Finite element analysis of class III treatment effects with bone-anchored maxillary protraction (BAMP) and tooth-borne Carriere Motion Appliance

The aim of this study was to comparatively evaluate the biomechanical effects of two different orthodontic approaches used in the treatment of skeletal Class III malocclusions Bone-Anchored Maxillary Protraction (BAMP) and the tooth-borne Carriere Motion Class III (CM3) appliance on craniofacial structures, teeth, and sutures by means of three-dimensional finite element analysis (FEA). A three-dimensional craniofacial model was reconstructed using cone-beam computed tomography (CBCT) data, and two distinct treatment scenarios were simulated. In the first model, the CM3 appliance with intermaxillary elastics was applied; in the second model, the BAMP system was simulated with miniplates placed bilaterally in the infrazygomatic crests of the maxilla and in the mandibular symphyseal region. Orthopedic elastic forces representing average clinical conditions were applied as 350 g for the CM3 model and 250 g for the BAMP model, directed between the maxillary and mandibular anchorage points. The analysis demonstrated that the BAMP system produced a more pronounced anterior displacement of the maxilla, achieved a more homogeneous stress distribution along the maxillary sutures, and induced minimal counteractive response in the mandible. In contrast, the CM3 appliance generated greater dental movement and stress concentration within the alveolar regions, with limited skeletal effects. Von Mises stress analyses revealed that stresses were predominantly concentrated in the anterolateral regions of the maxilla and at sutural junctions in the BAMP group, whereas in the CM3 group, stresses were mainly localized in the periodontal regions of the teeth. In conclusion, the findings indicate that the BAMP system provides a more effective and controlled skeletal protraction in the treatment of Class III malocclusion, while the Carriere Motion appliance primarily produces dental-level changes. These results suggest that skeletal anchorage–based maxillary protraction offers superior biomechanical efficiency compared to conventional tooth-borne approaches, particularly in patients with limited or completed craniofacial growth.