Many patients with facial differences, including cleft lip and palate, have changes to their jaws that result in the top jaw being behind the bottom jaw, resulting in an underbite. Potential treatment options include headgear, braces and surgery. One novel treatment option is bone anchored maxillary protraction, also known as bollard plates.
Bollard plates are small metal plates which are screwed (anchored) into the upper and lower jaw bones. They are used for a short period of time, along with rubber bands, to help slowly move the upper jaw into a better position. To place these plates, a craniofacial surgeon makes small incisions in the gums, with the patient under anesthesia. This procedure is an outpatient surgery.
What Do the Plates Look Like?
Most of the plate is hidden under the gums. The plates have hooks that stick out from the gums. The top hooks are behind the bottom hooks. Rubber bands are put on the hooks a few weeks after getting bollard plates.
What Are the Advantages of Bollard Plates?
Bollard plates are used to help improve the relationship between the top and bottom jaw at a younger age, usually between 11 and 13 years of age. It is possible that jaw surgery may still be needed later, but the plates can usually improve the position of the jaws and make the jaw surgery easier.
As opposed to other appliances (such as headgear) that are worn outside of the mouth, bollard plates are completely hidden inside the mouth. That allows them to be used for longer periods of time throughout the day and makes them less visible.
Who is a Candidate for Bollard Plates?
Candidates for bollard plates should be about 11-13 years old and should also be good candidates for orthodontics, meaning no cavities, healthy gums, and good oral hygiene. Candidates should also be motivated for treatment since treatment success is related to compliance with rubber bands.
What is the Outcome you Expect from Bollard Plates?
We can usually achieve forward movement of the top jaw between 2mm-4mm. However, this will vary from child to child and is highly dependent on compliance.
Do I Need to See an Orthodontist for Treatment?
Yes, you will need to see an orthodontist. You will see an orthodontist before starting treatment and then during your treatment. The orthodontist, along with your surgeon, will check to make sure you are wearing your rubber bands correctly, make sure the gums stay healthy and monitor changes in the bite.
Ibrahim Khansa, MD, is a surgeon within the Section of Plastic and Reconstructive Surgery at Nationwide Children's Hospital. Dr. Khansa received his medical degree from Harvard Medical School. He then completed a plastic and reconstructive surgery residency at The Ohio State University Wexner Medical Center, including serving as chief resident. This was followed by a pediatric craniofacial fellowship at Children’s Hospital Los Angeles.
Kaitrin Kramer, DDS, MS, PhD
Orthodontics
Kaitrin Kramer DDS, MS, PhD is a craniofacial orthodontist at Nationwide Children’s Hospital’s Cleft Palate-Craniofacial Clinic. She received her doctorate in Dental Surgery from The University of Michigan, and then completed a research post-doctoral training and was an adjunct clinical assistant professor at the University of Michigan School of Dentistry before heading to The Ohio State University for her M.S. and Certificate in Orthodontics.
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