamath, Shetty Suhani Sudhakar, Greeshma Kannan, Kripal Rai1 and
Athul SB2

Website:
www.jorthodsci.org Abstract
DOI:
INTRODUCTION: Protraction therapy for maxillary deficiency in the treatment of skeletal class III
10.4103/jos.jos_153_21 malocclusion involves the use of facemask. Conventionally facemask has been anchored to the
maxillary dentition, which is responsible for some of the counter‑productive effects of facemask
therapy including backward and downward rotation of the chin, increase in the lower anterior facial
height, proclination of maxillary incisors, retroclination of mandibular incisors apart from mesialization
of maxillary molars with extrusion and decreased overbite.
AIM: The aim of this article is to highlight the nuances of Bone‑Anchored Maxillary Protraction (BAMP)
including a literature review, which is comprehensive and narrative and comparing the different
techniques involved such as type 1 BAMP versus type 2 BAMP and BAMP versus facemask.
MATERIALS AND METHODS: A computerized search was performed in electronic databases such
as PubMed, PubMed Central, Cochrane, Embase, DOAJ, and Google scholar using key words
such as “bone‑anchored maxillary protraction” and “BAMP.” The search was confined to articles in
English published till March 2021. Forty‑seven case‑controlled, cross‑sectional, retrospective and
prospective studies, as well as systematic reviews and meta‑analysis were included in this article,
which were limited to human subjects. A hand search of the reference lists of the included articles
was also carried out to include missed out articles.
CONCLUSION: To overcome these drawbacks, BAMP was introduced, which causes both maxillary
protraction, restraint of mandibular growth with minimal dentoalveolar changes. BAMP is used widely
nowadays in the treatment of skeletal class III malocclusion.
Keywords:
BAMP, bone anchored maxillary protraction, class III, facemask, malocclusion

Departments of
Orthodontics and Introduction and the concomitant problems associated
1
Public Health Dentistry, with a long span of treatment.[4]

S
Srinivas Institute of keletal class III malocclusion, which is
Dental Sciences, caused due to maxillary retrusion or Two‑phase therapy in the correction of
Mukka, Mangaluru, skeletal class III malocclusion entails an
mandibular protrusion or a combination of
Karnataka, 2Department
both, has a prevalence as high as 4%–14% initial phase of correction of the skeletal
of Orthodontics, Kannur
in certain Asian populations and 1–3% in discrepancy using orthopedic appliances,
Dental College, Kerala,
India whites.[1,2] It poses a treatment challenge to which is followed by fixed orthodontic
the orthodontist due to differential growth of mechanotherapy. Facemask, an orthopedic
Address for the mandible, which progressively worsens appliance used for such a correction utilizes
correspondence: with age.[3] Due to this, resolving the skeletal the dentition for force transmission that
Dr. Apoorva Kamath,
discrepancy with a fixed appliance is not can cause counter‑productive effects
Department of
Orthodontics, Srinivas helpful. This extends the treatment duration on it such as retroclination of lower
Institute of Dental incisors, proclination of upper incisors,
Sciences, Mukka, and mesial movement of upper molars
Mangaluru ‑ 574146, This is an open access journal, and articles are
with extrusion.[5] Also, it causes clockwise
Karnataka, India. distributed under the terms of the Creative Commons
E‑mail: apoorva11kamath Attribution‑NonCommercial‑ShareAlike 4.0 License, which rotation of the mandible, increase in the
@gmail.com allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and How to cite this article: Kamath A, Sudhakar SS,
Submitted: 13-Jun-2021
the new creations are licensed under the identical terms. Kannan G, Rai K, Athul SB. Bone‑anchored maxillary
Revised: 04-Aug-2021
protraction (BAMP): A review. J Orthodont Sci
Accepted: 01-Nov-2021
2022;11:8.
Published: 04-May-2022 For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

© 2022 Journal of Orthodontic Science | Published by Wolters Kluwer - Medknow 1

 Kamath, et al.: Review on bamp

dimension of the lower facial third, correction of overjet, Results

and open bite with improvement in the profile in cases
of overclosure. Rationale
BAMP is best done during the late mixed/early
Alternatively, to overcome these effects seen with permanent dentition because of maturation of maxillary
conventionally used facemasks, they have been used bone and eruption of the mandibular canine. [10‑13]
in conjunction with skeletally anchored miniplates to As accuracy of bone density is best with Cone Beam
apply forces directly to the maxillo‑facial complex (type 1 Computed Tomography/Computed Tomography, it
BAMP). A novel intraoral treatment technique with should be undertaken to evaluate the bone density in
its ensuing protocol for the correction of skeletal the area of miniplate insertion.[14]
class III malocclusion was developed by De Clerk
et al. constituting intraoral class III elastics applied Protocols
from the maxillary infra‑zygomatic miniplates to The two major types of BAMP therapy are:
the mandibular symphysis miniplates for 24 hours a (a) Type 1: It involves the installation of two miniplates
day (type 2 BAMP) and a comparative evaluation of at the infrazygomatic crest and the use of a facemask
both the protocols (i.e. type 1 and type 2) was carried for protraction.
out by Elnagar et al.[6] In cases where dentoalveolar (b) Type 2: It involves the installation of two miniplates
compensations can be detrimental, bone anchored each at the infrazygomatic crest and the mandibular
maxillary protraction (BAMP) is preferred, as it symphysis and use of Class III intermaxillary elastics
overcomes the effects of conventional dentition anchored for protraction.
facemask therapy and derives anchorage from the bone
and not the dentition.[7‑9] Procedure of placement
Type 1 BAMP Therapy [Figure 1]:
BAMP as a procedure has been used often over the
years in the treatment of Class III malocclusion. In BAMP, titanium miniplates (e.g., Multipurpose
Understanding the nuances involved with the procedure Implant; Tasarimmed, Istanbul, Turkey) are used as
will equip the clinician with knowledge so as to apply skeletal anchorage devices. Mucosal incisions are made
it in routine clinical practice. Literature summarizing in the labial sulcus bilaterally between lateral incisor and
the therapy comprehensively is scarce. Hence, here we canine. The muscles and periosteum should be incised,
review the BAMP therapy under the following headings, exposing the lateral nasal wall and aperture piriformis.
namely, rationale, application protocols, procedure Contoured miniplates are placed on the lateral nasal
for placement, activation and removal followed by wall and their extension into the oral cavity is bent into a
retention, short‑term and long‑term effects, success rate, hook for engaging elastics. Three screws are to be placed
complications with failures including its application for stabilization of the miniplates. After approximately
in cleft patients and in conjunction with Temporary 7–10 days of soft‑tissue healing, orthopedic forces are
Anchorage devices (TADs) and Rapid Maxillary applied.[15]
Expansion (RME).
An alternate method involves the installation of two
Materials and Methods miniplates at the infrazygomatic crest bilaterally and

A computerized search was performed in electronic

databases such as PubMed, PubMed Central, Cochrane,
Embase, DOAJ and Google scholar using keywords such
as “bone‑anchored maxillary protraction” and “BAMP.”
The search was confined to articles in English published
till March 2021. Case‑controlled studies, cross‑sectional,
retrospective and prospective studies, as well as
systematic reviews and meta‑analysis were included.
The 47 studies included were limited to human subjects.
Studies with both type 1 and type 2 BAMP intervention
in both cleft and non‑cleft subjects were included with
all outcomes. Case reports, opinions, letters to editorials,
and abstracts were excluded. To find additional relevant
articles that might have been missed in the electronic
search, a hand search of the reference lists of the included
articles was carried out. Figure 1: Type 1 BAMP Therapy

2 Journal of Orthodontic Science - 2022

 Kamath, et al.: Review on bamp

the use of a facemask. In this type, patients receive two Activation

surgical miniplates with one placed at each zygomatic In type 1 BAMP therapy, after allowing the soft tissues
buttress area. The incision is made in the buccal to heal for 3 weeks, heavy orthopedic forces are applied.
vestibule below the zygomatic buttress area under Extraoral elastics from the miniplates to the facemask
local anaesthesia. A mucoperiosteal flap is elevated applying 400–500 g of force per side are directed 30°
and the surface of the cortical bone is exposed. Surgical downwards and forward to the maxillary occlusal
miniplates are adapted and bent free hand using a plane. The patients are asked to wear the elastics for
bird‑beak orthodontic plier according to the anatomy of 14–16 hours continuously and replace them once each
the zygomatic buttress, in a curvilinear pattern and in day. A removable maxillary biteplate covering the
accordance to the shape of the zygomatic buttress area. posterior occlusal surfaces is placed to eliminate occlusal
They are fixed with three self‑tapping bone screws per interferences in the incisor region until correction of the
side (2 mm diameter, 6 mm length). Then the incisions anterior crossbite is obtained.[16]
are sutured exposing the end of the miniplates over the
keratinized attached gingiva near the canine to prevent In type 2 BAMP therapy, the miniplates are loaded
gingival irritation and to control the vector of elastic similarly, 3 weeks after the surgery. Class III elastics
traction. The end holes of the miniplates are cut to create apply an initial force of about 150 g on each side initially,
a hook for elastics.[16] which is increased to 200 g after 1 month of traction and
to 250 g after 3 months. The patients are asked to wear
Type 2 BAMP Therapy [Figure 2]: the elastics for 24 hours a day, replacing them daily. After
2–3 months of inter‑maxillary traction, a removable bite
Type 2 BAMP therapy involves the installation of four plate is inserted in the upper arch to eliminate occlusal
miniplates; two each in the maxilla and the mandible. interference in the incisor region until correction of
Patients receive two surgical miniplates at the right and the anterior crossbite is obtained.[13] The surgeons’ and
left zygomatic buttress area. An incision is made in the patients’ experiences and problems with the plates were
buccal vestibule below the zygomatic buttress under described by De Clerck et al. In one case, elastic wear
local or general anesthesia. The mucoperiosteal flap was commenced after 1 month and in the other 2 cases
is elevated and the underlying surface of the cortical after 2 months. Moderate continuous traction by the
bone is exposed. Pre‑drilling with 1.6 mm diameter virtue of elastic wear was found to produce favourable
bur is to be followed by fixing the miniplates to the results in all the three cases. Unlike orthognathic surgery
bone. Surgical miniplates are adapted and bent free which is performed at the completion of the growth
hand using a bird‑beak orthodontic plier according phase, in BAMP, the patient’s appearance does not
to the anatomy of the zygomatic buttress and in worsen through the growth years thereby providing a
accordance with the shape of the zygomatic buttress psychological benefit as well.[12]
area. They are fixed with 2–3 self‑tapping bone screws
per side (2.3 mm diameter, 5 mm length). The incisions Removal
are then sutured exposing the end of the miniplates After 7–12 months of orthopedic traction, the bite plate
over the keratinized attached gingiva near the canine is removed. The traction should be maintained for a total
to prevent gingival irritation and to control the vector period of 12–16 months.[12]
of elastic traction.[12]
Retention
During the follow‑up period after the active treatment,
the patients should be asked to wear the elastics at night
for retention until the growth is complete. Miniplates
remain in the patient’s mouth till growth completion as
it does not interfere in growth.[12]

Rationale for the differing force levels in type 1

and type 2 BAMP
Type 1 BAMP employs forces in the range of 400–500 g
which are applied for 14–16 hours a day, whereas Type 2
BAMP forces in the range of 200–250 g per side are
applied for 24 hours a day. Similar rates of maxillary
protraction have been observed in the two protocols
followed. However, the force of magnitude and duration
of elastic wear differs between the two types of BAMP
Figure 2: Type 2 BAMP Therapy because heavy interrupted forces are applied in type 1
Journal of Orthodontic Science - 2022 3
 Kamath, et al.: Review on bamp

BAMP in contrast to the moderate continuous traction Suture

applied in type 2 BAMP.[6] BAMP effects the circum‑maxillary sutures and this
distraction of the sutures is important for protraction
Short‑term effects of the maxilla. Greater maxillary protraction occurs in
Skeletal stage A and stage B (according to classification given
Maxillary component by Angelieri et al.[20]) of zygomaticomaxillary suture
BAMP is a contemporary counterpart of conventionally calcification either by BAMP or facemask and RME
used maxillary protraction procedures. It acts mainly on combination.[16]
the maxilla to bodily displace it forward in the sagittal
direction. The amount of such a displacement is on Fossa
an average 4.87 mm and 5.81 mm in type 1 and type 2 BAMP therapy leads to seating of the condyles
BAMP, respectively.[6] posteriorly within the glenoid fossa. Apposition at the
anterior eminence of the glenoid fossa that correlates
In comparison with other methods of maxillary with posterior displacement of anterior surface of
protraction such as RME with Facemask (RME/FM), condyle is seen after type 2 BAMP. Also, resorption of
type 2 BAMP leads to a greater forward displacement the posterior wall of the articular eminence of the TMJ
of point A, zygoma, and the orbit.[16] About 3.7 mm of correlates with posterior displacement of posterior
forward movement of maxilla was noted in type 2 BAMP, surface of condyle. A displacement of 2.7 mm was seen
whereas only 2.6 mm of maxillary protraction was seen in posterior border of ramus.[21]
in the RME/FM group.[17] De Clerck et al.[13] reported
4 mm of forward movement of point A, 2 mm of forward Dentoalveolar effect
movement of orbitale, 3 mm of forward movement of The dentoalveolar changes seen with BAMP therapy
point PTM, and clockwise rotation of the maxilla. These also contribute to the correction of the underlying
findings were corroborated by Bacetti and co‑workers skeletal discrepancy. De Clerk and co‑workers found
who also found significant and pronounced horizontal an improvement of overjet by 3.8 mm, molar relation
deformation of maxilla in type 2 BAMP therapy.[18] by ‑4.8 mm, bite deepening of 1.5 mm, and mandibular
incisor proclination of 1.7° with type 2 BAMP when
Skeletally anchored maxillary protraction and dentally compared with untreated cases. [2] Lower incisor
anchored maxillary protraction produced similar retroclination occurred in type 1 BAMP therapy, whereas
changes in the overjet. However, the skeletal component slight proclination of the lower incisor was observed in
of such a change exceeded that produced by dentally type 2 BAMP therapy.[6]
anchored maxillary protraction by 1 cm and horizontal
movement of point A by 3 mm was noted in the former.[19] Incisor mandibular plane angle increases in type 2
BAMP and decreases in type 1 BAMP.[22] However, no
Mandibular component significant changes occurred in the intermolar width
Both type 1 and type 2 BAMP therapy affects the forward of the maxilla and mandible or maxillary arch width
growth of the mandible. A restraining effect on point B in either type 1 or type 2 BAMP therapy. Mandibular
and Pogonion with –2 mm mandibular advancement arch depth decreases in skeletally anchored facemask
and counter‑clockwise movement of the mandible is seen and untreated cases.[23]
in type 2 BAMP.[13] In comparison with type 1 BAMP, a
greater backward displacement of mandible, decreased Soft tissue
mandibular plane angle occurs in type 2 BAMP.[6] Soft tissue changes in skeletally anchored facemask (Type 1
Intraoral skeletally anchored maxillary protraction also BAMP) and conventional facemask significantly differs
occasionally leads to a transient or a permanent only in vertical dimension.[7] Both type 1 and type 2
dysfunction of the temporomandibular joint owing to BAMP techniques of therapy significantly improve
the effect of class III elastics, which seats the condyle the soft tissue profile favorably which in effect leads
into the retro‑discal tissues.[19] Heymann et al.[11] have to an improvement of the concave profile. The upper
reported on the resorptive remodelling of the condyle lip, cheeks, and mid‑face display a significant positive
owing to BAMP therapy. sagittal displacement in both type 1 and type 2 BAMP in
comparison with untreated controls. Soft tissue growth
Maxillo‑mandibular component in the lower lip and chin area is more restrained in
The maxillo‑mandibular difference in the amount of horizontal and vertical direction in type 1 BAMP group
change between type 2 BAMP therapy and RME with when compared with type 2 BAMP.[24]
facemask is ‑5.7 mm.[13] Also, lower anterior facial height
significantly increases in type 1 BAMP with facemask in De Clerk and co‑workers showed a 4‑mm improvement
comparison with type 2 BAMP.[6] in maxillary soft tissue variable and 1.7–2.6 mm
4 Journal of Orthodontic Science - 2022
 Kamath, et al.: Review on bamp

improvement in mandibular soft tissue variable in type 2 miniplate is 97%. Initial retention of the osteosynthesis
BAMP when compared with untreated cases.[13] screws is by mechanical means dictated by the
thickness and density of the external cortical bone and
Airway is decreased in growing children compared to adults.
Extra‑oral tooth borne protraction devices are effective It is not recommended to use these plates below the
and promote skeletal changes in younger children up age of 11 years because of increased risk of poor bone
to 10 years. Forward movement of maxilla and the quality. Failures are noted predominantly in the upper
ensuing clockwise rotation of mandible after maxillary jaw compared to the lower jaw.
protraction therapy favorably alters the upper airway.[25]
A comparative study between type 2 BAMP therapy and Success rate in summary can be related to the following
untreated class III controls demonstrated an increase in factors:
the airway volume by 1499.64 mm3. Additionally, the 1. Pre‑surgical counselling of the patient.
most constricted area of airway increased by 15.44 mm3 2. Minimally invasive surgery with decreased patient
when compared to the control group.[22] morbidity and adequate postsurgical instructions.
3. A good follow‑up regimen by the orthodontist.[35]
2D data show increase in the length of the boundary
between the naso‑pharynx to the oro‑pharynx with Post surgical care
BAMP in comparison to controls. It also potentially Elocom cream (Mometasonefuroate 1 mg) application
improves obstructive sleep apnea in patients with to the lips, local anesthesia (Xylocaine, 1% adrenaline)
maxillary retrusion through an enlargement of the for vasoconstriction along with application of
nasopharyngeal airway. Redirection of mandibular Exacyl (transexamic acid) decreases postsurgical
growth however, did not show any significant changes swelling and patient morbidity. Rinsing with salt water
on the hypopharyngeal airway space.[26] is imperative to avoid infection. Application of wax to
the miniplates avoids irritation of the soft tissues.[22]
Type 1 BAMP and tooth‑borne facemask, both causing
maxillary protraction, demonstrate an enhancement in Complication with failures
the pharyngeal airway space. However, the magnitude Most miniplate failure occurs in younger patients.[10]
of this change is higher in type 1 BAMP compared to A study by Van Hevele showed 93.6% success rate of
facemask alone.[27] miniplates. Failure of the miniplates is 6 times higher
in maxilla, more often in younger boys but not girls.
Expansion of the constricted maxilla also improves
The chances of failure are lesser when post‑operative
the airway constriction. RME and Alternate Rapid
antibiotic is given and the neck of miniplate is placed
Maxillary Expansion and Contraction (Alt‑RAMEC)
in the attached gingiva. Self‑drilling screws have
are used frequently to expand the constricted maxillary
significantly fewer failures.[36]
arch. Type 1 BAMP (with Petit type facemask) however,
causes a greater increase in the nasopharyngeal and
BAMP in cleft patients
oropharyngeal airway dimensions in comparison to
Patients exhibiting Goslon’s index score between 3 and
the Alt RAMEC and RME procedures. Total pharyngeal
5 can be treated using BAMP therapy.[37] Treatment
airway area increases more in the BAMP group followed
outcomes in cleft patients are less optimal due to the
by the Alt‑RAMEC and RME groups.[28]
presence of scar tissue.[14] Failure of miniplates is most
Follow‑up studies on BAMP commonly seen in cleft area compared to the non‑cleft
Follow‑up studies on BAMP have been described in area.[14] BAMP should be performed after alveolar bone
Table 1.[22,29‑34] grafting since the load of the applied inter‑maxillary
traction is not found to compromise the status of the
Success rate secondary alveolar bone graft.[38‑40] In case of failure of
Efficacy of skeletally anchored maxillary protraction has the miniplates, the location should be changed to the
been found to be superior to dental anchored maxillary lateral nasal wall adjacent to nasal cavity.[41] Expansion
protraction. Also, intra‑oral skeletally anchored with RME may be performed only when needed and not
maxillary protraction (type 2 BAMP) was found to be for the purpose of enhancing the protraction protocol.[37]
more effective rather than extra‑oral skeletally anchored
protraction (type 1 BAMP) due to an improvement in Type 1 BAMP therapy in cleft cases have shown
patient compliance.[19] changes in the SNA angle by 0.5–4.2° whereas in type 2
BAMP a change of 1.2–1.7° can be observed. The ANB
Pre‑surgical counselling along with sedation or short angle in type 1 BAMP exhibited a change of 0.6–3°
general anesthesia appears to be better accepted by whereas in type 2 BAMP therapy the change was 1–3.5°.
patients. The success rate in terms of stability of the A forward movement of the zygoma by 1.1 mm and
Journal of Orthodontic Science - 2022 5
 Kamath, et al.: Review on bamp

Table 1: Follow‑up studies on effects of BAMP[22,29‑34]

Author, Sample Follow‑up Structure Aim Findings
Year duration studied
Nguyen, 25 patients, 1 year Mandible To measure amount Posterior chin displacement (0.45 mm); decrease in gonial angle;
2014[29] mean age of of skeletal changes posterior ramal distalization; distal condylar displacement in three
11.10±1.1 a year after BAMP patterns namely, downwards and backwards, straight backwards and
years in growing children upwards and backwards.
(aged 9-13 years)
Nguyen, 9-12 Maxilla To assess effects 5.2 mm of maxillary protraction was noted without counter‑clockwise
2020[30] months Mandible of BAMP of the rotation.
Lower skeletal and dental Restricted from forward movement by 0.6 mm compared to untreated
incisors structures matched controls who showed an anterior growth of 2.2 mm.
Proclination by 2° noted.
Cevidanes, BAMP‑21, 12 months Maxilla To compare the Greater orthopedic protraction with higher displacement of A‑ Vert
2010[31] FM/RME‑34, Mandible effects of BAMP T (2.3 mm) and A‑ Condylion (2.9 mm) in BAMP group.
mean age of Mandibular with facemask given Restraint of 0.6 mm in BAMP group and 1.2 mm in FM/RME group.
11 years 10 Incisors with rapid maxillary Reduction in mandibular plane angle in BAMP group by 1.2° whereas
months expansion (FM/ opening by 2.3° was noted in the FM/RME group.
RME) Distal displacement of the ramus along with closure of the mandible
lead to “swing back” of the mandible in the BAMP group whereas
downward and backward rotation was noted in the FM/RME group.
BAMP caused decompensation with 1.9° of proclination whereas FM/
RME caused a retroclination by 4.3°.
C. Ağlarcı, 59 patients; 9 months Maxillary Effects of BAMP Protrusion was twice in the facemask group than that of skeletal
2016[32] mean age, incisors on the dental and anchorage group.
cases, Mandibular skeletal structures Retroclined in facemask group and proclined in the skeletal anchorage
11.75±1.23 Incisors in comparison to group.
years, Occlusal Facemask therapy Steepened more in the facemask than the skeletal anchorage group.
controls, plane Increase in sagittal advancement of point A and ANS in the skeletal
11.21±1.32
Maxilla anchorage group was greater in comparison to the facemask group.
years
Mandible Downward and clockwise rotation higher in the facemask group.
Lagravère, 62 patients, 12 months Soft tissue To assess the 3D Significant positive sagittal displacement in the upper lips, cheeks,
2010[33] age range of soft tissue changes and mid face noted. Significant negative sagittal changes in the chin
10-14 years in growing Class III and lower lip thereby showing their restrained growth, which was more
patients evident in the BAMP group rather than the bone anchored facemask
group.
Cornelis, 28 studies; 3 1.9 years Skeletal To assess the Type 1 and type 2 BAMP showed similar changes in ANB
2021[22] 52 patients skeletal and dental correction (4.2 degrees for type 1, 3.5 degrees for type 2). Witts
changes produced correction of 5.1 mm was also similar in the two groups. Type 2 BAMP
by BAMP therapy was found to produce a lower incisor proclination of 1.3 degrees
whereas type 1 produced a retroclination of 4 degrees compared to
untreated controls.
Steegman, 19 cleft 1.5-3.5 Skeletal To evaluate the Point A showed an anterior displacement of 2.7±0.9 mm from T0‑T2.
2021[34] patients, 17 years skeletal changes Zygoma showed a displacement of 3.8±1.2 mm.
controls in growing class Point B showed no significant displacement from T0‑T2.
III cleft patients
ANB showed an improvement of 3.3°.
3.5 years after
therapy Changes between T0‑T1 and T1‑T2 showed no significant difference
indicating maintenance of the results in the first 1.5 years.
Also, continuous orthopedic effects were noted in the following 2 years.

outward movement of 0.7 mm was seen after BAMP Two‑thirds of the patient treated and studied had an
treatment.[14] improved lip projection, whereas the other one‑third
had an unchanged/worsened appearance.[41] Maxillary
In patients with unilateral cleft lip and palate, the protraction with BAMP in cleft patients was similar and
alveolar bone graft displayed no detrimental effects symmetrical in both the cleft and non‑cleft sides.[43]
after BAMP therapy despite heavy forces of the
intermaxillary elastics.[42] BAMP with TADs
Nowadays, BAMP is also being used in conjunction
A prospective control study of BAMP in cleft patients with TADs. The various types of TADs anchored
found that point A moved sagitally forward by maxillary protraction include TADs on the buttress of the
1.5 mm, point B by 0.8 mm, and Pogonion by 0.7 mm. zygomatic bone, TADs for intraoral force traction, TADs
6 Journal of Orthodontic Science - 2022
 Kamath, et al.: Review on bamp

on the lateral wall of the nose, and TADs on the palate. facemask on skeletal Class III malocclusion: A systematic review
Palatal plates are also now available instead of TADs.[44] and meta‑analysis. Orthod Craniofac Res 2014;17:133‑43.
4. Pinskaya YB, Hsieh TJ, Roberts WE, Hartsfield JK. Comprehensive
clinical evaluation as an outcome assessment for a graduate
TAD‑assisted rapid palatal expander and facemask is orthodontics program. Am J Orthod Dentofac Orthop
used with 380 g of traction per side for 12–14 hours per 2004;126:533‑43.
day. It is found to be a viable alternative to conventionally 5. Lin Y, Guo R, Hou L, Fu Z, Li W. Stability of maxillary protraction
used facemask with rapid palatal expansion as an therapy in children with Class III malocclusion: A systematic
review and meta‑analysis. Clin Oral Investig 2018;22:2639‑52.
increased forward movement of maxillary molar and
6. Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Evans CA.
incisor, downward movement of maxilla, and clockwise Comparative evaluation of 2 skeletally anchored maxillary
rotation of mandible is seen compared to the latter.[45] protraction protocols. Am J Orthod Dentofac Orthop
2016;150:751‑62.
TAD‑anchored protraction of the maxilla causes larger 7. Tripathi T, Rai P, Singh N, Kalra S. A comparative evaluation of
advancement compared to dentally anchored maxillary skeletal, dental, and soft tissue changes with skeletal anchored
and conventional facemask protraction therapy. J Orthod Sci
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However, a clockwise rotation of the palatal plane (1.6 Three‑dimensional analysis of maxillary protraction with
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carried out without maxillary expansion.[37] 12. De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC,
Tulloch CJ. Orthopedic traction of the maxilla with miniplates:
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Nil. changes associated with facemask and rapid maxillary expansion
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Conflicts of interest
18. Baccetti T, De Clerck HJ, Cevidanes LH, Franchi L. Morphometric
There are no conflicts of interest. analysis of treatment effects of bone‑anchored maxillary
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