Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial

Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial Marwa E. Shatla, Dina H. Elghoul, Islam T. Abbas, Ahmed M. Zaky, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7339985/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Maxillary deficiency in the three planes characterizes cleft lip and palate (CLP) patients, requiring interceptive treatment to restore arch integrity, adding up to the total burden of care for these families. Bilateral cleft lip and palate (BCLP) present a more complex deformity, where the premaxilla can be severely malaligned requiring extensive orthopedic or surgical correction. This randomized clinical trial aimed to compare the effects of a new design of the three-way palatal expander and the modified fan expander in maxillary arch development in cleft lip and palate patients. Methods: Twenty patients were recruited suffering from bilateral cleft lip and palate (age from 8 to 15 years). They were divided into two groups; A) Modified Fan expander (10 patients) and B) Three-way palatal expander (10 patients). Cephalometric radiographs were taken before expansion (T0) and after expansion was completed (T1) and were digitized and analyzed using a special orthodontic tracing software program. Dolphin Ver. 11.5 (Dolphin Imaging and Management Solutions, Chatsworth, Calif. USA) was used in this study. Statistical analysis through Paired t-test was used to evaluate the changes in each group. Results: Analysis of cephalometric radiographs showed positive statistically significant differences in maxillary length and dental measurements of both groups, where all incisor measurements increased significantly. Group (A) showed significantly greater increase in anteroposterior position of maxilla and showed distal molar movement and tipping. Conclusion: Both the fan expander with palatal springs and three-way expander can widen and lengthen maxilla of BCLP patients simultaneously, decreasing the burden of care of these patients by their families through using just one appliance. Trial registration: ClinicalTrials.gov Identifier: NCT07056296 (https://clinicaltrials.gov/); June 29, 2025, retrospective registration. Bilateral cleft lip and palate Expansion premaxilla three-dimensional Fan expander Three-way expander Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background Maxillary deficiency in the transverse dimension is a common abnormality in patients with unilateral and bilateral complete cleft lip and palate (UCLP and BLCP)[ 1 ]. The absence of the bony palatal vault and midpalatal suture, along with the iatrogenic effects of surgical scarring, are the reasons for this relative constriction of the maxillary dental arch during growth[ 2 ]. Cleft patients often have more constriction in the maxillary dental arch's anterior than posterior areas, with maxillary segments' mesial rotation and movement (yaw) with the fulcrum at maxillary tuberosity[ 3 ]. This can be explained by the fact that the canine region experiences a restrictive tension as a result of both lip and palate repairs. whilst the molar region is affected by tension due to palatal repair[ 4 ], that’s why in CLP patients, transverse discrepancy is more accentuated in the anterior region than the posterior one[ 1 ]. Maxillary expansion is essential in complete CLP and is typically performed during the mixed dentition[ 1 ]. For the majority of patients, maxillary expansion should be done before secondary alveolar bone grafting (SABG). The purpose of maxillary expansion is to restore the distorted maxillary arch shape, treat posterior crossbites and maxillary transverse deficiencies, prepare the maxillary dental arch for alveolar bone transplantation via widening the alveolar cleft for better accessibility at the cranial end for bone grafting surgery and space creation for alignment of teeth [ 5 ]. El Kassaby et al. [ 6 ] described a new detailed classification for Bilateral Complete Cleft Lip and Palate (BCLP) individuals, as it has great variations. They added to the ordinary general classifications further description of premaxilla, whether Rudimentary (R), or Prominent (P), as they differ in so many aspects morphologically, having different response to pre-surgical infant orthopedics and emphasize the effect of premaxillary characteristics on alveolar cleft grafting, maxillary arch form, occurrence of maxillary deficiency and post-operative facial appearance. BCLP patients with a prominent premaxilla, they have a good facial profile, where the premaxilla is protruded and palatally inclined[ 6 ]. The resulting malocclusion necessitates correction of the anterior crossbite usually via protraction devices for maxillary segments’ alignment. Yet, no efficient appliance addressed this problem for aligning segments without using a protraction appliance. De Medeiros Alves et al.[ 7 ] found that in BCLP patients after transverse expansion, a slight posterior movement of the premaxilla is observed. So, in BCLP cases with anterior crossbite and midface deficit, anterior extensions to the incisors can be included in the expander design and are recommended to preserve arch depth and prevent further impairment to the incisor's anteroposterior relationship. These extensions will stop the maxillary incisors from lingual tipping during the closure of the cleft gap. Moreover, it is possible to control that posterior migration of the premaxilla seen in BCLP following the expansion. Maxillary expansion can be obtained through different appliances, for example, orthodontic arch wires, stainless steel wire frameworks; Quad-helix, tri-helix, Nickle-Titanium (NiTi) shape memory expander and parallel expansion screws; removable or banded/ bonded expansion screws[ 1 ]. The geometry of transverse discrepancy implies the usage of Fan expander, inverted mini-Hyrax (iMini), expanders with differential opening and double hinge expanders for differential expansion in cleft patients. The activation strategy is quite similar in patients with CLP and non-cleft patients. It's possible to decide between using rapid maxillary expansion (RME) and slow maxillary expansion (SME)[ 8 ]. Slow expansion can be accomplished with the quad helix appliance, removable expanders, or nickel titanium expanders. The appliance activation is slow, and the active expansion phase can take 6–12 months. The amount of expansion and duration of the active phase will depend on the severity of the maxillary arch constriction[ 9 ]. Despite numerous studies comparing the effectiveness of various appliances and addressing expansion in the transverse dimension[ 3 , 10 , 11 ], there is currently no evidence evaluating the effect of treating both the sagittal and transverse at the same procedure with a single appliance which can noticeably lessen the burden of care on these families. The aim of this study was to evaluate the efficiency and the effectiveness of a new design for the three-way palatal expander and the modified fan expander in maxillary arch development in cleft lip and palate patients; to widen and lengthen the arch simultaneously. Methods Study design and settings This study was performed in the Outpatient Clinic of the Orthodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt. All the investigations were carried out according to the tenets of Declaration of Helsinki 2024) and was approved by the research ethical committee, Faculty of Dentistry, Ain Shams University, that approved the study design after reviewing the study protocol (FDASU-Rec ID 052316) and was registered under the protocol ID NCT03881813 ( https://clinicaltrials.gov/ ), according to the CONSORT statement of the updated guidelines for reporting randomized clinical trials. It was a Randomized clinical trial (RCT), with parallel group and allocation ratio 1:1. Patient recruitment started in June 2023, and the study ended in March 2025. Before treatment was carried out, an informed consent was signed by minor patients’ parents as well as an assent by the patients themselves before their enrolment in the current study. Sample size calculation Sample size for the study was calculated based on a significance level of 0.05 and a power of 95% through a study by Figueiredo DSF et al.[ 12 ] to evaluate the dentoskeletal effects of 3 maxillary expanders: the conventional hyrax and 2 modified types, especially designed to promote anterior expansion of the maxillary arch. The calculations were performed with the computer application G*Power*. Power analysis showed that 7 subjects were required, to compensate for possible dropouts during procedures 10 patients were included. Twenty patients were selected after assessment for eligibility according to the following inclusion and exclusion criteria presented in (Table 1 ). Table 1 Eligibility criteria for the participants Inclusion criteria Exclusion criteria Bilateral cleft lip and palate Syndromic cleft lip and palate Age ranging from 8 to 15 years old Very bad oral hygiene Late mixed or early permanent dentition Active periodontal disease Tapered maxillary arch, requiring palatal expansion as part of their treatment Vulnerable groups Repaired cleft lip and / or palate Fully erupted upper permanent 1st molars stage of cervical vertebral maturation before or at the growth spurt (CS1-CS4) Randomization, allocation concealment Patients who met the inclusion criteria and approved to participate in the study were randomly allocated to Fan expander group (A) or Three-way expander group (B). Block randomization (block size: 4 participants) was used for a balanced group distribution. A colleague not involved in the clinical trial, generated randomization sequences using the Microsoft Excel software (Microsoft, Redmond, Washington, USA). Each subject was given a number in the order in which they showed up for diagnosis. Allocation of the subjects into either group A or B was performed by matching that number with the generated sequence. The allocation sequence was concealed from the investigators of the study. Interventions Full orthodontic records were taken for patients who met the inclusion criteria. These records were: Intraoral and extraoral photographs, digital orthodontic diagnostic models, panoramic radiograph and lateral cephalometric radiograph. For group (A) cases, alginate impression was taken, and a custom-made modified Fan palatal expansion appliance was fabricated (A0625-09, Leone, Italy). The appliance was composed of Orthodontic bands on first permanent molars and fan expansion screw with break resistant retention legs with soldered finger springs just palatal to teeth in the premaxilla (Fig. 1). For group (B) cases, a custom-made Three-way palatal expansion appliance was made. The appliance was composed of Orthodontic bands on first permanent molars and three mini-expansion screws (Variety SP 602-809-11, Dentauram, Germany) with two break resistant retention legs, oriented as follows: a transverse screw and two bilateral sagittal screws (Fig. 2 ). The retentive arms of the anterior transverse screw were bent posteriorly and soldered on each side to the mesial retention arms of the two posterior sagittal screws. The distal retention arms of the latter were bent and soldered to the molar bands. Figure 1. Modified Fan expander with soldered palatal spring adapted on teeth in premaxilla (Group A) Then appliances were cemented in place. In group (A) palatal springs were activated before cementation using 139 Bird Beak plier in small increments, then after cementation, screw expansion rate was slow: activated by one quarter turn, day after day using the swivel key of the expander. In group (B) expansion rate was slow too; activated by one quarter turn, day after day for each jackscrew by the patients' parents or caregivers. Patients were seen every month for follow up and for assessment of need for reactivation. Fan expander reactivation was manufactured as follows: appliance was removed, alginate impression was taken and poured, solder joints at molar bands were broken, screw was closed again, and appliance readapted on cast, re-soldered and re-cemented. For the three-way expander, appliance was removed, alginate impression was taken and poured, screws were deactivated, acrylic resin was added anteriorly till it reattach to palatal surface of present incisors, retentive arms between anterior and posterior screws were re-adapted using three- prong plier and appliance was re-cemented. Follow up was continued when there is an over-correction in the anterior expansion in both dimensions; transverse and sagittal and appearance of interdental gap between teeth adjacent to the cleft as shown in (Fig. 3 a – 3 b) for a case in group (A) and another in group (B). After expansion completion, preparation of bone grafting surgery started. Fixed retainer was fabricated and cemented. The retainer consisted of molar bands, a rigid Trans-Palatal Arch (TPA) of 0.9 mm stainless steel wire and a gaushgarian palatal arch 0.9 mm stainless steel wire adapted on present teeth (Fig. 4 ),that is assembled from distal to mesial direction in a lingual sheath soldered on palatal surface of molar band, that arch could be detached in a distal direction during the alveolar bone grafting procedure so as not to obstruct the surgical field ( Fig. 5 a- 5 b- 5 c). Outcomes assessment Profile enhancement for patients was evident in profile photographs (Fig. 6 a-a’-b-b’). For analysis of treatment changes, digital lateral cephalometric radiographs were taken post-expansion using the same digital x-ray machine (Vatech Pax-i) (Vatech systems, Korea.) at radiology Department, Faculty of dentistry, Ain Shams University. Both the pre-treatment (T0) and post-expansion (T1) lateral cephalometric radiographs were digitized and analysed using a special orthodontic tracing software program (Dolphin Ver. 11.5) (Dolphin Imaging and Management Solutions, Chatsworth, Calif. USA) as shown in (Fig. 7 a- 7 b- 7 c- 7 d) the digital lateral cephalometric radiograph before and after expansion were digitally traced and analysed for the forty lateral cephalometries. The following measurements were analyzed (Table 2 ) in the 40 lateral cephalometric radiographs at (T0) and (T1). They comprised skeletal measurements in the anteroposterior and vertical dimensions, dental angular and linear measurements and soft tissue measurements. Table 2 Cephalometric measurements done for the (T0) and (T1) radiographs. Skeletal Anteroposterior measurements Skeletal vertical measurements Dental measurements Soft tissue measurements SNA° FMA° U1/SN° L1/MP° Nasolabial angle° SNB° Y-axis° U1/FH° U6/FH° Facial convexity° ANB° AFH mm U1/PP° U1-PP mm UL/ E-line mm A to N prep. mm PFH mm U1/NA° U6-PP mm LL/ E-line mm Pog. to N Prep. mm LAFH mm U1-NA mm U6-PTv mm Maxillary length mm (ANS-PNS) Jaraback ratio U1 protrusion- Apog mm U1-PTv mm Midface length mm U1 most labial -A mm Overbite mm Mandibular length mm U1/Npog mm Overjet mm Mx/Md Differential Statistical analysis All Data were collected, tabulated, and subjected to statistical analysis. Statistical analysis was performed by IBM (IBM Corporation, NY, USA) SPSS (SPSS, Inc., an IBM Company) (version 17). Shapiro-Wilk test of normality was used to test normality hypothesis of all quantitative variables for further choice of appropriate parametric and non-parametric tests. Most of the variables were found normally distributed allowing the use of parametric tests. Paired sample t-test was used for comparing pre- and post-measurements within each group. Independent samples t test was used for comparing the difference (post-pre) between the two groups. Significance level was considered at P ≤ 0.05. Results The flowchart diagram of the study is shown in (Fig. 8 ). Demographic distribution of enrolled cases is shown in (Table 3 ). Clinically, patients showed resolution of maxillary constriction in the transverse plane, area of cleft and any hidden fistula was revealed and expansion of the collapsed premaxilla with its incisors was evident. Patients reported no complaints about pain or increased mobility in the premaxilla. Radiographically, the Fan expander group (A) showed skeletally a statistically significant increase in SNA (1.28°±0.69), maxillary length(6.21mm ± 3.73), midface length(7.15mm ± 3.18), mandibular length(6.56mm ± 2.77) in the sagittal plane and significant increase in PFH(2.4mm ± 1.62) and Jaraback ratio(1.35 ± 1.16). On the dental basis, overjet and all measurements of upper incisor inclination and position showed statistically significant increase, lower incisor showed no significant alteration in inclination. While the upper first molar showed significant decrease in its axial inclination U6/FH(-6.13°±5.21), linear distance U6-PTv(-1.3 ± 0.92) denoting loss of anchorage in group A. regarding the soft tissue profile, facial convexity(2.21°±2) and upper lip position in relation to E-line(1.28mm ± 0.70) showed statistically significant increases (Table 4 ). The three-way group (B) on skeletal level showed only statistically significant increase in maxillary length(1.81mm ± 1.62) and PFH (3.93mm ± 3.72) measurements. Dentally, there was a statistically significant increase in overjet and all measurements of upper incisor inclination and position, in contrast to group (A), there were no significant changes in neither the upper first molar position, inclination nor the soft tissue profile of the patients (Table 5 ). Comparing the two groups together (Table 6 ) showed the differences between the effects of both appliances, were SNA, maxillary length, midface length showed statistically significant difference between the two groups, were fan group (A) increases were 1.28 ± 0.69, 6.21 ± 3.73 and 7.15 ± 3.18 respectively for these measurements, while the three-way group (B) differences were − 0.43 ± 1.61, 1.81 ± 1.62 and 2.30 ± 2.47. Apart from that, there is a significant difference between the two groups in the upper first molar measurements, where fan group (A) showed a statistically significant difference with a decreased upper first molar inclination U6/FH -6.13 ± 5.21, position U6-PTv − 1.3 ± 0.92 and U6-PP -1.65 ± 2.60 respectively compared to the three-way group (B) with differences 1.36 ± 4.88, 0.58 ± 1.50 and 1.75 ± 1.83 denoting more molar tipping and distalization in fan group (A). Table 3 Demographic distribution of patients Group Number of patients Gender Age Male Female Mean ± SD A 10 8 2 12 ± 1.88 years B 10 4 6 11.1 ± 2.51 years Table 4 Mean values of measurements at (T0) and (T1) and the mean difference (T1-T0) of the skeletal, dental and soft tissue measurements in the modified Fan expander group; paired t-test Measurement T0 T1 Mean diff. T1-T0 SD P-value Mean SD Mean SD SNA° 80.83 4.25 82.11 4.20 1.28 0.69 0.008* SNB° 75.83 3.04 75.73 2.54 -0.10 1.93 0.904 ANB° 5.01 4.02 6.38 4.65 1.36 1.52 0.080 A to N prep. mm 1.20 3.73 1.76 3.68 0.56 1.58 0.422 Pog. to N Prep. mm -6.03 5.86 -8.30 5.64 -2.26 3.83 0.207 Maxillary length mm 46.21 3.10 52.43 6.28 6.21 3.73 0.010* Midface length mm 78.16 5.59 85.31 6.36 7.15 3.18 0.003* Mandibular length mm 99.96 6.17 106.53 7.10 6.56 2.77 0.002* Mx/Md Differential 21.81 6.28 21.21 7.91 -0.60 3.48 0.691 FMA° 32.66 5.89 33.25 7.22 0.58 3.04 0.658 Y-axis° 60.28 3.27 61.80 3.19 1.51 1.82 0.098 AFH mm 107.41 8.61 109.05 7.40 1.63 1.65 0.061 PFH mm 60.98 4.81 63.38 4.83 2.40 1.62 0.015* LAFH mm 62.21 5.01 63.61 5.26 1.40 1.52 0.075 Jaraback ratio 56.86 3.54 58.21 3.91 1.35 1.16 0.036* U1/SN° 71.83 23.38 89.55 13.93 17.71 13.85 0.026* U1/FH° 82.33 26.90 99.63 16.20 17.3 14.23 0.031* U1/PP° 84.33 23.98 99.23 12.34 14.9 14.61 0.055* U1/NA° -8.98 24.76 7.40 17.02 16.38 13.72 0.033* U1-NA mm -6.13 4.68 -1.98 5.35 4.15 2.09 0.005* U1 protrusion- Apog mm -4.01 4.33 0.86 4.63 4.88 3.24 0.014* U1 most labial -A mm -2.71 4.59 0.11 4.39 2.83 1.12 0.002* U1/Npog mm -0.58 4.20 4.18 1.89 5.40 3.97 0.021* L1/MP° 86.88 3.24 86.80 3.76 -0.08 1.46 0.895 U6/FH° 86.15 2.92 80.01 5.42 -6.13 5.21 0.035* U1-PP mm 23.00 6.53 24.85 3.11 1.85 6.64 0.525 U6-PP mm 19.63 2.63 17.98 3.41 -1.65 2.60 0.181 U6-PTv mm 15.33 3.98 14.03 4.10 -1.30 0.92 0.018* U1-PTv mm 37.70 4.38 42.00 4.25 4.30 1.40 0.001* Overbite mm 0.80 4.69 0.20 1.42 -0.60 5.29 0.793 Overjet mm -6.06 3.95 0.26 3.59 6.33 2.82 0.003* Nasolabial angle° 125.11 23.64 120.56 20.78 -4.55 7.48 0.196 Facial convexity° 10.75 5.75 12.96 6.89 2.21 2.00 0.042* UL/ E-line mm -4.13 2.30 -2.85 2.04 1.28 0.70 0.007* LL/ E-line mm 3.95 1.38 4.48 2.03 0.53 0.85 0.185 * P -value significant ≤ 0.05 Table 5 Mean values of measurements at (T0) and (T1) and the mean difference (T1-T0) of the skeletal, dental and soft tissue measurements in the Three-way expander group; paired t-test Measurement T0 T1 Mean diff. T1-T0 SD P-value Mean SD Mean SD SNA° 76.88 4.90 76.45 5.67 -0.43 1.61 0.541 SNB° 73.26 3.13 72.30 3.89 -0.96 1.72 0.228 ANB° 3.61 5.42 4.13 7.04 0.51 2.21 0.592 A to N prep. mm -1.11 7.39 -0.66 8.89 0.45 2.30 0.652 Pog. to N Prep. mm -8.45 5.94 -8.71 7.38 -0.26 3.10 0.842 Maxillary length mm 47.50 5.32 49.31 5.58 1.81 1.62 0.041* Midface length mm 76.56 6.85 78.86 5.70 2.30 2.47 0.072 Mandibular length mm 97.75 8.31 100.81 9.18 3.06 4.42 0.150 Mx/Md Differential 21.16 6.83 21.93 7.88 0.76 2.81 0.534 FMA° 32.76 4.34 32.51 6.17 -0.25 2.83 0.838 Y-axis° 61.56 3.46 61.83 4.48 0.26 1.48 0.678 AFH mm 105.28 9.04 110.25 10.99 4.96 5.08 0.062 PFH mm 58.63 6.93 62.56 8.31 3.93 3.72 0.049* LAFH mm 61.73 6.45 65.48 6.7 3.75 4.45 0.094 Jaraback ratio 56.50 3.21 56.70 4.51 0.20 2.81 0.869 U1/SN° 77.15 16.46 92.20 9.23 15.05 8.93 0.009* U1/FH° 88.90 13.59 105.13 6.30 16.23 9.31 0.008* U1/PP° 91.13 14.19 105.30 6.33 14.16 9.71 0.016* U1/NA° 0.25 19.30 15.73 12.19 15.48 9.84 0.012* U1-NA mm -2.71 4.61 0.98 4.40 3.70 2.37 0.012* U1 protrusion- Apog mm -0.51 2.20 3.46 1.64 3.98 1.63 0.002* U1 most labial -A mm 0.08 1.73 2.11 1.72 2.03 1.80 0.040* U1/Npog mm 1.65 3.23 5.98 4.69 4.33 1.98 0.003* L1/MP° 86.58 4.27 86.76 5.24 0.18 2.89 0.883 U6/FH° 76.03 3.74 77.40 5.45 1.36 4.88 0.524 U1-PP mm 24.65 4.13 26.20 3.53 1.55 2.45 0.182 U6-PP mm 17.46 1.71 19.21 2.77 1.75 1.83 0.067 U6-PTv mm 10.06 2.27 10.65 1.95 0.58 1.50 0.386 U1-PTv mm 35.85 7.02 39.41 6.05 3.56 1.56 0.003* Overbite mm 0.91 3.11 -0.50 1.90 -1.41 2.80 0.271 Overjet mm -3.55 4.14 0.50 5.66 4.05 1.71 0.002* Nasolabial angle° 123.16 19.74 125.35 17.83 2.18 13.38 0.706 Facial convexity° 11.01 6.19 12.48 6.69 1.46 3.12 0.302 UL/ E-line mm -3.45 2.67 -3.16 2.69 0.28 0.88 0.470 LL/ E-line mm 3.53 3.47 3.26 3.14 -0.26 3.76 0.869 * P -value significant ≤ 0.05 Table 6 Comparison between Mean Differences (T1-T0) for the skeletal, dental and soft tissue measurements between the two groups; paired t-test Measurement Fan T1-T0 Three-way T1-T0 Mean diff. P-value Mean SD Mean SD SNA° 1.28 0.69 -0.43 1.61 -1.71 0.038* SNB° -0.1 1.93 -0.96 1.72 -0.86 0.431 ANB° 1.36 1.52 0.51 2.21 -0.85 0.457 A to N prep. mm 0.56 1.58 0.45 2.30 -0.11 0.921 Pog. to N Prep. mm -2.26 3.83 -0.26 3.10 2.00 0.344 Maxillary length mm 6.21 3.73 1.81 1.62 -4.40 0.025* Midface length mm 7.15 3.18 2.30 2.47 -4.85 0.015* Mandibular length mm 6.56 2.77 3.06 4.42 -3.50 0.131 Mx/Md Differential -0.6 3.48 0.76 2.81 1.36 0.472 FMA° 0.58 3.04 -0.25 2.83 -0.83 0.634 Y-axis° 1.51 1.82 0.26 1.48 -1.25 0.222 AFH mm 1.63 1.65 4.96 5.08 3.33 0.158 PFH mm 2.4 1.62 3.93 3.72 1.53 0.377 LAFH mm 1.4 1.52 3.75 4.45 2.35 0.249 Jaraback ratio 1.35 1.16 0.20 2.81 -1.15 0.377 U1/SN° 17.71 13.85 15.05 8.93 -2.66 0.700 U1/FH° 17.3 14.23 16.23 9.31 -1.06 0.881 U1/PP° 14.9 14.61 14.16 9.71 -0.73 0.921 U1/NA° 16.38 13.72 15.48 9.84 -0.90 0.899 U1-NA mm 4.15 2.09 3.70 2.37 -0.45 0.735 U1 protrusion- Apog mm 4.88 3.24 3.98 1.63 -0.90 0.558 U1 most labial -A mm 2.83 1.12 2.03 1.80 -0.80 0.378 U1/Npog mm 5.4 3.97 4.33 1.98 -1.06 0.569 L1/MP° -0.08 1.46 0.18 2.89 0.26 0.845 U6/FH° -6.13 5.21 1.36 4.88 7.50 0.028* U1-PP mm 1.85 6.64 1.55 2.45 -0.30 0.919 U6-PP mm -1.65 2.60 1.75 1.83 3.40 0.026* U6-PTv mm -1.3 0.92 0.58 1.50 1.88 0.026* U1-PTv mm 4.3 1.40 3.56 1.56 -0.73 0.413 Overbite mm -0.6 5.29 -1.41 2.80 -0.81 0.746 Overjet mm 6.33 2.82 4.05 1.71 -2.28 0.128 Nasolabial angle° -4.55 7.48 2.18 13.38 6.73 0.307 Facial convexity° 2.21 2.00 1.46 3.12 -0.75 0.631 UL/ E-line mm 1.28 0.70 0.28 0.88 -1.00 0.057 LL/ E-line mm 0.53 0.85 -0.26 3.76 -0.80 0.623 * P -value significant ≤ 0.05 Discussion Patients with repaired cleft lip and/or palate have maxillary deficiency and hypoplasia in the three planes of space; transverse, sagittal and vertical planes presented as crossbites, class III and open bites[ 13 ]. In BCLP, premaxillary characteristics vary from being prominent, protruded or being rudimentary and collapsing towards the posterior stumps of the arch[ 6 ]. A crucial step in management of BCLP patients is correcting the malpositioned premaxilla, that’s usually inferiorly positioned and palatally inclined. Anatomically, premaxilla is detached from the alveolar segments bilaterally and attached postero-superiorly to the vomer at the vomero-premaxillary suture[ 14 , 15 ]. In the literature, several studies dealt with conventional expansion appliances addressing only the transverse discrepancy or protraction appliances correcting the sagittal maxillary hypoplasia requiring a further step to re-align the premaxilla. Liou and Ching [ 16 ]used a double hinged expander in testing the Alternating Rapid Maxillary Expansion and Constriction (Alt-Ramec) protocol of expansion for maxillary sutures disarticulation. They found anterior repositioning for point A upon expansion, then they used an intermaxillary TMA spring for maxillary protraction, correcting both transverse and sagittal planes, but they didn’t solve the alignment problem of premaxilla. While in our study sagittal skeletal increases were encountered along with realignment of the premaxilla. Garib et al.[ 3 ] used a Rapid Maxillary Expander with Differential opening (EDO), The EDO can be activated at two positions to control the amount of activation in the anterior and posterior regions of the maxillary dental arch. Figueiredo et al. [ 12 ]analyzed the skeletal and dental alterations in the maxillae of cleft patients who received treatment with 3 expanders; the Hyrax expander, fan-type expander and inverted mini-hyrax expander positioned in the anterior region. Sebaey et al.[ 11 ] also evaluated the skeletal and dentoalveolar effects of rapid palatal expansion (RPE) in CLP children treated with fan expander and Hyrax expander. In those studies too only transverse dimension was addressed as in our study but without any notice for the sagittal component. Several studies also dealt with maxillary protraction, Alaglan[ 17 ] did a systematic review of different maxillary protraction appliances ranging from conventional facemask to bone anchored appliances. Elabbassy et al.[ 18 ] assessed the effectiveness of bone-anchored maxillary protraction (BAMP) in cleft patients. Another study examined the alt-RAMEC protocol of Eric Liou with facemask or with skeletal anchorage[ 19 ]. Another study evaluated the soft tissue effects of maxillary expansion and protraction in cleft patients[ 20 ]. Yet no former study addressed transverse, sagittal and premaxilla alignment simultaneously. With the development of Benefit system[ 21 ], they used hybrid hyrax distalizer made up of 3 hyrax expansion screws assembled as: one anterior transverse expansion screw and two rotated 90° posterior sagittal screws for simultaneous expansion and protraction in a class III, crowding patient in addition to skeletally anchored class III elastics. The results of the three-way expander comprised mainly upper molars distalization 4.5mm. Another case report [ 22 ] used a hyrax screw rotated 90° with anterior palatal acrylic coverage as an anchorage means, used for maxillary molar distalization in an ectopic canine case. Where a slight increase in upper incisor inclination and position occurred as well as 0.5° increase in SNA that was attributed to patient’s growth. Grummons [ 23 ] published a report about 3-way maxillary expander innovations comprised simultaneous maxillary expansion with expansion screw and molar distalization via posterior springs. Also another article was published used Ertty GAP III[ 24 ] for management of class III with a simultaneous protraction and molar distalization using a hyrax expansion screw rotated 90° with an anterior acrylic palatal coverage to serve as anchorage. From this point came up the idea of this research to investigate the efficiency of fan expander with conjunction of anterior springs and three-way expander in simultaneous widening and lengthening of maxillary arch on the expense of premaxilla anterior expansion and development. Two case reports were published addressing correction of both transverse and sagittal dimensions simultaneously. The 1st one used modified McNamara Rapid palatal expander with two double-helix digital springs, made of stainless steel 0.020 inches in an eight-year-old child. They found that the maxillary central incisors showed normal apicigenesis and an increase in root length, suggesting that the springs had no negative effects on these teeth. On cephalometric radiograph, they investigated only upper incisor inclination and position versus the NA plane, where they increased from (NA = 2 mm and NA = 15°) to (NA = 4 mm and NA = 22°) with no change in vertical dimension neither skeletal nor dental molar extrusion[ 25 ]. The 2nd report was a primary dentition child with posterior, anterior crossbite and light skeletal class III where he used modified Haas expander with finger springs and showed excellent results[ 26 ]. The study outcome assessment via cephalometric radiographs agreed with a study [ 27 ] that tested the accuracy of this tool in CLP diagnosis and assessment. The measurements focused on upper incisor position, measurements were selected comprehensively in accordance with former papers[ 28 ]. The statistical analysis encompassed the skeletal, dental and soft tissue changes occurring in each group per se to test their effectiveness, and then a comparison between the two groups to test their efficiency. The slow rate of expansion scheduled in this study was held in agreement with de Almeida et al.[ 9 ], who concluded that patients with complete bilateral cleft lip and palate experienced similar changes in terms of skeletal, dental, and alveolar bone plates with slow and rapid maxillary expansions. Both appliances produced significant skeletal gains in the transverse direction with minimal periodontal bone changes in. However, the length of the RME treatment was less than what was shown for SME. Also, slow rate here was used for standardization due to the fragile nature of premaxilla. Anatomically, The premaxillary septopremaxillary ligament dictates its position and the vomero-premaxillary suture is a site of active bone formation elongating the vomero-premaxillary stem[ 15 ]. Mechanically, the slow expansion of the springs in fan group (A) and fear of appliance dislodgement from the anterior teeth. The average time for this phase was from 6–12 months according to the severity of the starting maxillary constriction. In group (A), there was a statistically significant increase in SNA by a mean of 1.28°±0.69° and midface length changes also occurred with a difference 7.15mm ± 3.18 mm, denoting anterior displacement of point A. The possible confounders of this interpretation could be attributed to growth of these young patients as in [ 22 ], but in cleft patients maxillary growth is compromised with already a resorptive growth field in anterior maxilla. It can be compared too to forward displacement of maxilla after expansion as in Eric liou alt-RAMEC protocol[ 16 ]. Maxillary length measurement that represents the linear distance between ANS and PNS wan increased significantly with a difference 6.21 mm ± 3.73 mm denoting anteroposterior development of palatal plane. In group (A) a significant increase occurred in mandibular length reading, this could be explained due to the growth of these patients 12 ± 1.88 years. The vertical dimension in the group was slightly affected insignificantly that could share with a slight backward rotation of the mandible that can explain a decrease in Pog- N perpendicular measurement that is in significant too. Dental measurements in group (A) denoted that anteroposterior arch development occurred due to upper incisors proclination, anterior movement in their position besides distal tipping and distal movement of the anchor first molar with the encountered significant decrease in U6-PTv − 1.3mm ± 0.92 mm and U9/FH -6.13°±5.21. In contrast to the counterpart amount travelled by incisors U1-PTv 4.3 ± 1.40 mm and U1/FH 17.3°±14.23. The post-expansion inclination of the upper incisor remained within the normal ranges, excluding excessive unwanted proclination of teeth with post values of U1/SN, U1/PP 89.55°,99.23° respectively. Soft tissue measurements showed a statistically significant increase in facial convexity and linear distance between UL / E- line, due to the anterior movement of the underlying incisors. These patients usually have a straight or even convex profile, that doesn’t necessitate maxillary protraction, with a collapsed premaxilla making the upper lip retruded, where just incisor and premaxillary re alignment can resolve their facial esthetics. Analysis of the three-way group (B) in contrast to former studies that ordinarily used rotated hyrax for distalization[ 21 , 22 , 23 , 24 ],showed no statistical significant difference in upper first molar position. There were no significant skeletal changes except for the maxillary length ANS to PNS reading increases by 1.81mm ± 1.62mm. Comparison of both experimental groups showed significant differences at SNA, maxillary length and midface length readings denoting more anterior expansion with the palatal spring group as well as the upper first molar readings denoting arch length gains due to molar distalization too. After expansion completion, retention was delivered to maintain the gained expansion till patient receives the grafting of the alveolus to stabilize the maxillary segments. The fixed removable retainer used was an attempt to secure immobility of graft that could be compromised with removable retainers. Also it was easily removed in the surgical theater to make the surgical field clear on spot and was reassembled again. Other techniques employ a removable vacuum-formed retainer where a relief space is created in the area of the fistula and soft tissue closure to accommodate swelling, which is placed intraoperatively following the completion of the grafting procedure and is retained in place for a minimum of seven days without being removed, to stabilize the premaxilla during the healing process. Following primary healing, the patient is instructed to wear the device continuously, including while eating, and is shown how to take it off and clean it. To sustain the expansion, wear can be decreased to 12 hours per day after the eight-week period[ 29 ]. Limitations The limitations we faced in this study encountered the 10–11 years age range participants, were exfoliation of deciduous teeth occurred during study timing, at that time relapse occurred in the transverse expansion gained due to lack of support of maxillary segments, we had to wait till permanents erupt to support the expander, thus it is recommended to start expansion in young patients were panoramic radiograph shows enough timing ahead or postpone expansion till eruption of permanent dentition. Some cases during reactivation encountered screw dis-assembly that necessitated changing the defective screw and to monitor patients closely in frequent follow up visits, so as to prevent maximal expansion of the screw. The study was randomized, some cases at fan group had a narrow anterior maxillary width, implying screw fulcrum being placed posteriorly, that produced decreased amount of anterior transverse expansion, necessitating several re-activations to achieve needed expansion and place its fulcrum at the optimal place, so, these cases can receive the mini hyrax for better efficiency. It’s recommended to make a Cone Beam Computed Tomography (CBCT) study to study their effects in three-dimensional analysis and visualize the elongation of the vomero-premaxillary suture and to use three-dimensional 3D printing techniques for manufacturing a whole customized appliance. Conclusion In light of the results and limitations of this study, it can be concluded that: Both the fan expander with palatal springs and three-way expanders can widen and lengthen maxilla of BCLP patients simultaneously, decreasing the burden of care of these families using just one appliance Fan expander with springs encountered distal molar movement more than the three-way group Fan expander with springs can have a positive skeletal effect on maxillary anteroposterior position Any of the expanders can be used for 3D maxillary arch development according to the operator preference Abbreviations CLP Cleft lip and palate UCLP Unilateral cleft lip and palate BCLP Bilateral cleft lip and palate SABG secondary alveolar bone grafting RME Rapid maxillary expansion SME Slow maxillary expansion TPA Transpalatal arch 3D Three-dimensional SPSS Statistical package for social sciences Declarations Acknowledgements I would like to acknowledge Dr. Marium Elsayed Ahmed Shatla for her efforts in helping with statistical analysis of our study. Authors’ contributions MES was a principal investigator and a major contributor in data collection, manuscript writing and literature search. DHE was a co-investigator assisted in the selection of title, analysis and interpretation of data. ITA was a coinvestigator and a contributor in drafting and data entry. AMZ was a co-investigator and a major contributor in statistics. NIA was a coinvestigator and a contributor in analysis of data. All authors have read and approved the manuscript. Funding The research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This clinical trial was approved by Research ethics committee, Faculty of Dentistry, Ain Shams University (FDASU-Rec ID 052316) (Approved 25/05/2023) and was registered under the protocol ID NCT07056296 https://clinicaltrials.gov/) according to the CONSORT statement of the updated guidelines for reporting randomized clinical trials. An informed consent was signed by minor patients’ parents as well as an assent by the patients themselves before their enrolment in the current study. Consent for publication Consent was obtained from patients regarding publication of their data. Competing interests The authors declare that they have no competing interests. Author details 1-5 Department of Orthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt. 2 Department of Orthodontics, Faculty of Dentistry, Ahram Canadian University. 3,4 Department of Orthodontics, Faculty of Dentistry, British University in Egypt. References Gharib D, Massaro C, Laura R. Correcting transverse discrepancies in patients with clefts. Cleft and Craniofacial Orthodontics. Volume 1. Wiley Blackwell; 2023. pp. 279–96. http://journal.um-surabaya.ac.id/index.php/JKM/article/view/2203 . Isaacson RJ, Murphy TD. Some Efifects Of Rapid Maxillary Expansion In Cleft Lip And Palate Patients. Angle Orthod. 1964;34(3):143–54. 10.1043/0003-3219(1964)0342.0.CO;2 . Garib DG, Garcia LC, Pereira V, Lauris RCMC, Yen S. A rapid maxillary expander with differential opening. J Clin Orthod. 2014;48(7):430–5. da Silva Filho OG, Ramos AL, Camargo Abdo RC. The influence of unilateral cleft lip and palate on maxillary dental arch morphology. Angle Orthod. 1992;62(4):283–90. 10.1043/0003-3219(1992)0622.0.CO;2 . Freitas JA, de das Neves S, de Almeida LT. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)--Part 1: overall aspects. J Appl Oral Sci. 2012;20(1):9–15. 10.1590/s1678-77572012000100003 . El-Kassaby MA, Abdelrahman NI, Abbass IT. Premaxillary characteristics in complete bilateral cleft lip and palate: A predictor for treatment outcome. Ann Maxillofac Surg. 2013;3(1):11–9. 10.4103/2231-0746.110064 . de Medeiros Alves AC, Garib DG, Janson G, de Almeida AM, Calil LR. Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig. 2016;20(7):1837–47. 10.1007/s00784-015-1675-1 . Ayub PV, Janson G, Gribel BF, Lara TS, Garib DG. Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2016;149(5):705–15. 10.1016/j.ajodo.2015.11.022 . de Almeida AM, Ozawa TO, de Alves AC. Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial. Clin Oral Investig. 2017;21(5):1789–99. 10.1007/s00784-016-1943-8 . Suzuki A, Takahama Y. A jointed fan-type expander: a newly designed expansion appliance for the upper dental arch of patients with cleft lip and/or palate. Cleft Palate J. 1989;26(3):239–41. discussion 241. Sebaey A, El-Bayomy S, Abo Khalefa Y, Abdel-Rahman N. Rapid Arch Expansion in Cleft Lip and Palate Children: Comparison Between Fan-Shaped Expander and Hyrax-Type Expander by Using Cone Beam Computed Tomography. Egypt Dent J. 2019;65(4):3159–67. 10.21608/edj.2019.73993 . Figueiredo DSF, Bartolomeo FUC, Romualdo CR, et al. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study. Am J Orthod Dentofac Orthop. 2014;146(1):73–81. 10.1016/j.ajodo.2014.04.013 . Paradowska-Stolarz A, Kawala B. Occlusal disorders among patients with total clefts of lip, alveolar bone, and palate. Biomed Res Int. 2014;2014:583416. 10.1155/2014/583416 . Latham RA. Maxillary development and growth: the septo-premaxillary ligament. J Anat. 1970;107(Pt 3):471–8. Friede H, Morgan P. Growth of the vomero-premaxillary suture in children with bilateral cleft lip and palate. A histological and roentgencephalometric study. Scand J Plast Reconstr Surg. 1976;10(1):45–55. 10.1080/02844317609169745 . Liou EJW, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft palate-craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc. 2005;42(2):121–7. 10.1597/03-107.1 . Alaglan G. Different Treatment Modalities of Maxillary Protraction in Cleft Lip and Palate Patients. Literature Rev. 2022;10(1):4–7. 10.12691/ijdsr-10-1-2 . Elabbassy EH, Sabet NE, Hassan IT, Elghoul DH, Elkassaby MA. Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate. Angle Orthod. 2020;90(4):539–47. 10.2319/091919-598.1 . Yen SLK. Protocols for Late Maxillary Protraction in Cleft Lip and Palate Patients at Childrens Hospital Los Angeles. Semin Orthod. 2011;17(2):138–48. 10.1053/j.sodo.2011.01.001 . Hashem AS, Aboulmakarem OS, Refai WM. Evaluation of the effects of maxillary expansion and protraction on facial soft tissue profile in unilateral cleft lip and palate patients using cone beam computed tomography. Egypt Dent J. 2021;1–8. 10.21608/edj.2020.40590.1225 . 67(Issue 1-January (Orthodontics, Pediatric & Preventive Dentistry). Wilmes B, Ludwig B, Katyal V, Nienkemper M, Rein A, Drescher D. The Hybrid Hyrax Distalizer, a new all-in-one appliance for rapid palatal expansion, early class III treatment and upper molar distalization. J Orthod. 2014;41(Suppl 1):s47–53. 10.1179/1465313314Y.0000000107 . Takahashi M, Tabuchi M, Sato T, Hoshino R, Miyazawa K, Goto S. A Modified Hyrax-Type Expander Is Effective for Distal Bodily Movement of the Maxillary First Molar. Appl Sci. 2022;12(15). 10.3390/app12157620 . Grummons D. 3-Way maxillae expander appliance innovations. Orthod Pract US Contin Educ. 10(6):26–9. Ramos-Castro P, Bacchiega-Bustos D, Vergara-Santoro C, Rojas P. Análisis de los fundamentos biológicos del Sistema Ertty Gap III®. Int J Interdiscip Dent. 2022;15:44–7. 10.4067/S2452-55882022000100044 . Mendes WD, Macedo de Menezes L, Romano F, Matsumoto MAN, Stuani MBS. Correction of an anterior and posterior crossbite case with a modified McNamara appliance: A case report. Contemp Pediatr Dent. 2021;0(January):64–71. 10.51463/cpd.2021.39 . Machado AW. Modified Haas maxillary expander for anterior and posterior crossbite interception in patient with skeletal Class III. Clin Orthod . Published online 2023. https://doi.org/10.14436/2675-486X.22.4.020-029.ort Dogan E, Çınarcık H, Doğan S, Dindaroğlu F. Is Cephalometric Analysis Reliable in Cases with Cleft Lip and Palate? J Ege Univ Sch Dent. 2020;41:27–37. 10.5505/eudfd.2020.71463 . Ellis E 3rd, McNamara JAJ. Cephalometric evaluation of incisor position. Angle Orthod. 1986;56(4):324–44. 10.1043/0003-3219(1986)0562.0.CO;2 . Shetye PR. Orthodontic preparation for alveolar bone grafting in bilateral cleft lip and palate. Cleft and Craniofacial Orthodontics. John Wiley & Sons, Inc.; 2023. pp. 323–32. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7339985","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507042613,"identity":"541a7567-b1f9-4d77-a0a2-ca4b72162bed","order_by":0,"name":"Marwa E. Shatla","email":"data:image/png;base64,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","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Marwa","middleName":"E.","lastName":"Shatla","suffix":""},{"id":507042615,"identity":"b4aabfec-b84e-425c-9140-b24f0cdbe2b1","order_by":1,"name":"Dina H. 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Abdelrahman","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Noha","middleName":"I.","lastName":"Abdelrahman","suffix":""}],"badges":[],"createdAt":"2025-08-10 16:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7339985/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7339985/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90672401,"identity":"a9590912-9ec1-42ca-a196-d96c681d22c8","added_by":"auto","created_at":"2025-09-05 13:47:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":326562,"visible":true,"origin":"","legend":"\u003cp\u003eModified Fan expander with soldered palatal spring adapted on teeth in premaxilla (Group A)\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/6db24b4f177a41ad63147df7.png"},{"id":90673191,"identity":"a30199c5-6493-424c-942f-61fa46510893","added_by":"auto","created_at":"2025-09-05 13:55:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":384793,"visible":true,"origin":"","legend":"\u003cp\u003eThree-way expander (Group B)\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/f75b166a7743242f87e8339e.png"},{"id":90672399,"identity":"54e0af65-8b49-4af3-94bb-1770c087f0db","added_by":"auto","created_at":"2025-09-05 13:47:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1568158,"visible":true,"origin":"","legend":"\u003cp\u003e(a). Group (A) case (a-i) occlusal photograph pre-expansion, (a-ii) close up buccal view pre-expansion, (a-iii) occlusal photograph during expansion and (a-iv) close up buccal view post-expansion. (b) Group(B) case (b-i) before expansion, (b-ii) side view, (b-iii) during expansion and (b-iv) after expansion.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/e02153dc49656c670664064d.png"},{"id":90672405,"identity":"64478d3e-0607-4fd9-ba5d-a9f5f9877768","added_by":"auto","created_at":"2025-09-05 13:47:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":4642268,"visible":true,"origin":"","legend":"\u003cp\u003eFixed retainer after expansion completion\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/2d3ebfc3666a0e6d1db6d84d.png"},{"id":90673193,"identity":"a662093b-295c-41f3-b403-951cf5a88023","added_by":"auto","created_at":"2025-09-05 13:55:35","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":709120,"visible":true,"origin":"","legend":"\u003cp\u003eComponents of the retainer (a) Palatal TPA with gaushgarian palatal arch, (b) \u0026nbsp;assembled from distal to mesial,(c) detached in a posterior direction\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/5262b4718ee409d31362bf1a.png"},{"id":90672406,"identity":"2fbb6f48-6776-4a95-bbd5-1cb3795fc617","added_by":"auto","created_at":"2025-09-05 13:47:35","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":768501,"visible":true,"origin":"","legend":"\u003cp\u003e(a-a'). Profile before expansion, (b-b') Profile and profile with smile after 3D expansion\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/eca92fa6cfd45de90ae9f899.png"},{"id":90673197,"identity":"58ac666d-86fa-4377-ae89-8510aa2a763c","added_by":"auto","created_at":"2025-09-05 13:55:35","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":364414,"visible":true,"origin":"","legend":"\u003cp\u003e(a). Pre-expansion radiograph from group (A), (b) Digital tracing, (c) Post-expansion and (d) Post- expansion tracing\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/00b94920f28c899e999509e9.png"},{"id":90673194,"identity":"957262e0-51bc-49c7-b7bd-44489438dd49","added_by":"auto","created_at":"2025-09-05 13:55:35","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":26308,"visible":true,"origin":"","legend":"\u003cp\u003eConsort flowchart diagram for the study.\u003c/p\u003e","description":"","filename":"image8.png","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/08136d2229f8fb409fe7be91.png"},{"id":91423855,"identity":"b1045f0a-4e1b-4ac0-b0bf-b5d0d0e442e8","added_by":"auto","created_at":"2025-09-16 10:47:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":10231386,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7339985/v1/89fbea50-ff4e-44ce-8a5e-deea767f9c3b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial","fulltext":[{"header":"Background","content":"\u003cp\u003eMaxillary deficiency in the transverse dimension is a common abnormality in patients with unilateral and bilateral complete cleft lip and palate (UCLP and BLCP)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The absence of the bony palatal vault and midpalatal suture, along with the iatrogenic effects of surgical scarring, are the reasons for this relative constriction of the maxillary dental arch during growth[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCleft patients often have more constriction in the maxillary dental arch's anterior than posterior areas, with maxillary segments' mesial rotation and movement (yaw) with the fulcrum at maxillary tuberosity[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This can be explained by the fact that the canine region experiences a restrictive tension as a result of both lip and palate repairs. whilst the molar region is affected by tension due to palatal repair[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], that\u0026rsquo;s why in CLP patients, transverse discrepancy is more accentuated in the anterior region than the posterior one[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMaxillary expansion is essential in complete CLP and is typically performed during the mixed dentition[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For the majority of patients, maxillary expansion should be done before secondary alveolar bone grafting (SABG). The purpose of maxillary expansion is to restore the distorted maxillary arch shape, treat posterior crossbites and maxillary transverse deficiencies, prepare the maxillary dental arch for alveolar bone transplantation via widening the alveolar cleft for better accessibility at the cranial end for bone grafting surgery and space creation for alignment of teeth [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEl Kassaby et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] described a new detailed classification for Bilateral Complete Cleft Lip and Palate (BCLP) individuals, as it has great variations. They added to the ordinary general classifications further description of premaxilla, whether Rudimentary (R), or Prominent (P), as they differ in so many aspects morphologically, having different response to pre-surgical infant orthopedics and emphasize the effect of premaxillary characteristics on alveolar cleft grafting, maxillary arch form, occurrence of maxillary deficiency and post-operative facial appearance.\u003c/p\u003e\u003cp\u003eBCLP patients with a prominent premaxilla, they have a good facial profile, where the premaxilla is protruded and palatally inclined[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The resulting malocclusion necessitates correction of the anterior crossbite usually via protraction devices for maxillary segments\u0026rsquo; alignment. Yet, no efficient appliance addressed this problem for aligning segments without using a protraction appliance.\u003c/p\u003e\u003cp\u003eDe Medeiros Alves et al.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found that in BCLP patients after transverse expansion, a slight posterior movement of the premaxilla is observed. So, in BCLP cases with anterior crossbite and midface deficit, anterior extensions to the incisors can be included in the expander design and are recommended to preserve arch depth and prevent further impairment to the incisor's anteroposterior relationship. These extensions will stop the maxillary incisors from lingual tipping during the closure of the cleft gap. Moreover, it is possible to control that posterior migration of the premaxilla seen in BCLP following the expansion.\u003c/p\u003e\u003cp\u003eMaxillary expansion can be obtained through different appliances, for example, orthodontic arch wires, stainless steel wire frameworks; Quad-helix, tri-helix, Nickle-Titanium (NiTi) shape memory expander and parallel expansion screws; removable or banded/ bonded expansion screws[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The geometry of transverse discrepancy implies the usage of Fan expander, inverted mini-Hyrax (iMini), expanders with differential opening and double hinge expanders for differential expansion in cleft patients. The activation strategy is quite similar in patients with CLP and non-cleft patients. It's possible to decide between using rapid maxillary expansion (RME) and slow maxillary expansion (SME)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Slow expansion can be accomplished with the quad helix appliance, removable expanders, or nickel titanium expanders. The appliance activation is slow, and the active expansion phase can take 6\u0026ndash;12 months. The amount of expansion and duration of the active phase will depend on the severity of the maxillary arch constriction[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite numerous studies comparing the effectiveness of various appliances and addressing expansion in the transverse dimension[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], there is currently no evidence evaluating the effect of treating both the sagittal and transverse at the same procedure with a single appliance which can noticeably lessen the burden of care on these families.\u003c/p\u003e\u003cp\u003eThe aim of this study was to evaluate the efficiency and the effectiveness of a new design for the three-way palatal expander and the modified fan expander in maxillary arch development in cleft lip and palate patients; to widen and lengthen the arch simultaneously.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and settings\u003c/h2\u003e\u003cp\u003eThis study was performed in the Outpatient Clinic of the Orthodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt. All the investigations were carried out according to the tenets of Declaration of Helsinki 2024) and was approved by the research ethical committee, Faculty of Dentistry, Ain Shams University, that approved the study design after reviewing the study protocol (FDASU-Rec ID 052316) and was registered under the protocol ID NCT03881813 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), according to the CONSORT statement of the updated guidelines for reporting randomized clinical trials. It was a Randomized clinical trial (RCT), with parallel group and allocation ratio 1:1. Patient recruitment started in June 2023, and the study ended in March 2025. Before treatment was carried out, an informed consent was signed by minor patients\u0026rsquo; parents as well as an assent by the patients themselves before their enrolment in the current study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eSample size for the study was calculated based on a significance level of 0.05 and a power of 95% through a study by Figueiredo DSF et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] to evaluate the dentoskeletal effects of 3 maxillary expanders: the conventional hyrax and 2 modified types, especially designed to promote anterior expansion of the maxillary arch. The calculations were performed with the computer application G*Power*. Power analysis showed that 7 subjects were required, to compensate for possible dropouts during procedures 10 patients were included.\u003c/p\u003e\u003cp\u003eTwenty patients were selected after assessment for eligibility according to the following inclusion and exclusion criteria presented in (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEligibility criteria for the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExclusion criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral cleft lip and palate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSyndromic cleft lip and palate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge ranging from 8 to 15 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery bad oral hygiene\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLate mixed or early permanent dentition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive periodontal disease\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTapered maxillary arch, requiring palatal expansion as part of their treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVulnerable groups\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRepaired cleft lip and / or palate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully erupted upper permanent 1st molars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estage of cervical vertebral maturation before or at the growth spurt (CS1-CS4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eRandomization, allocation concealment\u003c/h3\u003e\n\u003cp\u003ePatients who met the inclusion criteria and approved to participate in the study were randomly allocated to Fan expander group (A) or Three-way expander group (B). Block randomization (block size: 4 participants) was used for a balanced group distribution. A colleague not involved in the clinical trial, generated randomization sequences using the Microsoft Excel software (Microsoft, Redmond, Washington, USA). Each subject was given a number in the order in which they showed up for diagnosis. Allocation of the subjects into either group A or B was performed by matching that number with the generated sequence. The allocation sequence was concealed from the investigators of the study.\u003c/p\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eFull orthodontic records were taken for patients who met the inclusion criteria. These records were: Intraoral and extraoral photographs, digital orthodontic diagnostic models, panoramic radiograph and lateral cephalometric radiograph. For group (A) cases, alginate impression was taken, and a custom-made modified Fan palatal expansion appliance was fabricated (A0625-09, Leone, Italy). The appliance was composed of Orthodontic bands on first permanent molars and fan expansion screw with break resistant retention legs with soldered finger springs just palatal to teeth in the premaxilla (Fig.\u0026nbsp;1). For group (B) cases, a custom-made Three-way palatal expansion appliance was made. The appliance was composed of Orthodontic bands on first permanent molars and three mini-expansion screws (Variety SP 602-809-11, Dentauram, Germany) with two break resistant retention legs, oriented as follows: a transverse screw and two bilateral sagittal screws (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The retentive arms of the anterior transverse screw were bent posteriorly and soldered on each side to the mesial retention arms of the two posterior sagittal screws. The distal retention arms of the latter were bent and soldered to the molar bands.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFigure 1. Modified Fan expander with soldered palatal spring adapted on teeth in premaxilla (Group A)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThen appliances were cemented in place. In group (A) palatal springs were activated before cementation using 139 Bird Beak plier in small increments, then after cementation, screw expansion rate was slow: activated by one quarter turn, day after day using the swivel key of the expander. In group (B) expansion rate was slow too; activated by one quarter turn, day after day for each jackscrew by the patients' parents or caregivers. Patients were seen every month for follow up and for assessment of need for reactivation.\u003c/p\u003e\u003cp\u003eFan expander reactivation was manufactured as follows: appliance was removed, alginate impression was taken and poured, solder joints at molar bands were broken, screw was closed again, and appliance readapted on cast, re-soldered and re-cemented. For the three-way expander, appliance was removed, alginate impression was taken and poured, screws were deactivated, acrylic resin was added anteriorly till it reattach to palatal surface of present incisors, retentive arms between anterior and posterior screws were re-adapted using three- prong plier and appliance was re-cemented. Follow up was continued when there is an over-correction in the anterior expansion in both dimensions; transverse and sagittal and appearance of interdental gap between teeth adjacent to the cleft as shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003ea \u0026ndash; \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eb) for a case in group (A) and another in group (B).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAfter expansion completion, preparation of bone grafting surgery started. Fixed retainer was fabricated and cemented. The retainer consisted of molar bands, a rigid Trans-Palatal Arch (TPA) of 0.9 mm stainless steel wire and a gaushgarian palatal arch 0.9 mm stainless steel wire adapted on present teeth (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e),that is assembled from distal to mesial direction in a lingual sheath soldered on palatal surface of molar band, that arch could be detached in a distal direction during the alveolar bone grafting procedure so as not to obstruct the surgical field ( Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003ea-\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003eb-\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003ec).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eOutcomes assessment\u003c/h3\u003e\n\u003cp\u003e\u003c/p\u003e\u003cp\u003eProfile enhancement for patients was evident in profile photographs (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003ea-a\u0026rsquo;-b-b\u0026rsquo;). For analysis of treatment changes, digital lateral cephalometric radiographs were taken post-expansion using the same digital x-ray machine (Vatech Pax-i) (Vatech systems, Korea.) at radiology Department, Faculty of dentistry, Ain Shams University. Both the pre-treatment (T0) and post-expansion (T1) lateral cephalometric radiographs were digitized and analysed using a special orthodontic tracing software program (Dolphin Ver. 11.5) (Dolphin Imaging and Management Solutions, Chatsworth, Calif. USA) as shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003ea-\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003eb-\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003ec-\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003ed) the digital lateral cephalometric radiograph before and after expansion were digitally traced and analysed for the forty lateral cephalometries.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe following measurements were analyzed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) in the 40 lateral cephalometric radiographs at (T0) and (T1). They comprised skeletal measurements in the anteroposterior and vertical dimensions, dental angular and linear measurements and soft tissue measurements.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCephalometric measurements done for the (T0) and (T1) radiographs.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkeletal Anteroposterior measurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSkeletal vertical measurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eDental measurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSoft tissue measurements\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFMA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1/SN\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eL1/MP\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNasolabial angle\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eY-axis\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1/FH\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU6/FH\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFacial convexity\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1/PP\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU1-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA to N prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1/NA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU6-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePog. to N Prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1-NA mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU6-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary length mm (ANS-PNS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJaraback ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1 protrusion- Apog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU1-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidface length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1 most labial -A mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverbite mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eU1/Npog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverjet mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMx/Md Differential\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll Data were collected, tabulated, and subjected to statistical analysis. Statistical analysis was performed by IBM (IBM Corporation, NY, USA) SPSS (SPSS, Inc., an IBM Company) (version 17). Shapiro-Wilk test of normality was used to test normality hypothesis of all quantitative variables for further choice of appropriate parametric and non-parametric tests. Most of the variables were found normally distributed allowing the use of parametric tests. Paired sample t-test was used for comparing pre- and post-measurements within each group. Independent samples t test was used for comparing the difference (post-pre) between the two groups. Significance level was considered at P\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe flowchart diagram of the study is shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Demographic distribution of enrolled cases is shown in (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Clinically, patients showed resolution of maxillary constriction in the transverse plane, area of cleft and any hidden fistula was revealed and expansion of the collapsed premaxilla with its incisors was evident. Patients reported no complaints about pain or increased mobility in the premaxilla.\u003c/p\u003e\u003cp\u003eRadiographically, the Fan expander group (A) showed skeletally a statistically significant increase in SNA (1.28\u0026deg;\u0026plusmn;0.69), maxillary length(6.21mm\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73), midface length(7.15mm\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18), mandibular length(6.56mm\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77) in the sagittal plane and significant increase in PFH(2.4mm\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62) and Jaraback ratio(1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16). On the dental basis, overjet and all measurements of upper incisor inclination and position showed statistically significant increase, lower incisor showed no significant alteration in inclination. While the upper first molar showed significant decrease in its axial inclination U6/FH(-6.13\u0026deg;\u0026plusmn;5.21), linear distance U6-PTv(-1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92) denoting loss of anchorage in group A. regarding the soft tissue profile, facial convexity(2.21\u0026deg;\u0026plusmn;2) and upper lip position in relation to E-line(1.28mm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70) showed statistically significant increases (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe three-way group (B) on skeletal level showed only statistically significant increase in maxillary length(1.81mm\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62) and PFH (3.93mm\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72) measurements. Dentally, there was a statistically significant increase in overjet and all measurements of upper incisor inclination and position, in contrast to group (A), there were no significant changes in neither the upper first molar position, inclination nor the soft tissue profile of the patients (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComparing the two groups together (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) showed the differences between the effects of both appliances, were SNA, maxillary length, midface length showed statistically significant difference between the two groups, were fan group (A) increases were 1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69, 6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73 and 7.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18 respectively for these measurements, while the three-way group (B) differences were \u0026minus;\u0026thinsp;0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61, 1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62 and 2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47. Apart from that, there is a significant difference between the two groups in the upper first molar measurements, where fan group (A) showed a statistically significant difference with a decreased upper first molar inclination U6/FH -6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21, position U6-PTv \u0026minus;\u0026thinsp;1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92 and U6-PP -1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60 respectively compared to the three-way group (B) with differences 1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88, 0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50 and 1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83 denoting more molar tipping and distalization in fan group (A).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic distribution of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean values of measurements at (T0) and (T1) and the mean difference (T1-T0) of the skeletal, dental and soft tissue measurements in the modified Fan expander group; paired t-test\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasurement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean diff.\u003c/p\u003e\u003cp\u003eT1-T0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.008*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.904\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA to N prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePog. to N Prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-6.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-8.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.010*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidface length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMx/Md Differential\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.691\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFMA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.658\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eY-axis\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e109.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.015*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJaraback ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.036*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/SN\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.026*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/FH\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.031*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/PP\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.055*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/NA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-8.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.033*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-NA mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.005*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1 protrusion- Apog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.014*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1 most labial -A mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/Npog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eL1/MP\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.895\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU6/FH\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.035*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.525\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU6-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.181\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU6-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.018*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverbite mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverjet mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-6.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasolabial angle\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacial convexity\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.042*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.007*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.185\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e* P\u003c/em\u003e-value significant\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean values of measurements at (T0) and (T1) and the mean difference (T1-T0) of the skeletal, dental and soft tissue measurements in the Three-way expander group; paired t-test\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasurement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean diff.\u003c/p\u003e\u003cp\u003eT1-T0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.541\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.228\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.592\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA to N prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.652\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePog. to N Prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-8.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-8.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.842\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.041*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidface length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMx/Md Differential\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.534\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFMA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.838\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eY-axis\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.678\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.049*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c5\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.386\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverbite mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverjet mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasolabial angle\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e125.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacial convexity\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003e* P\u003c/em\u003e-value significant\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison between Mean Differences (T1-T0) for the skeletal, dental and soft tissue measurements between the two groups; paired t-test\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasurement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFan T1-T0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eThree-way T1-T0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean diff.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.038*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eANB\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.457\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA to N prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePog. to N Prep. mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidface length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.015*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular length mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMx/Md Differential\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.472\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFMA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAFH mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJaraback ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" 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colname=\"c4\"\u003e\u003cp\u003e16.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.881\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/PP\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/NA\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-NA mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1 protrusion- Apog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.558\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1 most labial -A mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.378\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1/Npog mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c1\"\u003e\u003cp\u003eU1-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.919\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU6-PP mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.026*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU6-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.026*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU1-PTv mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.413\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverbite mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverjet mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasolabial angle\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFacial convexity\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLL/ E-line mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.623\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e* P\u003c/em\u003e-value significant\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients with repaired cleft lip and/or palate have maxillary deficiency and hypoplasia in the three planes of space; transverse, sagittal and vertical planes presented as crossbites, class III and open bites[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In BCLP, premaxillary characteristics vary from being prominent, protruded or being rudimentary and collapsing towards the posterior stumps of the arch[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A crucial step in management of BCLP patients is correcting the malpositioned premaxilla, that’s usually inferiorly positioned and palatally inclined. Anatomically, premaxilla is detached from the alveolar segments bilaterally and attached postero-superiorly to the vomer at the vomero-premaxillary suture[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the literature, several studies dealt with conventional expansion appliances addressing only the transverse discrepancy or protraction appliances correcting the sagittal maxillary hypoplasia requiring a further step to re-align the premaxilla. Liou and Ching [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]used a double hinged expander in testing the Alternating Rapid Maxillary Expansion and Constriction (Alt-Ramec) protocol of expansion for maxillary sutures disarticulation. They found anterior repositioning for point A upon expansion, then they used an intermaxillary TMA spring for maxillary protraction, correcting both transverse and sagittal planes, but they didn’t solve the alignment problem of premaxilla. While in our study sagittal skeletal increases were encountered along with realignment of the premaxilla.\u003c/p\u003e\u003cp\u003eGarib et al.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] used a Rapid Maxillary Expander with Differential opening (EDO), The EDO can be activated at two positions to control the amount of activation in the anterior and posterior regions of the maxillary dental arch. Figueiredo et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]analyzed the skeletal and dental alterations in the maxillae of cleft patients who received treatment with 3 expanders; the Hyrax expander, fan-type expander and inverted mini-hyrax expander positioned in the anterior region. Sebaey et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] also evaluated the skeletal and dentoalveolar effects of rapid palatal expansion (RPE) in CLP children treated with fan expander and Hyrax expander. In those studies too only transverse dimension was addressed as in our study but without any notice for the sagittal component.\u003c/p\u003e\u003cp\u003eSeveral studies also dealt with maxillary protraction, Alaglan[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] did a systematic review of different maxillary protraction appliances ranging from conventional facemask to bone anchored appliances. Elabbassy et al.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] assessed the effectiveness of bone-anchored maxillary protraction (BAMP) in cleft patients. Another study examined the alt-RAMEC protocol of Eric Liou with facemask or with skeletal anchorage[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Another study evaluated the soft tissue effects of maxillary expansion and protraction in cleft patients[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eYet no former study addressed transverse, sagittal and premaxilla alignment simultaneously. With the development of Benefit system[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], they used hybrid hyrax distalizer made up of 3 hyrax expansion screws assembled as: one anterior transverse expansion screw and two rotated 90° posterior sagittal screws for simultaneous expansion and protraction in a class III, crowding patient in addition to skeletally anchored class III elastics. The results of the three-way expander comprised mainly upper molars distalization 4.5mm. Another case report [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] used a hyrax screw rotated 90° with anterior palatal acrylic coverage as an anchorage means, used for maxillary molar distalization in an ectopic canine case. Where a slight increase in upper incisor inclination and position occurred as well as 0.5° increase in SNA that was attributed to patient’s growth.\u003c/p\u003e\u003cp\u003eGrummons [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] published a report about 3-way maxillary expander innovations comprised simultaneous maxillary expansion with expansion screw and molar distalization via posterior springs. Also another article was published used Ertty GAP III[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] for management of class III with a simultaneous protraction and molar distalization using a hyrax expansion screw rotated 90° with an anterior acrylic palatal coverage to serve as anchorage. From this point came up the idea of this research to investigate the efficiency of fan expander with conjunction of anterior springs and three-way expander in simultaneous widening and lengthening of maxillary arch on the expense of premaxilla anterior expansion and development.\u003c/p\u003e\u003cp\u003eTwo case reports were published addressing correction of both transverse and sagittal dimensions simultaneously. The 1st one used modified McNamara Rapid palatal expander with two double-helix digital springs, made of stainless steel 0.020 inches in an eight-year-old child. They found that the maxillary central incisors showed normal apicigenesis and an increase in root length, suggesting that the springs had no negative effects on these teeth. On cephalometric radiograph, they investigated only upper incisor inclination and position versus the NA plane, where they increased from (NA = 2 mm and NA = 15°) to (NA = 4 mm and NA = 22°) with no change in vertical dimension neither skeletal nor dental molar extrusion[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The 2nd report was a primary dentition child with posterior, anterior crossbite and light skeletal class III where he used modified Haas expander with finger springs and showed excellent results[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study outcome assessment via cephalometric radiographs agreed with a study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] that tested the accuracy of this tool in CLP diagnosis and assessment. The measurements focused on upper incisor position, measurements were selected comprehensively in accordance with former papers[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The statistical analysis encompassed the skeletal, dental and soft tissue changes occurring in each group per se to test their effectiveness, and then a comparison between the two groups to test their efficiency.\u003c/p\u003e\u003cp\u003eThe slow rate of expansion scheduled in this study was held in agreement with de Almeida et al.[\u003csup\u003e9\u003c/sup\u003e], who concluded that patients with complete bilateral cleft lip and palate experienced similar changes in terms of skeletal, dental, and alveolar bone plates with slow and rapid maxillary expansions. Both appliances produced significant skeletal gains in the transverse direction with minimal periodontal bone changes in. However, the length of the RME treatment was less than what was shown for SME. Also, slow rate here was used for standardization due to the fragile nature of premaxilla. Anatomically, The premaxillary septopremaxillary ligament dictates its position and the vomero-premaxillary suture is a site of active bone formation elongating the vomero-premaxillary stem[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Mechanically, the slow expansion of the springs in fan group (A) and fear of appliance dislodgement from the anterior teeth. The average time for this phase was from 6–12 months according to the severity of the starting maxillary constriction.\u003c/p\u003e\u003cp\u003eIn group (A), there was a statistically significant increase in SNA by a mean of 1.28°±0.69° and midface length changes also occurred with a difference 7.15mm ± 3.18 mm, denoting anterior displacement of point A. The possible confounders of this interpretation could be attributed to growth of these young patients as in [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], but in cleft patients maxillary growth is compromised with already a resorptive growth field in anterior maxilla. It can be compared too to forward displacement of maxilla after expansion as in Eric liou alt-RAMEC protocol[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Maxillary length measurement that represents the linear distance between ANS and PNS wan increased significantly with a difference 6.21 mm ± 3.73 mm denoting anteroposterior development of palatal plane. In group (A) a significant increase occurred in mandibular length reading, this could be explained due to the growth of these patients 12 ± 1.88 years. The vertical dimension in the group was slightly affected insignificantly that could share with a slight backward rotation of the mandible that can explain a decrease in Pog- N perpendicular measurement that is in significant too.\u003c/p\u003e\u003cp\u003eDental measurements in group (A) denoted that anteroposterior arch development occurred due to upper incisors proclination, anterior movement in their position besides distal tipping and distal movement of the anchor first molar with the encountered significant decrease in U6-PTv − 1.3mm ± 0.92 mm and U9/FH -6.13°±5.21. In contrast to the counterpart amount travelled by incisors U1-PTv 4.3 ± 1.40 mm and U1/FH 17.3°±14.23. The post-expansion inclination of the upper incisor remained within the normal ranges, excluding excessive unwanted proclination of teeth with post values of U1/SN, U1/PP 89.55°,99.23° respectively.\u003c/p\u003e\u003cp\u003eSoft tissue measurements showed a statistically significant increase in facial convexity and linear distance between UL / E- line, due to the anterior movement of the underlying incisors. These patients usually have a straight or even convex profile, that doesn’t necessitate maxillary protraction, with a collapsed premaxilla making the upper lip retruded, where just incisor and premaxillary re alignment can resolve their facial esthetics.\u003c/p\u003e\u003cp\u003eAnalysis of the three-way group (B) in contrast to former studies that ordinarily used rotated hyrax for distalization[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e],showed no statistical significant difference in upper first molar position. There were no significant skeletal changes except for the maxillary length ANS to PNS reading increases by 1.81mm ± 1.62mm.\u003c/p\u003e\u003cp\u003eComparison of both experimental groups showed significant differences at SNA, maxillary length and midface length readings denoting more anterior expansion with the palatal spring group as well as the upper first molar readings denoting arch length gains due to molar distalization too.\u003c/p\u003e\u003cp\u003eAfter expansion completion, retention was delivered to maintain the gained expansion till patient receives the grafting of the alveolus to stabilize the maxillary segments. The fixed removable retainer used was an attempt to secure immobility of graft that could be compromised with removable retainers. Also it was easily removed in the surgical theater to make the surgical field clear on spot and was reassembled again. Other techniques employ a removable vacuum-formed retainer where a relief space is created in the area of the fistula and soft tissue closure to accommodate swelling, which is placed intraoperatively following the completion of the grafting procedure and is retained in place for a minimum of seven days without being removed, to stabilize the premaxilla during the healing process. Following primary healing, the patient is instructed to wear the device continuously, including while eating, and is shown how to take it off and clean it. To sustain the expansion, wear can be decreased to 12 hours per day after the eight-week period[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe limitations we faced in this study encountered the 10–11 years age range participants, were exfoliation of deciduous teeth occurred during study timing, at that time relapse occurred in the transverse expansion gained due to lack of support of maxillary segments, we had to wait till permanents erupt to support the expander, thus it is recommended to start expansion in young patients were panoramic radiograph shows enough timing ahead or postpone expansion till eruption of permanent dentition. Some cases during reactivation encountered screw dis-assembly that necessitated changing the defective screw and to monitor patients closely in frequent follow up visits, so as to prevent maximal expansion of the screw. The study was randomized, some cases at fan group had a narrow anterior maxillary width, implying screw fulcrum being placed posteriorly, that produced decreased amount of anterior transverse expansion, necessitating several re-activations to achieve needed expansion and place its fulcrum at the optimal place, so, these cases can receive the mini hyrax for better efficiency. It’s recommended to make a Cone Beam Computed Tomography (CBCT) study to study their effects in three-dimensional analysis and visualize the elongation of the vomero-premaxillary suture and to use three-dimensional 3D printing techniques for manufacturing a whole customized appliance.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn light of the results and limitations of this study, it can be concluded that:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBoth the fan expander with palatal springs and three-way expanders can widen and lengthen maxilla of BCLP patients simultaneously, decreasing the burden of care of these families using just one appliance\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFan expander with springs encountered distal molar movement more than the three-way group\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFan expander with springs can have a positive skeletal effect on maxillary anteroposterior position\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAny of the expanders can be used for 3D maxillary arch development according to the operator preference\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCLP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCleft lip and palate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUCLP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnilateral cleft lip and palate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBCLP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBilateral cleft lip and palate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSABG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esecondary alveolar bone grafting\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRME\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRapid maxillary expansion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSME\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSlow maxillary expansion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTPA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTranspalatal arch\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e3D\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThree-dimensional\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical package for social sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to acknowledge Dr. Marium Elsayed Ahmed Shatla for her efforts in helping with statistical analysis of our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMES was a principal investigator and a major contributor in data collection, manuscript writing and literature search. DHE was a co-investigator assisted in the selection of title, analysis and interpretation of data. ITA was a coinvestigator and a contributor in drafting and data entry. AMZ was a co-investigator and a major contributor in statistics. NIA was a coinvestigator and a contributor in analysis of data. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis clinical trial was approved by Research ethics committee, Faculty of Dentistry, Ain Shams University (FDASU-Rec ID 052316) (Approved 25/05/2023) and was registered under the protocol ID NCT07056296 https://clinicaltrials.gov/) according to the CONSORT statement of the updated guidelines for reporting randomized clinical trials. An informed consent was signed by minor patients\u0026rsquo; parents as well as an assent by the patients themselves before their enrolment in the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent was obtained from patients regarding publication of their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1-5\u003c/sup\u003eDepartment of Orthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt. \u003csup\u003e2\u0026nbsp;\u003c/sup\u003eDepartment of Orthodontics, Faculty of Dentistry, Ahram Canadian University. \u003csup\u003e3,4\u0026nbsp;\u003c/sup\u003eDepartment of Orthodontics, Faculty of Dentistry, British University in Egypt.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGharib D, Massaro C, Laura R. Correcting transverse discrepancies in patients with clefts. Cleft and Craniofacial Orthodontics. Volume 1. Wiley Blackwell; 2023. pp. 279\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://journal.um-surabaya.ac.id/index.php/JKM/article/view/2203\u003c/span\u003e\u003cspan address=\"http://journal.um-surabaya.ac.id/index.php/JKM/article/view/2203\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIsaacson RJ, Murphy TD. Some Efifects Of Rapid Maxillary Expansion In Cleft Lip And Palate Patients. Angle Orthod. 1964;34(3):143\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1043/0003-3219(1964)034\u0026lt;0143:SEORME\u0026gt;2.0.CO;2\u003c/span\u003e\u003cspan address=\"10.1043/0003-3219(1964)034%3C0143:SEORME%3E2.0.CO;2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarib DG, Garcia LC, Pereira V, Lauris RCMC, Yen S. A rapid maxillary expander with differential opening. J Clin Orthod. 2014;48(7):430\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eda Silva Filho OG, Ramos AL, Camargo Abdo RC. The influence of unilateral cleft lip and palate on maxillary dental arch morphology. Angle Orthod. 1992;62(4):283\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1043/0003-3219(1992)062\u0026lt;0283:TIOUCL\u0026gt;2.0.CO;2\u003c/span\u003e\u003cspan address=\"10.1043/0003-3219(1992)062%3C0283:TIOUCL%3E2.0.CO;2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFreitas JA, de das Neves S, de Almeida LT. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)--Part 1: overall aspects. J Appl Oral Sci. 2012;20(1):9\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/s1678-77572012000100003\u003c/span\u003e\u003cspan address=\"10.1590/s1678-77572012000100003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Kassaby MA, Abdelrahman NI, Abbass IT. Premaxillary characteristics in complete bilateral cleft lip and palate: A predictor for treatment outcome. Ann Maxillofac Surg. 2013;3(1):11\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2231-0746.110064\u003c/span\u003e\u003cspan address=\"10.4103/2231-0746.110064\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Medeiros Alves AC, Garib DG, Janson G, de Almeida AM, Calil LR. Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig. 2016;20(7):1837\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00784-015-1675-1\u003c/span\u003e\u003cspan address=\"10.1007/s00784-015-1675-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyub PV, Janson G, Gribel BF, Lara TS, Garib DG. Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2016;149(5):705\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajodo.2015.11.022\u003c/span\u003e\u003cspan address=\"10.1016/j.ajodo.2015.11.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Almeida AM, Ozawa TO, de Alves AC. Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial. Clin Oral Investig. 2017;21(5):1789\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00784-016-1943-8\u003c/span\u003e\u003cspan address=\"10.1007/s00784-016-1943-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuzuki A, Takahama Y. A jointed fan-type expander: a newly designed expansion appliance for the upper dental arch of patients with cleft lip and/or palate. Cleft Palate J. 1989;26(3):239\u0026ndash;41. discussion 241.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSebaey A, El-Bayomy S, Abo Khalefa Y, Abdel-Rahman N. Rapid Arch Expansion in Cleft Lip and Palate Children: Comparison Between Fan-Shaped Expander and Hyrax-Type Expander by Using Cone Beam Computed Tomography. Egypt Dent J. 2019;65(4):3159\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21608/edj.2019.73993\u003c/span\u003e\u003cspan address=\"10.21608/edj.2019.73993\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFigueiredo DSF, Bartolomeo FUC, Romualdo CR, et al. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study. Am J Orthod Dentofac Orthop. 2014;146(1):73\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajodo.2014.04.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ajodo.2014.04.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParadowska-Stolarz A, Kawala B. Occlusal disorders among patients with total clefts of lip, alveolar bone, and palate. Biomed Res Int. 2014;2014:583416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2014/583416\u003c/span\u003e\u003cspan address=\"10.1155/2014/583416\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLatham RA. Maxillary development and growth: the septo-premaxillary ligament. J Anat. 1970;107(Pt 3):471\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFriede H, Morgan P. Growth of the vomero-premaxillary suture in children with bilateral cleft lip and palate. A histological and roentgencephalometric study. Scand J Plast Reconstr Surg. 1976;10(1):45\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/02844317609169745\u003c/span\u003e\u003cspan address=\"10.1080/02844317609169745\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiou EJW, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft palate-craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc. 2005;42(2):121\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1597/03-107.1\u003c/span\u003e\u003cspan address=\"10.1597/03-107.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlaglan G. Different Treatment Modalities of Maxillary Protraction in Cleft Lip and Palate Patients. Literature Rev. 2022;10(1):4\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12691/ijdsr-10-1-2\u003c/span\u003e\u003cspan address=\"10.12691/ijdsr-10-1-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElabbassy EH, Sabet NE, Hassan IT, Elghoul DH, Elkassaby MA. Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate. Angle Orthod. 2020;90(4):539\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2319/091919-598.1\u003c/span\u003e\u003cspan address=\"10.2319/091919-598.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYen SLK. Protocols for Late Maxillary Protraction in Cleft Lip and Palate Patients at Childrens Hospital Los Angeles. Semin Orthod. 2011;17(2):138\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.sodo.2011.01.001\u003c/span\u003e\u003cspan address=\"10.1053/j.sodo.2011.01.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHashem AS, Aboulmakarem OS, Refai WM. Evaluation of the effects of maxillary expansion and protraction on facial soft tissue profile in unilateral cleft lip and palate patients using cone beam computed tomography. Egypt Dent J. 2021;1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21608/edj.2020.40590.1225\u003c/span\u003e\u003cspan address=\"10.21608/edj.2020.40590.1225\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 67(Issue 1-January (Orthodontics, Pediatric \u0026amp; Preventive Dentistry).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilmes B, Ludwig B, Katyal V, Nienkemper M, Rein A, Drescher D. The Hybrid Hyrax Distalizer, a new all-in-one appliance for rapid palatal expansion, early class III treatment and upper molar distalization. J Orthod. 2014;41(Suppl 1):s47\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1179/1465313314Y.0000000107\u003c/span\u003e\u003cspan address=\"10.1179/1465313314Y.0000000107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTakahashi M, Tabuchi M, Sato T, Hoshino R, Miyazawa K, Goto S. A Modified Hyrax-Type Expander Is Effective for Distal Bodily Movement of the Maxillary First Molar. Appl Sci. 2022;12(15). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/app12157620\u003c/span\u003e\u003cspan address=\"10.3390/app12157620\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrummons D. 3-Way maxillae expander appliance innovations. Orthod Pract US Contin Educ. 10(6):26\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamos-Castro P, Bacchiega-Bustos D, Vergara-Santoro C, Rojas P. An\u0026aacute;lisis de los fundamentos biol\u0026oacute;gicos del Sistema Ertty Gap III\u0026reg;. Int J Interdiscip Dent. 2022;15:44\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4067/S2452-55882022000100044\u003c/span\u003e\u003cspan address=\"10.4067/S2452-55882022000100044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMendes WD, Macedo de Menezes L, Romano F, Matsumoto MAN, Stuani MBS. Correction of an anterior and posterior crossbite case with a modified McNamara appliance: A case report. Contemp Pediatr Dent. 2021;0(January):64\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.51463/cpd.2021.39\u003c/span\u003e\u003cspan address=\"10.51463/cpd.2021.39\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMachado AW. Modified Haas maxillary expander for anterior and posterior crossbite interception in patient with skeletal Class III. \u003cem\u003eClin Orthod\u003c/em\u003e. Published online 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14436/2675-486X.22.4.020-029.ort\u003c/span\u003e\u003cspan address=\"10.14436/2675-486X.22.4.020-029.ort\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDogan E, \u0026Ccedil;ınarcık H, Doğan S, Dindaroğlu F. Is Cephalometric Analysis Reliable in Cases with Cleft Lip and Palate? J Ege Univ Sch Dent. 2020;41:27\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5505/eudfd.2020.71463\u003c/span\u003e\u003cspan address=\"10.5505/eudfd.2020.71463\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEllis E 3rd, McNamara JAJ. Cephalometric evaluation of incisor position. Angle Orthod. 1986;56(4):324\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1043/0003-3219(1986)056\u0026lt;0324:CEOIP\u0026gt;2.0.CO;2\u003c/span\u003e\u003cspan address=\"10.1043/0003-3219(1986)056%3C0324:CEOIP%3E2.0.CO;2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShetye PR. Orthodontic preparation for alveolar bone grafting in bilateral cleft lip and palate. Cleft and Craniofacial Orthodontics. John Wiley \u0026amp; Sons, Inc.; 2023. pp. 323\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bilateral cleft lip and palate, Expansion, premaxilla, three-dimensional, Fan expander, Three-way expander","lastPublishedDoi":"10.21203/rs.3.rs-7339985/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7339985/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/sup\u003eMaxillary deficiency in the three planes characterizes cleft lip and palate (CLP) patients, requiring interceptive treatment to restore arch integrity, adding up to the total burden of care for these families. Bilateral cleft lip and palate (BCLP) present a more complex deformity, where the premaxilla can be severely malaligned requiring extensive orthopedic or surgical correction. This randomized clinical trial aimed\u003csup\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/sup\u003eto compare the effects of a new design of the three-way palatal expander and the modified fan expander in maxillary arch development in cleft lip and palate patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eTwenty patients were recruited suffering from bilateral cleft lip and palate (age from 8 to 15 years). They were divided into two groups; A) Modified Fan expander (10 patients) and B) Three-way palatal expander (10 patients). Cephalometric radiographs were taken before expansion (T0) and after expansion was completed (T1) and were digitized and analyzed using a special orthodontic tracing software program. Dolphin Ver. 11.5 (Dolphin Imaging and Management Solutions, Chatsworth, Calif. USA) was used in this study. Statistical analysis through Paired t-test was used to evaluate the changes in each group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAnalysis of cephalometric radiographs showed positive statistically significant differences in maxillary length and dental measurements of both groups, where all incisor measurements increased significantly. Group (A) showed significantly greater increase in anteroposterior position of maxilla and showed distal molar movement and tipping.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBoth the fan expander with palatal springs and three-way expander can widen and lengthen maxilla of BCLP patients simultaneously, decreasing the burden of care of these patients by their families through using just one appliance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eClinicalTrials.gov Identifier: NCT07056296 (https://clinicaltrials.gov/); June 29, 2025, retrospective registration.\u003c/p\u003e","manuscriptTitle":"Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-05 13:47:30","doi":"10.21203/rs.3.rs-7339985/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75eebce9-7cbe-42a2-8a25-a825e8d7be33","owner":[],"postedDate":"September 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-16T10:38:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-05 13:47:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7339985","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7339985","identity":"rs-7339985","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}