{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:23:48Z","timestamp":1791671028459,"version":"4.3.4"},"reference-count":29,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T00:00:00Z","timestamp":1715644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Bone-anchored maxillary protraction (BAMP) aims to correct midfacial deficiencies, with proven positive skeletal changes without potential unwanted side effects. However, the influence of BAMP treatment on facial soft tissues, particularly in subjects with complete unilateral cleft lip, alveolus, and palate (CUCLAP), remains unclear. Methods: This single-center longitudinal cohort study examined the effects of 1.5 years of BAMP treatment on facial soft tissues in growing subjects with complete unilateral cleft lip, alveolus, and palate. The sample consisted of 25 patients, age range 9.7 to 12.6 years. Three-dimensional surface models derived from CBCT scans were superimposed on stable structures of the anterior cranial base and on the occipital area posterior of the foramen magnum to assess three-dimensional changes due to growth and BAMP therapy. Results: The results revealed a moderate positive correlation (Pearson\u2019s correlation coefficient from 0.203 to 0.560) between changes in hard tissue and soft tissue; some correlations were found to be weak (&lt;0.300). Linear changes in soft tissue following BAMP were in the same direction as skeletal changes, showing downward, forward, and outward displacement. The only exception was in the vertical dimension. The lower facial third showed a slight but significant reduction, mainly in lip length (\u22121.2 mm), whereas the middle facial third showed a small increase (1.1 mm). Conclusions: It was concluded that during BAMP, soft tissue changes occur in the same direction as skeletal changes, although with a larger variability and less pronounced effects.<\/jats:p>","DOI":"10.3390\/jcm13102890","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T06:28:12Z","timestamp":1715668092000},"page":"2890","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Three-Dimensional Cone Beam Computed Tomography (CBCT)-Derived Soft Tissue Changes in Patients with Unilateral Cleft Lip, Alveolus, and Palate with Midfacial Deficiency after 1.5 Years of Bone-Anchored Maxillary Protraction"],"prefix":"10.3390","volume":"13","author":[{"given":"Ralph M.","family":"Steegman","sequence":"first","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Zijlweg Orthodontie, Orthodontic Private Practice, Zijlweg 148B2, 2015 BJ Haarlem, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarlien F.","family":"Klein Meulekamp","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Renkema","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista I.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8172-0090","authenticated-orcid":false,"given":"Anne Marie","family":"Kuijpers-Jagtman","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland"},{"name":"Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2374-1771","authenticated-orcid":false,"given":"Yijin","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1597\/08-116.1","article-title":"Sagittal Maxillary Growth in Patients with Unoperated Isolated Cleft Palate","volume":"46","author":"Chen","year":"2009","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/j.joms.2016.03.019","article-title":"Isolated Influences of Surgery Repair on Maxillofacial Growth in Complete Unilateral Cleft Lip and Palate","volume":"74","author":"Zheng","year":"2016","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1097\/SCS.0b013e3181b3edb5","article-title":"Interdisciplinary Evaluation of Consecutive Patients With Unilateral Cleft Lip and Palate at Age 6, 15, and 25 Years: A Concurrent Standardized Procedure and Documentation by Plastic Surgeon; Speech and Language Pathologist; Ear, Nose, and Throat Specialist; and Orthodontist","volume":"20","author":"Tindlund","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1597\/12-032","article-title":"Maxillary Protraction in Patients with Cleft Lip and Palate in Mixed Dentition: Cephalometric Evaluation after Completion of Growth","volume":"51","author":"Susami","year":"2014","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1597\/15-082","article-title":"Cephalometric Outcomes of Maxillary Expansion and Protraction in Patients with Unilateral Cleft Lip and Palate after Two Types of Palatoplasty","volume":"53","author":"Tome","year":"2016","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ajodo.2020.04.034","article-title":"Three-Dimensional Comparative Evaluation of Customized Bone-Anchored vs Tooth-Borne Maxillary Protraction in Patients with Skeletal Class III Malocclusion","volume":"160","author":"Liang","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"561","DOI":"10.2319\/030207-108.1","article-title":"Orthopedic Treatment Outcomes in Class III Malocclusion","volume":"78","author":"Toffol","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/ocr.12532","article-title":"Comparative Efficacy of the Bone-anchored Maxillary Protraction Protocols for Orthopaedic Treatment in Skeletal Class III Malocclusion: A Bayesian Network Meta-analysis","volume":"25","author":"Hu","year":"2022","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1007\/s00784-018-2627-3","article-title":"Bone-Anchored Maxillary Protraction in Patients with Unilateral Complete Cleft Lip and Palate and Class III Malocclusion","volume":"23","author":"Ren","year":"2019","journal-title":"Clin. Oral. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Steegman, R.M., Meulekamp, A.F.K., Dieters, A., Jansma, J., van der Meer, W.J., and Ren, Y. (2021). Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction\u2014A 3.5-Year Follow-Up. JCM, 10.","DOI":"10.3390\/jcm10040750"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.ajodo.2016.12.024","article-title":"Bone-Anchored Maxillary Protraction Therapy in Patients with Unilateral Complete Cleft Lip and Palate: 3-Dimensional Assessment of Maxillary Effects","volume":"152","author":"Yatabe","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.ajodo.2015.03.028","article-title":"Oral Health\u2013Related Quality of Life Changes in Standard, Cleft, and Surgery Patients after Orthodontic Treatment","volume":"148","author":"Antoun","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1177\/1055665619840220","article-title":"Quality of Life Among Dutch Children With a Cleft Lip and\/or Cleft Palate: A Follow-Up Study","volume":"56","author":"Nolte","year":"2019","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1597\/13-104","article-title":"Measurement of Health-Related and Oral Health\u2013Related Quality of Life among Individuals with Nonsyndromic Orofacial Clefts: A Systematic Review and Meta-Analysis","volume":"52","author":"Herkrath","year":"2015","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.ajodo.2021.07.021","article-title":"Three-Dimensional Volumetric Changes in the Airway of Growing Unilateral Complete Cleft Lip and Palate Patients after Bone-Anchored Maxillary Protraction","volume":"162","author":"Steegman","year":"2022","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.5177\/ntvt.2014.02.13175","article-title":"Interceptieve Behandeling van Een Maxillaire Hypoplasie Met Behulp van Botankers. Een Literatuuronderzoek","volume":"121","author":"Vermeulen","year":"2014","journal-title":"NTvT"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gkantidis, N., Schauseil, M., Pazera, P., Zorkun, B., Katsaros, C., and Ludwig, B. (2015). Evaluation of 3-Dimensional Superimposition Techniques on Various Skeletal Structures of the Head Using Surface Models. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118810"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ajodo.2009.10.037","article-title":"Dentofacial Effects of Bone-Anchored Maxillary Protraction: A Controlled2 Study of Consecutively Treated Class III Patients","volume":"138","author":"Cevidanes","year":"2010","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0889-5406(96)70161-0","article-title":"Soft Tissue and Dentoskeletal Profile Changes Associated with Maxillary Expansion and Protraction Headgear Treatment","volume":"109","author":"Ngan","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s00056-010-9931-0","article-title":"3D Soft Tissue Changes in Facial Morphology in Patients with Cleft Lip and Palate and Class III Mal Occlusion under Therapy with Rapid Maxillary Expansion and Delaire Facemask","volume":"71","author":"Bacher","year":"2010","journal-title":"J. Orofac. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ajodo.2017.01.022","article-title":"Three-Dimensional Assessment of Soft Tissue Changes Associated with Bone-Anchored Maxillary Protraction Protocols","volume":"152","author":"Elnagar","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13005-021-00264-4","article-title":"Effects of Different Surgical Techniques and Displacement Distances on the Soft Tissue Profile via Orthodontic-Orthognathic Treatment of Class II and Class III Malocclusions","volume":"17","author":"Peters","year":"2021","journal-title":"Head. Face Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.joms.2004.04.019","article-title":"Evaluation of Facial Soft Tissue Changes with Optical Surface Scan after Surgical Correction of Class III Deformities","volume":"62","author":"Soncul","year":"2004","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jcms.2021.11.009","article-title":"Le Fort I Osteotomy and Soft Tissue Response: A Retrospective Cohort Study Comparing Three Different Techniques","volume":"50","author":"Gil","year":"2022","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s00056-021-00294-2","article-title":"Changes in the Facial Soft Tissue Profile after Maxillary Orthognathic Surgery","volume":"83","author":"Rupperti","year":"2022","journal-title":"J. Orofac. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Olivetti, E.C., Nicotera, S., Marcolin, F., Vezzetti, E., Sotong, J.P.A., Zavattero, E., and Ramieri, G. (2019). 3D Soft-Tissue Prediction Methodologies for Orthognathic Surgery\u2014A Literature Review. Appl. Sci., 9.","DOI":"10.3390\/app9214550"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1016\/j.joms.2011.11.022","article-title":"Nasolabial Soft Tissue Changes After Le Fort I Advancement","volume":"70","author":"Vasudavan","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.ajodo.2013.07.007","article-title":"Orthodontic soft-tissue parameters: A comparison of cone-beam computed tomography and the 3dMD imaging system","volume":"144","author":"Metzger","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2890\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:41:59Z","timestamp":1760107319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2890"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,14]]},"references-count":29,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13102890"],"URL":"https:\/\/doi.org\/10.3390\/jcm13102890","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,14]]}}}