BAMP & MAMP — Skeletal Maxillary Protraction Explained
> DISCLAIMER: This is an educational write-up about orthodontic treatment. I am researching this under the supervision of a professional orthodontist, and my own treatment decisions are being made with professional clinical oversight. This post is not a substitute for an orthodontic examination or personalised medical advice. Don't DNR your orthodontist because some dude on .org posted a cephalometric measurement.
---
INTRODUCTION
This article is about two forms of skeletal maxillary protraction:
BAMP — Bone-Anchored Maxillary Protraction
MAMP — Miniscrew-Anchored Maxillary Protraction
Both are orthodontic/orthopaedic approaches designed primarily to treat skeletal Class III malocclusion, particularly when the Class III relationship is associated with a deficient or retrusive maxilla.
The important distinction between these treatments and conventional tooth-borne protraction is where the protraction force is anchored.
With conventional facemask therapy, forces are transmitted substantially through the teeth and dental structures. With skeletal anchorage, the objective is to transmit the force through bone anchorage, allowing the treatment to produce a greater skeletal component while reducing some unwanted dental compensation.
That does not mean that BAMP or MAMP simply grabs the entire maxilla and moves it forward like a Lego brick. The observed response is a combination of skeletal displacement, growth modification, remodelling and dental changes.
So, unfortunately, there is no “+5 mm maxilla” button.
---
WHY WOULD MAXILLARY PROTRACTION BE USED?
The most established indication is skeletal Class III malocclusion caused partly or predominantly by maxillary deficiency.
Class III malocclusion describes a sagittal discrepancy in which the lower jaw/teeth are positioned relatively forward compared with the upper jaw/teeth. This can result from:
maxillary retrusion/deficiency;
mandibular prognathism;
or a combination of both.
A dental Class III appearance does not automatically mean the maxilla is deficient. This distinction is important because the appropriate treatment depends on the underlying skeletal pattern.
A patient can therefore have an underbite without being an appropriate candidate for maxillary protraction.
The assessment normally involves clinical examination alongside orthodontic records such as photographs, dental models/scans and cephalometric radiographs. Additional imaging such as CBCT may be indicated in particular circumstances, but it is not something that should automatically be obtained simply because someone wants to investigate their facial structure.
The aim is to determine what is actually causing the malocclusion before deciding what, if anything, should be done about it.
---
WHAT EXACTLY IS BEING PROTRACTED?
This is probably the most important concept in the entire post.
Maxillary protraction is not synonymous with moving the upper teeth forward.
The maxilla is a complex skeletal structure forming much of the middle third of the facial skeleton. In a growing patient with maxillary deficiency, orthopaedic protraction attempts to influence the position and growth of the maxillofacial complex.
However, even with skeletal anchorage, the treatment response isn't exclusively skeletal.
Research examining BAMP and MAMP demonstrates changes in cephalometric measurements associated with maxillary position and the sagittal jaw relationship, but these measurements should not be interpreted as literal measurements of “how many millimetres the entire maxilla moved forward.”
This distinction matters because some online discussions treat a change in SNA, ANB or Wits as though it directly represents a specific amount of forward movement of the whole midface.
It doesn't.
Cephalometrics is based on measurements and landmarks, not a facial displacement meter.
---
BAMP — BONE-ANCHORED MAXILLARY PROTRACTION
BAMP is one of the best-known skeletal-anchorage approaches to maxillary protraction.
The classic BAMP protocol uses titanium miniplates surgically attached to the facial skeleton. Anchorage is established in both the maxillary and mandibular regions, and intermaxillary Class III elastics are subsequently used to apply a forward-directed force to the maxilla relative to the mandible.
The major theoretical advantage is that the elastics are attached to skeletal anchorage rather than relying primarily on the teeth.
This allows the orthodontist to reduce some of the dental side effects associated with conventional facemask treatment.
The original clinical research on BAMP demonstrated measurable dentofacial changes in growing Class III patients, and subsequent studies have investigated the technique extensively.
Installation
Unlike ordinary orthodontic brackets, BAMP requires a minor surgical procedure to place the miniplates.
The exact placement depends on the protocol, but the plates are secured to suitable areas of the maxillary and mandibular facial skeleton. After healing, elastics can be attached between the upper and lower anchorage points.
Because this involves a surgical procedure and implanted hardware, BAMP has considerations that conventional orthodontic appliances do not.
This is one of the major trade-offs:
more skeletal anchorage → more invasive installation.
---
MAMP — MINISCREW-ANCHORED MAXILLARY PROTRACTION
MAMP uses orthodontic miniscrews/miniscrew-supported appliances to create skeletal anchorage for maxillary protraction.
However, there isn't one universally identical “MAMP appliance.”
Different published protocols use different combinations of skeletal anchorage and orthodontic appliances. For example, one randomized controlled trial used a hybrid hyrax in the maxilla and a bone-supported mandibular bar, with full-time Class III elastics.
This means that when someone says:
> “I'm getting MAMP”
that alone doesn't tell you exactly what appliance configuration they're getting.
The common principle is skeletal anchorage.
Instead of relying predominantly on the teeth to resist the protraction force, miniscrews/bone-supported components provide anchorage closer to the skeletal structures being treated.
---
BAMP VS MAMP
BAMPMAMP
Full nameBone-Anchored Maxillary ProtractionMiniscrew-Anchored Maxillary Protraction
Main purposeSkeletal Class III/maxillary deficiencySkeletal Class III/maxillary deficiency
AnchorageUsually titanium miniplatesMiniscrew/bone-supported anchorage
Surgical placementYesDepends on the appliance/protocol
ElasticsCommonly Class III elasticsCommonly Class III elastics
Main theoretical advantageStrong skeletal anchorageSkeletal anchorage with less invasive hardware in some protocols
Main drawbackSurgical procedureMiniscrew/anchorage limitations
EvidenceRelatively extensiveGrowing evidence base
A 2022 systematic review and network meta-analysis examined different bone-anchored maxillary protraction approaches and found that bone-anchored approaches generally produced greater skeletal changes and fewer some dental effects than tooth-anchored approaches. However, the authors also highlighted differences between protocols and the limitations of the evidence.
More recent evidence continues to support skeletal-anchored approaches, but the literature still doesn't justify treating every BAMP/MAMP protocol as interchangeable.
---
EFFECTIVENESS — DOES IT ACTUALLY WORK?
Short answer:
Yes, there is evidence that skeletal maxillary protraction can produce genuine skeletal changes.
The more complicated answer is how much, in whom, and compared with what?
A 2021 systematic review and meta-analysis of BAMP identified 28 eligible studies. It found evidence of maxillary advancement, but rated the overall evidence supporting the magnitude of the effect as relatively low and noted substantial heterogeneity between studies. The authors also warned that some published results may have appeared more positive because similar patient samples were reported repeatedly.
This is an important reality check.
If someone posts:
> “BAMP = +4 mm maxilla guaranteed”
DNR.
The biological response isn't that predictable.
---
More recent BAMP evidence
A particularly important study is the 2024 multicentre randomized controlled trial examining BAMP in children aged 11–14 with skeletal Class III malocclusion.
The trial compared BAMP with an untreated control group and assessed skeletal, dental and other outcomes over time. It found significantly greater improvements in skeletal/dental measures in the BAMP group, supporting the idea that BAMP can modify the developing Class III relationship in appropriately selected growing patients.
This is particularly useful evidence because randomized controlled trials are considerably stronger than simply looking at before-and-after photographs.
---
WHAT ABOUT MAMP?
MAMP also has controlled clinical evidence behind it.
A randomized controlled trial involving 40 growing patients with Class III malocclusion and maxillary deficiency compared MAMP with an untreated control group. The treatment protocol used a hybrid hyrax in the maxilla, a bone-supported mandibular bar and Class III elastics.
The study found significant dentofacial changes associated with MAMP compared with untreated growth.
More recently, a 2026 systematic review specifically examining MAMP combined with the Alt-RAMEC protocol identified seven controlled studies, including six RCTs. The review found evidence of greater maxillary advancement in MAMP/Alt-RAMEC groups compared with untreated controls, while also emphasizing substantial heterogeneity and low-to-moderate certainty for many outcomes.
So MAMP isn't some experimental .org invention.
The literature is real.
The internet just occasionally explains it like it's a cheat code.
---
WHY DOES AGE/GROWTH MATTER?
Growth is an important factor in orthopaedic maxillary protraction.
The objective in a growing patient is not simply to physically reposition an already mature facial skeleton. Treatment is intended to modify the developing dentofacial relationship while growth is occurring.
This is one reason skeletal Class III treatment is often considered during childhood or adolescence rather than simply waiting until skeletal maturity.
However, “still growing” does not mean:
> “I have unlimited maxillary forward-growth potential.”
Growth patterns vary enormously between individuals.
A patient's skeletal maturity, growth direction, severity of maxillary deficiency, mandibular growth pattern and dental relationship all influence treatment planning.
Therefore, the fact that someone is 15, for example, is not by itself enough information to determine whether BAMP or MAMP would work for them.
---
BAMP/MAMP AND THE AIRWAY
This is where things get particularly interesting.
Some studies have investigated changes in upper-airway dimensions following skeletal maxillary protraction.
For example, a randomized controlled trial examining MAMP with hybrid/hyrax expanders found changes in upper-airway measurements following treatment.
However, airway volume ≠ airway function.
A CBCT showing a larger airway does not automatically mean:
sleep apnea has been cured;
breathing will definitely improve;
snoring will disappear;
or someone should receive maxillary protraction solely for airway purposes.
Airway disorders are multifactorial and require their own clinical assessment.
Therefore, I would describe airway changes as a potential secondary effect being investigated in the literature, rather than as a primary indication for BAMP/MAMP.
---
LIMITATIONS AND RISKS
Neither treatment is risk-free.
BAMP
Because BAMP requires surgical placement of miniplates, potential complications include:
postoperative discomfort;
infection/inflammation;
soft-tissue irritation;
hardware problems;
loosening or failure of the anchorage;
and the need for another procedure if hardware needs to be removed or replaced.
The exact complication rate depends on the surgical technique, patient anatomy, hygiene and other clinical factors.
MAMP
MAMP generally involves less invasive skeletal anchorage than surgically placed miniplates, depending on the specific protocol.
However, miniscrews aren't magic titanium tentacles.
Potential problems include:
discomfort;
inflammation around the screw;
loosening;
failure of anchorage;
soft-tissue irritation;
and the need for replacement or adjustment.
The specific risk profile depends heavily on the appliance and location of the miniscrews.
---
DENTAL SIDE EFFECTS
One of the major reasons skeletal anchorage is interesting is the possibility of reducing unwanted dental compensation.
Traditional tooth-borne maxillary protraction can produce dental effects because the force is transmitted through the teeth.
Bone-anchored approaches attempt to shift more of the treatment effect toward the skeleton.
A network meta-analysis found that bone-anchored interventions produced greater skeletal changes than tooth-anchored approaches while producing fewer increases in some dental measurements.
However:
“fewer dental effects” ≠ “zero dental effects.”
Teeth can still move.
The final result is a dentofacial response involving both skeletal and dental components.
---
BAMP/MAMP IS NOT THE SAME THING AS “FORWARD FACE SURGERY”
This is another distinction that gets lost online.
BAMP and MAMP are growth-modification/orthodontic treatments.
They are not equivalent to Le Fort surgery or mandibular surgery.
The objective is to influence the developing skeletal relationship during growth rather than surgically repositioning a fully developed facial skeleton.
Consequently, the magnitude of change is constrained by biology.
Someone with severe skeletal discrepancy should not assume that BAMP can necessarily eliminate the future need for orthognathic surgery.
Interestingly, the 2024 BAMP RCT did report a reduced perceived need for orthognathic surgery in the treated group at follow-up, but this does not mean BAMP guarantees that surgery will be avoided in every patient.
---
SO WHICH ONE IS BETTER?
There isn't a universal answer.
BAMP has a relatively mature evidence base and provides very strong skeletal anchorage through miniplates, but requires a surgical procedure.
MAMP can provide skeletal anchorage through miniscrew-supported appliances and may offer a less invasive approach depending on the specific configuration, but the terminology covers several different protocols and the evidence base is still developing.
A recent systematic review and meta-analysis comparing different bone-borne protraction protocols found that approaches combining skeletal anchorage with expansion and maxillary protraction can produce substantial skeletal effects, but the evidence quality ranged from low to moderate.
Therefore, asking:
> “BAMP or MAMP?”
without looking at the patient's actual skeletal anatomy is basically asking:
> “Which suspension setup is better?”
without knowing what car we're building.
---
WHAT SHOULD ACTUALLY BE ASSESSED?
For somebody being considered for skeletal maxillary protraction, the important questions aren't:
> “How recessed do I look?”
or
> “Can I get +3 mm SNA?”
Instead, the clinician should establish:
1. Is there actually maxillary deficiency?
2. How much of the Class III relationship comes from the maxilla vs the mandible?
3. What is the patient's skeletal maturity/growth status?
4. What is the vertical growth pattern?
5. What is the dental compensation already present?
6. Is there transverse maxillary deficiency?
7. What is the periodontal status?
8. What treatment alternatives exist?
9. What are the realistic expected skeletal and dental changes?
10. Would treatment meaningfully improve the patient's function/occlusion?
Only after those questions are answered does it make sense to discuss the specific appliance.
---
CONCLUSION
BAMP and MAMP are legitimate skeletal-anchored orthodontic approaches for appropriately selected growing patients with skeletal Class III malocclusion, particularly when maxillary deficiency is a significant component.
The fundamental concept is simple:
apply protraction forces through skeletal anchorage rather than relying predominantly on the teeth.
The evidence supports real skeletal effects, but the magnitude of those effects varies considerably between patients and treatment protocols.
BAMP has a relatively extensive research history, while MAMP has a growing evidence base including randomized controlled trials and recent systematic reviews.
Neither treatment should be viewed as a guaranteed facial-aesthetic transformation, an automatic cure for airway problems, or a universal solution to every Class III bite.
The most important factor is patient selection.
If the underlying problem is genuinely maxillary deficiency in a growing patient, skeletal maxillary protraction can be a powerful orthodontic tool.
If the underlying problem is primarily mandibular prognathism, dental compensation, a transverse discrepancy, or something else entirely, maxillary protraction may not be the appropriate solution.
Basically:
Don't diagnose yourself from a mirror, don't prescribe yourself an appliance from a PubMed abstract, and don't DNR professional orthodontic assessment.
The goal should be to identify the actual skeletal problem first and then select the least invasive treatment capable of addressing it.
---
REFERENCES
[1] Cornelis MA, Tepedino M, de Vos Riis N, Niu X, Cattaneo PM. Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis. European Journal of Orthodontics. 2021;43(1):51–68. [PubMed](https://pubmed.ncbi.nlm.nih.gov/32815989/)
[2] Mandall N, et al. The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11–14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial. 2024. [PubMed](https://pubmed.ncbi.nlm.nih.gov/38845172/)
[3] Wang J, Yang Y, Wang Y, et al. Clinical effectiveness of different types of bone-anchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis. Korean Journal of Orthodontics. 2022;52(5):313–323. [PubMed](https://pubmed.ncbi.nlm.nih.gov/35844098/)
[4] Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial. [PubMed](https://pubmed.ncbi.nlm.nih.gov/37303011/)
[5] Miranda F, Garib D, Pugliese F, et al. Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial. [PubMed](https://pubmed.ncbi.nlm.nih.gov/34041608/)
[6] Kathem SJ, Pedersen TK. Treatment modalities in bone-borne maxillary protraction in children with maxillary retrognathism: a systematic review and meta-analysis. European Journal of Orthodontics. 2025. [PubMed](https://pubmed.ncbi.nlm.nih.gov/40539254/)
[7] Skeletal and dental effects of Alt-RAMEC protocol combined with miniscrew-anchored maxillary protraction in Class III children and adolescents: a systematic review. 2026. [PubMed](https://pubmed.ncbi.nlm.nih.gov/41839333/)
---
Sources copy pasted...
If you read this to the end thanks bro love you all WE are ascending cause ITS BEGUN pls show support one way or another
> DISCLAIMER: This is an educational write-up about orthodontic treatment. I am researching this under the supervision of a professional orthodontist, and my own treatment decisions are being made with professional clinical oversight. This post is not a substitute for an orthodontic examination or personalised medical advice. Don't DNR your orthodontist because some dude on .org posted a cephalometric measurement.
---
INTRODUCTION
This article is about two forms of skeletal maxillary protraction:
BAMP — Bone-Anchored Maxillary Protraction
MAMP — Miniscrew-Anchored Maxillary Protraction
Both are orthodontic/orthopaedic approaches designed primarily to treat skeletal Class III malocclusion, particularly when the Class III relationship is associated with a deficient or retrusive maxilla.
The important distinction between these treatments and conventional tooth-borne protraction is where the protraction force is anchored.
With conventional facemask therapy, forces are transmitted substantially through the teeth and dental structures. With skeletal anchorage, the objective is to transmit the force through bone anchorage, allowing the treatment to produce a greater skeletal component while reducing some unwanted dental compensation.
That does not mean that BAMP or MAMP simply grabs the entire maxilla and moves it forward like a Lego brick. The observed response is a combination of skeletal displacement, growth modification, remodelling and dental changes.
So, unfortunately, there is no “+5 mm maxilla” button.
---
WHY WOULD MAXILLARY PROTRACTION BE USED?
The most established indication is skeletal Class III malocclusion caused partly or predominantly by maxillary deficiency.
Class III malocclusion describes a sagittal discrepancy in which the lower jaw/teeth are positioned relatively forward compared with the upper jaw/teeth. This can result from:
maxillary retrusion/deficiency;
mandibular prognathism;
or a combination of both.
A dental Class III appearance does not automatically mean the maxilla is deficient. This distinction is important because the appropriate treatment depends on the underlying skeletal pattern.
A patient can therefore have an underbite without being an appropriate candidate for maxillary protraction.
The assessment normally involves clinical examination alongside orthodontic records such as photographs, dental models/scans and cephalometric radiographs. Additional imaging such as CBCT may be indicated in particular circumstances, but it is not something that should automatically be obtained simply because someone wants to investigate their facial structure.
The aim is to determine what is actually causing the malocclusion before deciding what, if anything, should be done about it.
---
WHAT EXACTLY IS BEING PROTRACTED?
This is probably the most important concept in the entire post.
Maxillary protraction is not synonymous with moving the upper teeth forward.
The maxilla is a complex skeletal structure forming much of the middle third of the facial skeleton. In a growing patient with maxillary deficiency, orthopaedic protraction attempts to influence the position and growth of the maxillofacial complex.
However, even with skeletal anchorage, the treatment response isn't exclusively skeletal.
Research examining BAMP and MAMP demonstrates changes in cephalometric measurements associated with maxillary position and the sagittal jaw relationship, but these measurements should not be interpreted as literal measurements of “how many millimetres the entire maxilla moved forward.”
This distinction matters because some online discussions treat a change in SNA, ANB or Wits as though it directly represents a specific amount of forward movement of the whole midface.
It doesn't.
Cephalometrics is based on measurements and landmarks, not a facial displacement meter.
---
BAMP — BONE-ANCHORED MAXILLARY PROTRACTION
BAMP is one of the best-known skeletal-anchorage approaches to maxillary protraction.
The classic BAMP protocol uses titanium miniplates surgically attached to the facial skeleton. Anchorage is established in both the maxillary and mandibular regions, and intermaxillary Class III elastics are subsequently used to apply a forward-directed force to the maxilla relative to the mandible.
The major theoretical advantage is that the elastics are attached to skeletal anchorage rather than relying primarily on the teeth.
This allows the orthodontist to reduce some of the dental side effects associated with conventional facemask treatment.
The original clinical research on BAMP demonstrated measurable dentofacial changes in growing Class III patients, and subsequent studies have investigated the technique extensively.
Installation
Unlike ordinary orthodontic brackets, BAMP requires a minor surgical procedure to place the miniplates.
The exact placement depends on the protocol, but the plates are secured to suitable areas of the maxillary and mandibular facial skeleton. After healing, elastics can be attached between the upper and lower anchorage points.
Because this involves a surgical procedure and implanted hardware, BAMP has considerations that conventional orthodontic appliances do not.
This is one of the major trade-offs:
more skeletal anchorage → more invasive installation.
---
MAMP — MINISCREW-ANCHORED MAXILLARY PROTRACTION
MAMP uses orthodontic miniscrews/miniscrew-supported appliances to create skeletal anchorage for maxillary protraction.
However, there isn't one universally identical “MAMP appliance.”
Different published protocols use different combinations of skeletal anchorage and orthodontic appliances. For example, one randomized controlled trial used a hybrid hyrax in the maxilla and a bone-supported mandibular bar, with full-time Class III elastics.
This means that when someone says:
> “I'm getting MAMP”
that alone doesn't tell you exactly what appliance configuration they're getting.
The common principle is skeletal anchorage.
Instead of relying predominantly on the teeth to resist the protraction force, miniscrews/bone-supported components provide anchorage closer to the skeletal structures being treated.
---
BAMP VS MAMP
BAMPMAMP
Full nameBone-Anchored Maxillary ProtractionMiniscrew-Anchored Maxillary Protraction
Main purposeSkeletal Class III/maxillary deficiencySkeletal Class III/maxillary deficiency
AnchorageUsually titanium miniplatesMiniscrew/bone-supported anchorage
Surgical placementYesDepends on the appliance/protocol
ElasticsCommonly Class III elasticsCommonly Class III elastics
Main theoretical advantageStrong skeletal anchorageSkeletal anchorage with less invasive hardware in some protocols
Main drawbackSurgical procedureMiniscrew/anchorage limitations
EvidenceRelatively extensiveGrowing evidence base
A 2022 systematic review and network meta-analysis examined different bone-anchored maxillary protraction approaches and found that bone-anchored approaches generally produced greater skeletal changes and fewer some dental effects than tooth-anchored approaches. However, the authors also highlighted differences between protocols and the limitations of the evidence.
More recent evidence continues to support skeletal-anchored approaches, but the literature still doesn't justify treating every BAMP/MAMP protocol as interchangeable.
---
EFFECTIVENESS — DOES IT ACTUALLY WORK?
Short answer:
Yes, there is evidence that skeletal maxillary protraction can produce genuine skeletal changes.
The more complicated answer is how much, in whom, and compared with what?
A 2021 systematic review and meta-analysis of BAMP identified 28 eligible studies. It found evidence of maxillary advancement, but rated the overall evidence supporting the magnitude of the effect as relatively low and noted substantial heterogeneity between studies. The authors also warned that some published results may have appeared more positive because similar patient samples were reported repeatedly.
This is an important reality check.
If someone posts:
> “BAMP = +4 mm maxilla guaranteed”
DNR.
The biological response isn't that predictable.
---
More recent BAMP evidence
A particularly important study is the 2024 multicentre randomized controlled trial examining BAMP in children aged 11–14 with skeletal Class III malocclusion.
The trial compared BAMP with an untreated control group and assessed skeletal, dental and other outcomes over time. It found significantly greater improvements in skeletal/dental measures in the BAMP group, supporting the idea that BAMP can modify the developing Class III relationship in appropriately selected growing patients.
This is particularly useful evidence because randomized controlled trials are considerably stronger than simply looking at before-and-after photographs.
---
WHAT ABOUT MAMP?
MAMP also has controlled clinical evidence behind it.
A randomized controlled trial involving 40 growing patients with Class III malocclusion and maxillary deficiency compared MAMP with an untreated control group. The treatment protocol used a hybrid hyrax in the maxilla, a bone-supported mandibular bar and Class III elastics.
The study found significant dentofacial changes associated with MAMP compared with untreated growth.
More recently, a 2026 systematic review specifically examining MAMP combined with the Alt-RAMEC protocol identified seven controlled studies, including six RCTs. The review found evidence of greater maxillary advancement in MAMP/Alt-RAMEC groups compared with untreated controls, while also emphasizing substantial heterogeneity and low-to-moderate certainty for many outcomes.
So MAMP isn't some experimental .org invention.
The literature is real.
The internet just occasionally explains it like it's a cheat code.
---
WHY DOES AGE/GROWTH MATTER?
Growth is an important factor in orthopaedic maxillary protraction.
The objective in a growing patient is not simply to physically reposition an already mature facial skeleton. Treatment is intended to modify the developing dentofacial relationship while growth is occurring.
This is one reason skeletal Class III treatment is often considered during childhood or adolescence rather than simply waiting until skeletal maturity.
However, “still growing” does not mean:
> “I have unlimited maxillary forward-growth potential.”
Growth patterns vary enormously between individuals.
A patient's skeletal maturity, growth direction, severity of maxillary deficiency, mandibular growth pattern and dental relationship all influence treatment planning.
Therefore, the fact that someone is 15, for example, is not by itself enough information to determine whether BAMP or MAMP would work for them.
---
BAMP/MAMP AND THE AIRWAY
This is where things get particularly interesting.
Some studies have investigated changes in upper-airway dimensions following skeletal maxillary protraction.
For example, a randomized controlled trial examining MAMP with hybrid/hyrax expanders found changes in upper-airway measurements following treatment.
However, airway volume ≠ airway function.
A CBCT showing a larger airway does not automatically mean:
sleep apnea has been cured;
breathing will definitely improve;
snoring will disappear;
or someone should receive maxillary protraction solely for airway purposes.
Airway disorders are multifactorial and require their own clinical assessment.
Therefore, I would describe airway changes as a potential secondary effect being investigated in the literature, rather than as a primary indication for BAMP/MAMP.
---
LIMITATIONS AND RISKS
Neither treatment is risk-free.
BAMP
Because BAMP requires surgical placement of miniplates, potential complications include:
postoperative discomfort;
infection/inflammation;
soft-tissue irritation;
hardware problems;
loosening or failure of the anchorage;
and the need for another procedure if hardware needs to be removed or replaced.
The exact complication rate depends on the surgical technique, patient anatomy, hygiene and other clinical factors.
MAMP
MAMP generally involves less invasive skeletal anchorage than surgically placed miniplates, depending on the specific protocol.
However, miniscrews aren't magic titanium tentacles.
Potential problems include:
discomfort;
inflammation around the screw;
loosening;
failure of anchorage;
soft-tissue irritation;
and the need for replacement or adjustment.
The specific risk profile depends heavily on the appliance and location of the miniscrews.
---
DENTAL SIDE EFFECTS
One of the major reasons skeletal anchorage is interesting is the possibility of reducing unwanted dental compensation.
Traditional tooth-borne maxillary protraction can produce dental effects because the force is transmitted through the teeth.
Bone-anchored approaches attempt to shift more of the treatment effect toward the skeleton.
A network meta-analysis found that bone-anchored interventions produced greater skeletal changes than tooth-anchored approaches while producing fewer increases in some dental measurements.
However:
“fewer dental effects” ≠ “zero dental effects.”
Teeth can still move.
The final result is a dentofacial response involving both skeletal and dental components.
---
BAMP/MAMP IS NOT THE SAME THING AS “FORWARD FACE SURGERY”
This is another distinction that gets lost online.
BAMP and MAMP are growth-modification/orthodontic treatments.
They are not equivalent to Le Fort surgery or mandibular surgery.
The objective is to influence the developing skeletal relationship during growth rather than surgically repositioning a fully developed facial skeleton.
Consequently, the magnitude of change is constrained by biology.
Someone with severe skeletal discrepancy should not assume that BAMP can necessarily eliminate the future need for orthognathic surgery.
Interestingly, the 2024 BAMP RCT did report a reduced perceived need for orthognathic surgery in the treated group at follow-up, but this does not mean BAMP guarantees that surgery will be avoided in every patient.
---
SO WHICH ONE IS BETTER?
There isn't a universal answer.
BAMP has a relatively mature evidence base and provides very strong skeletal anchorage through miniplates, but requires a surgical procedure.
MAMP can provide skeletal anchorage through miniscrew-supported appliances and may offer a less invasive approach depending on the specific configuration, but the terminology covers several different protocols and the evidence base is still developing.
A recent systematic review and meta-analysis comparing different bone-borne protraction protocols found that approaches combining skeletal anchorage with expansion and maxillary protraction can produce substantial skeletal effects, but the evidence quality ranged from low to moderate.
Therefore, asking:
> “BAMP or MAMP?”
without looking at the patient's actual skeletal anatomy is basically asking:
> “Which suspension setup is better?”
without knowing what car we're building.
---
WHAT SHOULD ACTUALLY BE ASSESSED?
For somebody being considered for skeletal maxillary protraction, the important questions aren't:
> “How recessed do I look?”
or
> “Can I get +3 mm SNA?”
Instead, the clinician should establish:
1. Is there actually maxillary deficiency?
2. How much of the Class III relationship comes from the maxilla vs the mandible?
3. What is the patient's skeletal maturity/growth status?
4. What is the vertical growth pattern?
5. What is the dental compensation already present?
6. Is there transverse maxillary deficiency?
7. What is the periodontal status?
8. What treatment alternatives exist?
9. What are the realistic expected skeletal and dental changes?
10. Would treatment meaningfully improve the patient's function/occlusion?
Only after those questions are answered does it make sense to discuss the specific appliance.
---
CONCLUSION
BAMP and MAMP are legitimate skeletal-anchored orthodontic approaches for appropriately selected growing patients with skeletal Class III malocclusion, particularly when maxillary deficiency is a significant component.
The fundamental concept is simple:
apply protraction forces through skeletal anchorage rather than relying predominantly on the teeth.
The evidence supports real skeletal effects, but the magnitude of those effects varies considerably between patients and treatment protocols.
BAMP has a relatively extensive research history, while MAMP has a growing evidence base including randomized controlled trials and recent systematic reviews.
Neither treatment should be viewed as a guaranteed facial-aesthetic transformation, an automatic cure for airway problems, or a universal solution to every Class III bite.
The most important factor is patient selection.
If the underlying problem is genuinely maxillary deficiency in a growing patient, skeletal maxillary protraction can be a powerful orthodontic tool.
If the underlying problem is primarily mandibular prognathism, dental compensation, a transverse discrepancy, or something else entirely, maxillary protraction may not be the appropriate solution.
Basically:
Don't diagnose yourself from a mirror, don't prescribe yourself an appliance from a PubMed abstract, and don't DNR professional orthodontic assessment.
The goal should be to identify the actual skeletal problem first and then select the least invasive treatment capable of addressing it.
---
REFERENCES
[1] Cornelis MA, Tepedino M, de Vos Riis N, Niu X, Cattaneo PM. Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis. European Journal of Orthodontics. 2021;43(1):51–68. [PubMed](https://pubmed.ncbi.nlm.nih.gov/32815989/)
[2] Mandall N, et al. The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11–14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial. 2024. [PubMed](https://pubmed.ncbi.nlm.nih.gov/38845172/)
[3] Wang J, Yang Y, Wang Y, et al. Clinical effectiveness of different types of bone-anchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis. Korean Journal of Orthodontics. 2022;52(5):313–323. [PubMed](https://pubmed.ncbi.nlm.nih.gov/35844098/)
[4] Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial. [PubMed](https://pubmed.ncbi.nlm.nih.gov/37303011/)
[5] Miranda F, Garib D, Pugliese F, et al. Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial. [PubMed](https://pubmed.ncbi.nlm.nih.gov/34041608/)
[6] Kathem SJ, Pedersen TK. Treatment modalities in bone-borne maxillary protraction in children with maxillary retrognathism: a systematic review and meta-analysis. European Journal of Orthodontics. 2025. [PubMed](https://pubmed.ncbi.nlm.nih.gov/40539254/)
[7] Skeletal and dental effects of Alt-RAMEC protocol combined with miniscrew-anchored maxillary protraction in Class III children and adolescents: a systematic review. 2026. [PubMed](https://pubmed.ncbi.nlm.nih.gov/41839333/)
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Sources copy pasted...
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