Dr Nicky Mandall: What is the Impact of BAMP and RME on Class III Skeletal Malocclusion?

DB Orthodontics is delighted to support Dr. Nicky Mandall in raising awareness on the positive outcomes of her ground-breaking research on Bone Anchored Maxillary Protraction (BAMP). Her eight-year clinical trial, soon to be published in the Journal of Orthodontics, has shown that BAMP can effectively correct a class III skeletal pattern and reverse overjet in young teenagers, potentially eliminating the need for orthognathic surgery in later years. In further support of this, separate studies have shown that when BAMP is combined with a Temporary Anchorage Device (TAD) based Rapid Maxillary Expansion (RME); (MAMP), the results are enhanced.

Significant Findings from the Clinical Trial

Dr. Mandall et al carried out a multi-centre randomised controlled trial to evaluate the effectiveness of BAMP. Results show there was a 27% reduction in the need for class III orthognathic surgery following the BAMP technique. This means that many young patients may avoid the prolonged recovery associated with surgical intervention, and the potential distress associated with malocclusion, during a time when peer opinion is particularly important to them.

The trial included 57 patients, who were randomly assigned to either the BAMP group or a control group with no treatment. Over a three-year follow-up period, significant improvements were observed in the BAMP group. At the 18-month mark, 22% of the BAMP group achieved a positive overjet. By the three-year follow-up, only 48% of the BAMP group were perceived to still need orthognathic surgery, compared to 75% in the control group. This substantial reduction highlights the potential of BAMP to change the types of treatments utilised for class III malocclusion.

Multidisciplinary treatments: The Promise of BAMP

Class III skeletal malocclusion, characterised by a forward-positioned lower jaw and a retrusive upper jaw, can lead to severe dental and facial disharmony. Traditionally, treatment for this condition often requires orthognathic surgery in late teenage years, a procedure that requires a 4-6 hr operation under general anaesthetic and a 3 night stay in hospital. Dr. Mandall’s research suggests that BAMP can significantly reduce the need for invasive surgery, offering a less stressful treatment for patients, and a more time/cost-effective solution for hospitals.

The only current alternative to orthognathic surgery is the use of reverse headgear, suitable for patients under the age of ten years. This treatment has a 70% success rate, and has shown to reduce the need for orthognathic / facial surgery from 2/3 to 1/3 of cases (Mandall et al. 2010, 2012, 2014). If patients are referred after the age of ten, reverse headgear is no longer an option.

How BAMP Works

BAMP, when utilised with the RME, is designed to protract the maxilla, or upper jaw, forward in children aged 11 to 14 years. This age group is ideal as their facial bones are still growing, allowing for more effective treatment outcomes. The procedure involves a 3D printed metal rapid maxillary expansion device, cemented to the upper teeth and anchored with palatal orthodontic mini implants (TADs). The device has buccal hooks near the upper first permanent molars, and lower miniplates are strategically placed between the lower permanent canines and first premolars.

Patients wear class III elastics full-time, generating a force of 150-200 grams from the upper first molar hooks to the lower miniplates. This continuous force helps to move the upper jaw forward, correcting the reverse overjet. The active treatment phase typically lasts around one year.

A Multidisciplinary Kit inventory

The BAMP, and 3D Metal printed palatal expander and kit necessary to carry out the treatment is available from DB Orthodontics. Simply contact the customer services team via sales@dbortho.com or call 01535 656 999 to learn more about this innovative, game-changing treatment.

For the Maxillofacial Surgical Team:

  • OBA Instrument Kit ST03-0025, consisting of:
  • Screwdriver handle ST99-901A,
  • Screwdriver insert 3.5mm flat ST99-915S,
  • Screwdriver insert 1.4mm Internal pentagon ST99-909S,
  • Spiral drill dia 1.65mm Stop 5mm, L 50mm ST50-212W,
  • Spiral drill dia 1.65mm Stop 7mm, L 50mm ST50-222W,
  • 2 x OBA Long Neck ST02-006S,
  • 2 x Spiral drills (Stop 5mm/7mm),
  • 1 pack x round /slot head screws (pk 5) ST70-105S,
  • 1 pack x pentagon head screws 5mm (pk 5) ST70-205S,
  • 1 pack x pentagon head screws 7mm (pk 5) ST70-207S.

For the Orthodontic Team:

  • Metal Printed 3D RME
  • TAD Screws

Future Implications

Dr. Mandall’s work paves the way for broader adoption of BAMP in orthodontic practice, offering a promising alternative to surgery. By addressing class III malocclusion earlier and more effectively, BAMP has the potential to transform patient care, saving time, reducing costs, and improving overall patient well-being.

In conclusion, advancing orthodontic treatment through innovative techniques like BAMP may make a significant difference in the lives of young patients. Her research offers hope for a future where invasive orthognathic surgery is not needed for many patients; the emotional burden on teens is alleviated and financial outlay for hospitals is significantly reduced.

About Nicky Mandall

Nicky Mandall is consultant orthodontist and clinical lead of the orthodontic department at Tameside Hospital NHS Foundation Trust.  Her research interests include making a contribution to orthodontic clinical research through randomised controlled trials. She has been invited to speak about her scientific research at national and European conferences.  She was the MSc supervisor for the winner of the Houston research award in 2010, was awarded best scientific paper in the Journal of Orthodontics in 2011 and 2012 and was presented with the FEO award for the best scientific paper in Europe in 2011 and 2012.