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Davami K, Talma E, Harzer W, Lagravère MO. Long term skeletal and dental changes between tooth-anchored versus Dresden bone-anchored rapid maxillary expansion using CBCT images in adolescents: Randomized clinical trial. Int Orthod 2020; 18:317-329. [PMID: 32245745 DOI: 10.1016/j.ortho.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to determine long-term skeletal and dental changes in tooth-anchored versus Dresden bone-anchored rapid maxillary expansion using CBCT images in adolescents. MATERIALS AND METHODS In all, 29 adolescent patients (11-17 years of age) needing skeletal expansion were randomly allocated to two different groups treated by either a Dresden bone-anchored expander or a conventional hyrax expander. Patients included did not have previous orthodontic treatment, were non-syndromic and had all teeth present in mouth. CBCT images were taken before expansion and two or more years after expansion. An independent T-test was used to determine the statistical significance between treatment groups and paired T-test was used to compare the results before and after expansion in each group. RESULTS Neither treatment group showed overall long-term different skeletal and dental changes in the transverse, anterior-posterior and vertical planes (P<0.05). Both treatment groups showed mild asymmetric skeletal expansion, but these were clinically insignificant. CONCLUSIONS Both expanders had similar skeletal and dental results. The greatest changes were in the transverse plane. Changes in vertical and anterior-posterior were negligible.
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Affiliation(s)
| | - Elissa Talma
- University of Minas Gerais, Structural Engineering School, Minas Gerais, Brazil
| | - Winfried Harzer
- Technical University of Dresden, department of Orthodontics, Fetscherstr. 72, D-01307 Dresden, Germany
| | - Manuel O Lagravère
- University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405-87 Ave, T6G 1C9 Edmonton, AB, Canada.
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102
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Andrucioli MCD, Matsumoto MAN. Transverse maxillary deficiency: treatment alternatives in face of early skeletal maturation. Dental Press J Orthod 2020; 25:70-79. [PMID: 32215481 PMCID: PMC7077945 DOI: 10.1590/2177-6709.25.1.070-079.bbo] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 12/04/2022] Open
Abstract
Transverse deficiencies should be a priority in orthodontic treatment, and should be corrected as soon as diagnosed, to restore the correct transverse relationship between maxilla and mandible and, consequently, normal maxillary growth. Corrections may be performed at the skeletal level, by opening the midpalatal suture, or by dentoalveolar expansion. The choice of a treatment alternative depends on certain factors, such as age, sex, degree of maxillary hypoplasia and maturation of the midpalatal suture. Thus, the present study discusses different treatment approaches to correct maxillary hypoplasia in patients with advanced skeletal maturation.
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Affiliation(s)
- Marcela Cristina Damião Andrucioli
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Curso de Especialização em Ortodontia (Ribeirão Preto / SP, Brasil)
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103
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Lee SR, Lee JW, Chung DH, Lee SM. Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: A three-dimensional stereophotogrammetry study. Korean J Orthod 2020; 50:75-85. [PMID: 32257933 PMCID: PMC7093666 DOI: 10.4041/kjod.2020.50.2.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study was to evaluate changes in the nasal soft tissues, including movements of landmarks, changes in linear distances, and volumetric changes, using three-dimensional (3D) stereophotogrammetry after microimplant-assisted rapid palatal expansion (MARPE) in adult patients. Methods Facial data were scanned using a white light scanner before and after MARPE in 30 patients. In total, 7 mm of expansion was achieved over a 4-week expansion period. We determined 10 soft tissue landmarks using reverse engineering software and measured 3D vector changes at those points. In addition, we calculated the distances between points to determine changes in the width of the nasal soft tissues. The volumetric change in the nose was also measured. Results All landmarks except pronasale and subnasale showed statistically significant movement on the x-axis. Pronasale, subnasale, alar right, and alar left showed significant movement on the y-axis, while all landmarks except subnasale showed significant movement on the z-axis. The alar base width, alar width, and alar curvature width increased by 1.214, 0.932, and 0.987 mm, respectively. The average volumetric change was 993.33 mm3, and the amount of increase relative to the average initial volume was 2.96%. Conclusions The majority of soft tissue landmarks around the nasal region show significant positional changes after MARPE in adults. The nose tends to widen and move forward and downward. The post-treatment nasal volume may also exhibit a significant increase relative to the initial volume. Clinicians should thoroughly explain the anticipated changes to patients before MARPE initiation.
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Affiliation(s)
- Seung-Ryeol Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Jin-Woo Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Dong-Hwa Chung
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Sang-Min Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
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Yi F, Liu S, Lei L, Liu O, Zhang L, Peng Q, Lu Y. Changes of the upper airway and bone in microimplant-assisted rapid palatal expansion: A cone-beam computed tomography (CBCT) study. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:271-283. [PMID: 31985485 DOI: 10.3233/xst-190597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the changes of maxillary expansion and upper airway structure after microimplant assisted rapid palatal expansion (MARPE) using cone-beam computed tomography (CBCT). METHODS This retrospective study included 19 subjects (15 females and 4 males) aged 15-29 years old (mean, 19.95±4.39 years) with maxillary transverse deficiency treated with MARPE. CBCT was performed at the initial diagnosis and 3 months after MARPE treatment. Measurements were taken to evaluate the amount of total expansion, skeletal expansion, and dental expansion at the maxillary first premolar (P1), second premolar (P2), first molar (M1), second molar (M2) regions and upper airway changes. RESULTS After MARPE treatment, the maxillary skeletal base expansion, skeletal expansion, alveolar expansion and dental expansion were achieved at the P1, P2, M1, M2 region. The nasopharyngeal volume significantly increased 8.48% after MARPE treatment compared with that before the treatment (P < 0.05). The change of nasal lateral width (NLW) was also significantly different before and after MARPE (P < 0.05). However, there were no statistically significant change in the oropharyngeal, palatopharyngeal, glossopharyngeal and airway total volume (all P > 0.05). CONCLUSIONS MARPE can produce more transverse bone expansion, relieve maxillary transverse deficiency and improve upper airway ventilation.
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Affiliation(s)
- Fang Yi
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Siling Liu
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Lei Lei
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Ousheng Liu
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Lingling Zhang
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Qian Peng
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yanqin Lu
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
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105
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Three-dimensional changes of the zygomaticomaxillary complex after mini-implant assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2019; 156:653-662. [PMID: 31677674 DOI: 10.1016/j.ajodo.2018.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to investigate 3-dimensional changes of the zygomaticomaxillary complex (ZMC) after mini-implant assisted rapid maxillary expansion (MARME). METHODS A total of 15 pairs of cone-beam computed tomography 3-dimensional images taken before expansion (T0) and after expansion (T1) were analyzed by measuring changes in the coordinates of the landmarks of the ZMC. RESULTS Changes in the x coordinates of the landmarks showed significant expansion (P <0.01) and greater expansion at the lower than upper portion of the ZMC (P <0.05) in the transverse dimension. All y coordinates of the landmarks except the jugal point (J) showed forward displacement (P <0.05), and the z coordinates of ANS, PNS, Alare, A, and ectocanine showed downward displacement (P <0.01) in the sagittal and vertical dimensions. Also, z coordinates of the landmarks that were closer to the midsagittal plane and in a more posterior portion of the ZMC displaced further downward (P <0.05). SNA and ANB angles increased (P <0.05 and P <0.001, respectively) and the SNB angle decreased (P <0.01). There was a significant correlation between changes in the x coordinates of the ectomolare and ectocanine and the amount of expansion measured from the center of resistance of the maxillary first molars (CR6; P <0.05). There was no significant correlation between the amount of CR6 expansion and changes in y and z coordinates of the landmarks. CONCLUSIONS 3-Dimensional changes of the ZMC after MARME showed expansion in a pyramidal shape from the coronal view, downward and forward displacement from the sagittal view, and parallel palatal expansion from the axial view. These findings might be useful for understanding skeletal expansion patterns using MARME.
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106
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Shin H, Hwang CJ, Lee KJ, Choi YJ, Han SS, Yu HS. Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: A preliminary study. Korean J Orthod 2019; 49:360-371. [PMID: 31815104 PMCID: PMC6883215 DOI: 10.4041/kjod.2019.49.6.360] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We sought to determine the predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion (MARPE) in young adults. METHODS The following variables were selected as possible predictors: chronological age, palate length and depth, midpalatal suture maturation (MPSM) stage, midpalatal suture density (MPSD) ratio, the sella-nasion (SN)-mandibular plane (MP) angle as an indicator of the vertical skeletal pattern, and the point A-nasion-point B (ANB) angle for anteroposterior skeletal classification. For 31 patients (mean age, 22.52 years) who underwent MARPE treatment, palate length and depth, MPSM stage and MPSD ratio from the initial cone-beam computed tomography images, and the SN-MP angle and ANB angle from lateral cephalograms were assessed. The midpalatal suture opening ratio was calculated from the midpalatal suture opening width measured in periapical radiographs and the MARPE screw expansion. Statistical analyses of correlations were performed for the entire patient group of 31 subjects and subgroups categorized by sex, vertical skeletal pattern, and anteroposterior skeletal classification. RESULTS In the entire patient group, the midpalatal suture opening ratio showed statistically significant negative correlations with age, palate length, and MPSM stage (r = -0.506, -0.494, and -0.746, respectively, all p < 0.01). In subgroup analyses, a strong negative correlation was observed with the palate depth in the skeletal Class II subgroup (r = -0.900, p < 0.05). CONCLUSIONS The findings of this study indicated that age, palate length, and MPSM stage can be predictors of midpalatal suture expansion by MARPE in young adults.
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Affiliation(s)
- Hyerin Shin
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung Seog Yu
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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107
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Krishnaswamy NR. Expansion in the absence of crossbite – rationale and protocol. APOS TRENDS IN ORTHODONTICS 2019. [DOI: 10.25259/apos_115_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transverse maxillomandibular discrepancies are a major component of several malocclusions. Clinically, posterior crossbite is a common and valid indicator of maxillary transverse problems and orthopedic and orthodontic forces are routinely used to correct maxillary transverse deficiency. However, crossbite and transverse discrepancies are not a homologous group but must be viewed as a continuum with varying degree of abnormality. The etiology, diagnostic protocol, rationale, and procedures employed for correcting maxillary transverse discrepancy in the absence of crossbite are discussed in the article.
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108
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Bloomquist DS, Joondeph DR. Orthognathic surgical procedures on non-growing patients with maxillary transverse deficiency. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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109
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Guerrero-Vargas JA, Silva TA, Macari S, de Las Casas EB, Garzón-Alvarado DA. Influence of interdigitation and expander type in the mechanical response of the midpalatal suture during maxillary expansion. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 176:195-209. [PMID: 31200906 DOI: 10.1016/j.cmpb.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The orthopedic Maxillary Expansion (ME) procedure is used for treating the transverse maxillary deficiency. This pathology consists in a smaller transverse dimension in the maxilla and leads to malocclusion. The treatment takes advantage of the existence of the midpalatal suture (MPS), which corresponds to the junction at the palatine bones of its horizontal portions. The technique employs a device, conventionally a palatal expander attached to the posterior teeth, to separate the two maxillary bones in the MPS. The objective of this study was to analyze, using the Finite Element Method, the biomechanical behavior of the MPS when an expansion is applied. METHODS A Computer Tomography image of the maxilla was reconstructed, the suture geometry was modeled with different interdigitation levels and types of hyrax devices. A total of 12 geometric models (three levels for interdigitation and four types of hyrax devices) were prepared and analyzed taking into account the chewing forces and the expansion displacement. For each case, maximum principal stresses on the maxilla (bone), and equivalent stresses on the expander device (stainless steel) were observed. In the MPS, maximum principal stresses and directional displacement were evaluated. RESULTS The results showed that the interdigitation does not have an important influence on the deformation behavior of the maxilla but it affects the stress distribution. In addition, the type of expander device and anchorage have a direct relationship with the treatment effectiveness; larger deformation in the expansion direction was obtained with skeletal when compared to dental anchorage. CONCLUSIONS A study that allows a better understanding of the oral biomechanics during the application of ME was presented. To our knowledge, it is the first study based on computational simulations that takes into account bone structures, like maxilla and part of the skull, to analyze the interdigitation influence on the MPS behavior when exposed to a ME.
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Affiliation(s)
- J A Guerrero-Vargas
- Department of Mechanical and Mechatronic Engineering, Faculty of Engineering, Universidad Nacional de Colombia, Bogotá, Colombia; Department of Mechanical Engineering, School of Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Mechanical Engineering, Faculty of Engineering, Universidad ECCI, Bogotá, Colombia.
| | - T A Silva
- Department of Clinical, Pathology and Dental Surgery, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - S Macari
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - E B de Las Casas
- Department of Structural Engineering, School of Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - D A Garzón-Alvarado
- Department of Mechanical and Mechatronic Engineering, Faculty of Engineering, Universidad Nacional de Colombia, Bogotá, Colombia
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Nojima LI, Nojima MDCG, Cunha ACD, Guss NO, Sant'Anna EF. Mini-implant selection protocol applied to MARPE. Dental Press J Orthod 2019; 23:93-101. [PMID: 30427498 PMCID: PMC6266324 DOI: 10.1590/2177-6709.23.5.093-101.sar] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010. Objective: This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.
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Affiliation(s)
- Lincoln Issamu Nojima
- Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil)
| | | | - Amanda Carneiro da Cunha
- Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil)
| | - Natan Oliveira Guss
- Universidade Federal do Rio de Janeiro, Post-graduation Program in Orthodontics (Rio de Janeiro/RJ, Brazil)
| | - Eduardo Franzotti Sant'Anna
- Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil)
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111
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Garcez AS, Suzuki SS, Storto CJ, Cusmanich KG, Elkenawy I, Moon W. Effects of maxillary skeletal expansion on respiratory function and sport performance in a para-athlete – A case report. Phys Ther Sport 2019; 36:70-77. [DOI: 10.1016/j.ptsp.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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112
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Kavand G, Lagravère M, Kula K, Stewart K, Ghoneima A. Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion. Angle Orthod 2019; 89:566-574. [PMID: 30768911 DOI: 10.2319/070818-507.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare changes in upper airway volume after maxillary expansion with bone- and tooth-borne appliances in adolescents and to evaluate the dentoskeletal effects of each expansion modality. MATERIALS AND METHODS This retrospective study included 36 adolescents who had bilateral maxillary crossbite and received bone-borne maxillary expansion (average age: 14.7 years) or tooth-borne maxillary expansion (average age: 14.4 years). Subjects had two cone beam computed tomography images acquired, one before expansion (T1) and a second after a 3-month retention period (T2). Images were oriented, and three-dimensional airway volume and dentoskeletal expansion were measured. Analysis of variance was used to test for differences between the two expansion methods for pretreatment, posttreatment, and prepost changes. Paired t-tests were used to test for significance of prepost changes within each method. RESULTS Both groups showed significant increase only in nasal cavity and nasopharynx volume (P < .05), but not oropharynx and maxillary sinus volumes. Intermolar and maxillary width increased significantly in both groups (P < .05); however, the buccal inclination of maxillary molars increased significantly only in the tooth-borne group (P < .05). There was no significant difference between tooth- and bone-borne expansion groups, except for the significantly larger increase in buccal inclination of the maxillary right first molar after tooth-borne expansion. CONCLUSIONS In adolescents, both tooth- and bone-borne RME resulted in an increase in nasal cavity and nasopharynx volume, as well as expansion in maxillary intermolar and skeletal widths. However, only tooth-borne expanders caused significant buccal tipping of maxillary molars.
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113
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Seif-Eldin NF, Elkordy SA, Fayed MS, Elbeialy AR, Eid FH. Transverse Skeletal Effects of Rapid Maxillary Expansion in Pre and Post Pubertal Subjects: A Systematic Review. Open Access Maced J Med Sci 2019; 7:467-477. [PMID: 30834021 PMCID: PMC6390138 DOI: 10.3889/oamjms.2019.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/26/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the transverse skeletal effects of rapid maxillary expansion (RME) in pre and post-pubertal subjects. MATERIAL AND METHODS Five databases were searched till May 2018; Pubmed, Cochrane, Scopus, Lilacs and Web of science in addition to the manual search of other sources. There were no language restrictions. Methodological Index for Non-Randomized Studies MINORS was used to assess the quality and risk of bias of the trials included. RESULTS Six studies were finally included in the qualitative analysis. A meta-analysis wasn't performed due to the heterogeneity of methodologies and outcomes. All of the included studies showed drawbacks in their structure yielding weak evidence. On the short term, RME caused an increase in the maxillary and lateral-nasal widths in pre-pubertal subjects by 3.4 mm and 3.3 mm, and by 2.8 and 2.2 mm respectively in post-pubertal subjects. Although statistically insignificant, the maxillary width increase was more than that of the post-pubertal subjects by 0.6 mm. Over the long term, expansion produced permanent increases in the transverse dimensions of both the dento-alveolar and skeletal components of the maxilla and circum-maxillary structures in pre-pubertal subjects. The post-pubertal subjects presented with a statistically significant increase only in the later-nasal width by 1.3 mm than the untreated controls with no permanent increase in the skeletal maxillary width. CONCLUSION The literature is very deficient regarding the use of skeletal age as a reference in the treatment of skeletal crossbites using RME. Only weak evidence exists supporting the increased maxillary and lateral-nasal widths after tooth-tissue borne RME in pre-pubertal subjects, with these effects being less in the post-pubertal ones.
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Affiliation(s)
| | - Sherif Aly Elkordy
- Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mona Salah Fayed
- Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Amr Ragab Elbeialy
- Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Faten Hussein Eid
- Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Corticopuncture Facilitated Microimplant-Assisted Rapid Palatal Expansion. Case Rep Dent 2019; 2018:1392895. [PMID: 30627452 PMCID: PMC6305058 DOI: 10.1155/2018/1392895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Microimplant-assisted rapid palatal expansion (MARPE) has been considered an alternative to avoid extensive surgical procedures. In order to obtain skeletal results of MARPE, force should be enough to overcome areas of resistance and the first one that is required to be disrupted is the midpalatal suture, which becomes increasingly interdigitated after adolescence. Objective The present study aimed at providing a novel approach using a minimally invasive method called corticopuncture (CP) in association with MARPE illustrated by a case report of a 35-year-old Brazilian female Caucasian patient presenting maxillary transverse deficiency. Method Treatment plan started with an orthopedic correction of the transverse problem using a MARPE device. After many unsuccessful attempts to activate MARPE, corticopunctures were performed along the midpalatal suture. CP procedure at the midpalatal suture included 8 perforations (2 mm apart), performed after previous predrilling followed by miniscrew insertion (5 mm thread length and 1.8 mm diameter). Results After CP and new activation protocol, the opening of the midpalatal suture was observed by CBCT images, showing skeletal results, suture split of 3.14 mm (premolar area) and 2.06 (molar area), an increase of 4.3 mm (premolar) and 3.03 mm (molar) in basal bone width, 4.43 mm (premolar) and 3.1 mm (molar) in cortical bone width, and minimal dental effects (mean of 1.2° of tooth tipping). Conclusion The combination of MARPE and corticopuncture method was proved to be a nonsurgical treatment option to correct maxillary transverse deficiency in an adult patient. CP was able to weaken suture interdigitation thus facilitating the split.
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115
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Costa JG, Galindo TM, Mattos CT, Cury-Saramago ADA. Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review. Dental Press J Orthod 2018; 22:35-44. [PMID: 28658354 PMCID: PMC5484268 DOI: 10.1590/2177-6709.22.2.035-044.oar] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/12/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author’s opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.
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Affiliation(s)
- Julia Garcia Costa
- Orthodontics department, Universidade Federal Fluminense, Niterói, Brazil
| | | | - Claudia Trindade Mattos
- Professor of Orthodontics, Dental Clinic department, Universidade Federal Fluminense, Niterói, Brazil
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Lombardo L, Carlucci A, Maino BG, Colonna A, Paoletto E, Siciliani G. Class III malocclusion and bilateral cross-bite in an adult patient treated with miniscrew-assisted rapid palatal expander and aligners. Angle Orthod 2018; 88:649-664. [PMID: 29714067 DOI: 10.2319/111617-790.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This case report describes the use of a miniscrew-assisted rapid palatal expander and aligners to correct bilateral cross-bite and crowding in an adult patient with a Class III skeletal pattern. A digitally designed surgical guide was three-dimensionally printed and used to accurately insert four miniscrews into the palate; these were employed to anchor a novel miniscrew-assisted rapid palatal expander appliance without any dental anchorage. Cone-beam computed tomograms before and after miniscrew-assisted rapid palatal expander treatment demonstrated the orthopedic expansion of the maxilla without dental tipping. The patient was then fitted with aligners to correct crowding and malocclusion. This case report demonstrates the successful treatment of an adult patient with a narrow maxilla and bilateral cross-bite using a nonsurgical, conservative treatment.
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Kim SY, Park YC, Lee KJ, Lintermann A, Han SS, Yu HS, Choi YJ. Assessment of changes in the nasal airway after nonsurgical miniscrew-assisted rapid maxillary expansion in young adults. Angle Orthod 2018; 88:435-441. [PMID: 29561652 DOI: 10.2319/092917-656.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate changes in the volume and cross-sectional area of the nasal airway before and 1 year after nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults. MATERIALS AND METHODS Fourteen patients (mean age, 22.7 years; 10 women, four men) with a transverse discrepancy who underwent cone beam computed tomography before (T0), immediately after (T1), and 1 year after (T2) expansion were retrospectively included in this study. The volume of the nasal cavity and nasopharynx and the cross-sectional area of the anterior, middle, and posterior segments of the nasal airway were measured and compared among the three timepoints using paired t-tests. RESULTS The volume of the nasal cavity showed a significant increase at T1 and T2 ( P < .05), while that of the nasopharynx increased only at T2 ( P < .05). The anterior and middle cross-sectional areas significantly increased at T1 and T2 ( P < .05), while the posterior cross-sectional area showed no significant change throughout the observation period ( P > .05). CONCLUSIONS The results demonstrate that the volume and cross-sectional area of the nasal cavity increased after MARME and were maintained at 1 year after expansion. Therefore, MARME may be helpful in expanding the nasal airway.
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118
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Brunetto DP, Sant'Anna EF, Machado AW, Moon W. Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE). Dental Press J Orthod 2018; 22:110-125. [PMID: 28444019 PMCID: PMC5398849 DOI: 10.1590/2177-6709.22.1.110-125.sar] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). OBJECTIVE The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA). METHODS All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. CONCLUSION It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.
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Affiliation(s)
- Daniel Paludo Brunetto
- Department of Restorative Dentistry, Dental School, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Eduardo Franzzotti Sant'Anna
- Department of Pediatric Dentistry and Orthodontics, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andre Wilson Machado
- Department of Orthodontics, Dental School, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Won Moon
- Dental School, University of California, Los Angeles, CA, USA
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Lee KJ, Choi SH, Choi TH, Shi KK, Keum BT. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes. Semin Orthod 2018. [DOI: 10.1053/j.sodo.2018.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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120
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Seong EH, Choi SH, Kim HJ, Yu HS, Park YC, Lee KJ. Evaluation of the effects of miniscrew incorporation in palatal expanders for young adults using finite element analysis. Korean J Orthod 2018; 48:81-89. [PMID: 29564217 PMCID: PMC5854885 DOI: 10.4041/kjod.2018.48.2.81] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/21/2017] [Accepted: 07/01/2017] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of this study was to evaluate the stress distribution and displacement of various craniofacial structures after nonsurgical rapid palatal expansion (RPE) with conventional (C-RPE), bone-borne (B-RPE), and miniscrew-assisted (MARPE) expanders for young adults using three-dimensional finite element analysis (3D FEA). Methods Conventional, bone-borne, and miniscrew-assisted palatal expanders were designed to simulate expansion in a 3D FE model created from a 20-year-old human dry skull. Stress distribution and the displacement pattern for each circumaxillary suture and anchor tooth were calculated. Results The results showed that C-RPE induced the greatest stress along the frontal process of the maxilla and around the anchor teeth, followed by the suture area, whereas B-RPE generated the greatest stress around the miniscrew, although the area was limited within the suture. Compared with the other appliances, MARPE caused relatively even stress distribution, decreased the stress on the buccal plate of the anchor teeth, and reduced tipping of the anchor teeth. Conclusions The findings of this study suggest that the incorporation of miniscrews in RPE devices may contribute to force delivery to the sutures and a decrease in excessive stress on the buccal plate. Thus, MARPE may serve as an effective modality for the nonsurgical treatment of transverse maxillary deficiency in young adults.
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Affiliation(s)
- Eui-Hyang Seong
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.,Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hee-Jin Kim
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.,Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Chel Park
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.,Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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121
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Kim H, Cha KS. Evaluation of the stability of maxillary expansion using cone-beam computed tomography after segmental Le Fort I osteotomy in adult patients with skeletal Class III malocclusion. Korean J Orthod 2018; 48:63-70. [PMID: 29423378 PMCID: PMC5799308 DOI: 10.4041/kjod.2018.48.1.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The aim of this study is to quantitatively evaluate the stability of the skeletal and dental widths using cone-beam computed tomography (CBCT) after segmental Le Fort I osteotomy in adult patients with skeletal Class III malocclusion requiring maxillary expansion. Methods In total, 25 and 36 patients with skeletal Class III malocclusion underwent Le Fort I osteotomy (control group) and segmental Le Fort I osteotomy (experimental group), respectively. Coronal CBCT images were used to measure the dental and skeletal widths before (T1) and after (T2) surgery and at the end of treatment (T3). The correlation between the extent of surgery and the amount of relapse in the experimental group was also determined. Results In the control group, the dental width exhibited a significant decrease of 0.70 ± 1.28 mm between T3 and T2. In the experimental group, dental and skeletal expansion of 1.83 ± 1.66 and 2.55 ± 1.94 mm, respectively, was observed between T2 and T1. The mean changes in the dental and skeletal widths between T3 and T2 were -1.41 ± 1.98 and -0.67 ± 0.72 mm, respectively. There was a weak correlation between the amount of skeletal expansion during segmental Le Fort I osteotomy and the amount of postoperative skeletal relapse in the experimental group. Conclusions Maxillary expansion via segmental Le Fort I osteotomy showed good stability, with a skeletal relapse rate of 26.3% over approximately 12 months. Our results suggest that a greater amount of expansion requires greater efforts for the prevention of relapse.
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Affiliation(s)
| | - Kyung-Suk Cha
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
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How do geometry-related parameters influence the clinical performance of orthodontic mini-implants? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2017; 46:1539-1551. [DOI: 10.1016/j.ijom.2017.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/14/2017] [Indexed: 01/27/2023]
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123
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Lam R, Goonewardene MS, Allan BP, Sugawara J. Success rates of a skeletal anchorage system in orthodontics: A retrospective analysis. Angle Orthod 2017; 88:27-34. [PMID: 29053335 DOI: 10.2319/060617-375.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the premise that skeletal anchorage with SAS miniplates are highly successful and predictable for a range of complex orthodontic movements. MATERIALS AND METHODS This retrospective cross-sectional analysis consisted of 421 bone plates placed by one clinician in 163 patients (95 female, 68 male, mean age 29.4 years ± 12.02). Simple descriptive statistics were performed for a wide range of malocclusions and desired movements to obtain success, complication, and failure rates. RESULTS The success rate of skeletal anchorage system miniplates was 98.6%, where approximately 40% of cases experienced mild complications. The most common complication was soft tissue inflammation, which was amenable to focused oral hygiene and antiseptic rinses. Infection occurred in approximately 15% of patients where there was a statistically significant correlation with poor oral hygiene. The most common movements were distalization and intrusion of teeth. More than a third of the cases involved complex movements in more than one plane of space. CONCLUSIONS The success rate of skeletal anchorage system miniplates is high and predictable for a wide range of complex orthodontic movements.
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Suzuki H, Moon W, Previdente LH, Suzuki SS, Garcez AS, Consolaro A. Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement. Dental Press J Orthod 2017; 21:17-23. [PMID: 27653260 PMCID: PMC5029312 DOI: 10.1590/2177-6709.21.4.017-023.oin] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022] Open
Abstract
The midpalatal suture has bone margins with thick connective tissue interposed between them, and it does not represent the fusion of maxillary palatal processes only, but also the fusion of palatal processes of the jaws and horizontal osseous laminae of palatal bones. Changing it implies affecting neighboring areas. It has got three segments that should be considered by all clinical analyses, whether therapeutic or experimental: the anterior segment (before the incisive foramen, or intermaxillary segment), the middle segment (from the incisive foramen to the suture transversal to the palatal bone ) and the posterior segment (after the suture transversal to the palatal bone ). Rapid palatal expansion might be recommended for patients at the final pubertal growth stage, in addition to adult patients with maxillary constriction. It represents a treatment solution that can potentially avoid surgical intervention. When performed in association with rapid palatal expanders, it might enhance the skeletal effects of the latter. Of the various designs of expansion appliances, MARPE (miniscrew-assisted rapid palatal expander) has been modified in order to allow its operational advantages and outcomes to become familiar in the clinical practice.
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Affiliation(s)
- Hideo Suzuki
- Professor, responsible for the Masters Program in Orthodontics, São Leopoldo Mandic, School of Dentistry, Campinas, São Paulo, Brazil
| | - Won Moon
- Associate clinical professor and director of the Residency Program of Orthodontics, University of California, Los Angeles, USA
| | - Luiz Henrique Previdente
- Professor, São Leopoldo Mandic, School of Dentistry, Graduate Program, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Professor, São Leopoldo Mandic, School of Dentistry, Masters Program in Orthodontics, Campinas, São Paulo, Brazil
| | - Aguinaldo Silva Garcez
- Professor of Microbiology, São Leopoldo Mandic, School of Dentistry, Campinas, São Paulo, Brazil
| | - Alberto Consolaro
- Full professor, Universidade de São Paulo (USP), School of Dentistry, Department of Orthodontics, Bauru, São Paulo, Brazil. Professor, Universidade de São Paulo (USP), School of Dentistry, Graduate Program, Ribeirão Preto, São Paulo, Brazil
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Lim HM, Park YC, Lee KJ, Kim KH, Choi YJ. Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion. Korean J Orthod 2017; 47:313-322. [PMID: 28861393 PMCID: PMC5548712 DOI: 10.4041/kjod.2017.47.5.313] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/02/2017] [Accepted: 04/24/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Miniscrew-assisted rapid palatal expansion (MARPE) is a means for expanding the basal bone without surgical intervention in young adults. Here, we assessed the differences in dental, alveolar, and skeletal measurements taken before (T0), immediately after (T1), and 1 year after (T2) MARPE. METHODS Twenty-four patients (mean age, 21.6 years) who had undergone MARPE and cone-beam computed tomography at T0, T1, and T2 were included. Changes in the following parameters were compared using paired t-tests: intercusp, interapex, alveolar, nasal floor, and nasal cavity widths; inclination of the first molar (M1) and its alveolus; and thickness and height of the alveolar bone. A linear mixed-effects model was used to determine variables that affected periodontal changes in the M1. RESULTS MARPE produced significant increases in most measurements during T0-T2, despite relapse of some measurements during T1-T2. The alveolar thickness decreased on the buccal side, but increased on the palatal side. The alveolar crest level at the first premolar moved apically. Changes in the thickness and height of the alveolar bone were affected by the corresponding initial values. CONCLUSIONS MARPE can be used as an effective tool for correcting maxillomandibular transverse discrepancy, showing stable outcomes 1 year after expansion.
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Affiliation(s)
- Hyun-Mook Lim
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Chel Park
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Ahmed VKS. Indian Board of Orthodontics Case Report – Dr. Prem Prakash Memorial Award. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2017. [DOI: 10.4103/jios.jios_129_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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127
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Lee RJ, Moon W, Hong C. Effects of monocortical and bicortical mini-implant anchorage on bone-borne palatal expansion using finite element analysis. Am J Orthod Dentofacial Orthop 2017; 151:887-897. [PMID: 28457266 DOI: 10.1016/j.ajodo.2016.10.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bone-borne palatal expansion relies on mini-implant stability for successful orthopedic expansion. The large magnitude of applied force experienced by mini-implants during bone-borne expansion may lead to high failure rates. Use of bicortical mini-implant anchorage rather than monocortical anchorage may improve mini-implant stability. The aims of this study were to analyze and compare the effects of bicortical and monocortical anchorages on stress distribution and displacement during bone-borne palatal expansion using finite element analysis. METHODS Two skull models were constructed to represent expansion before and after midpalatal suture opening. Three clinical situations with varying mini-implant insertion depths were studied in each skull model: monocortical, 1-mm bicortical, and 2.5-mm bicortical. Finite element analysis simulations were performed for each clinical situation in both skull models. Von Mises stress distribution and transverse displacement were evaluated for all models. RESULTS Peri-implant stress was greater in the monocortical anchorage model compared with both bicortical anchorage models. In addition, transverse displacement was greater and more parallel in the coronal plane for both bicortical models compared with the monocortical model. Minimal differences were observed between the 1-mm and the 2.5-mm bicortical models for both peri-implant stress and transverse displacement. CONCLUSIONS Bicortical mini-implant anchorage results in improved mini-implant stability, decreased mini-implant deformation and fracture, more parallel expansion in the coronal plane, and increased expansion during bone-borne palatal expansion. However, the depth of bicortical mini-implant anchorage was not significant.
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Affiliation(s)
- Robert J Lee
- Division of Orthodontics, University of California at San Francisco, San Francisco, Calif
| | - Won Moon
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif
| | - Christine Hong
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif.
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Tonello DL, Ladewig VDM, Guedes FP, Ferreira Conti ACDC, Almeida-Pedrin RR, Capelozza-Filho L. Midpalatal suture maturation in 11- to 15-year-olds: A cone-beam computed tomographic study. Am J Orthod Dentofacial Orthop 2017; 152:42-48. [DOI: 10.1016/j.ajodo.2016.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022]
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Clement EA, Krishnaswamy NR. Skeletal and Dentoalveolar Changes after Skeletal Anchorage-assisted Rapid Palatal Expansion in Young Adults: A Cone Beam Computed Tomography Study. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/2321-1407.207220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective
The aim of this study was to evaluate skeletal and dentoalveolar changes before and after skeletal anchorage-assisted rapid palatal expansion in young adults by cone beam computed tomography.
Materials and Methods
This pilot study included ten patients with a mean age of 21.5 years with maxillary transverse deficiency treated with the skeletal expander. Three dimensional evaluation of the changes before and after expansion was evaluated with Cone Beam CT. Statistical analysis was performed using paired t-test.
Results
Skeletal expander produced an increase in maxillary transverse dimension at the skeletal, alveolar, and dental level. The maximum expansion was at the level of dentition, and the least amount of expansion was at the level of the frontonasal suture. There was also evidence of sutural divergence and buccal tipping.
Conclusion
The maxillary skeletal expander is an effective method for correction of maxillary transverse deficiency without surgery in adults.
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Affiliation(s)
- Evan. A. Clement
- Department of Orthodontics, Ragas Dental College, Chennai, Tamil Nadu, India
| | - N. R. Krishnaswamy
- Department of Orthodontics, Ragas Dental College, Chennai, Tamil Nadu, India
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da Cunha AC, Lee H, Nojima LI, Nojima MDCG, Lee KJ. Miniscrew-assisted rapid palatal expansion for managing arch perimeter in an adult patient. Dental Press J Orthod 2017; 22:97-108. [PMID: 28746493 PMCID: PMC5525451 DOI: 10.1590/2177-6709.22.3.097-108.oar] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/11/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION: Etiology of dental crowding may be related to arch constriction in diverse dimensions, and an appropriate manipulation of arch perimeter by intervening in basal bone discrepancies cases, may be a key for crowding relief, especially when incisors movement is limited due to underlying pathology, periodontal issues or restrictions related to soft tissue profile. OBJECTIVES: This case report illustrates a 24-year old woman, with maxillary transverse deficiency, upper and lower arches crowding, Class II, division 1, subdivision right relationship, previous upper incisors traumatic episode and straight profile. A non-surgical and non-extraction treatment approach was feasible due to the miniscrew-assisted rapid palatal expansion technique (MARPE). METHODS: The MARPE appliance consisted of a conventional Hyrax expander supported by four orthodontic miniscrews. A slow expansion protocol was adopted, with an overall of 40 days of activation and a 3-month retention period. Intrusive traction miniscrew-anchored mechanics were used for correcting the Class II subdivision relationship, managing lower arch perimeter and midline deviation before including the upper central incisors. RESULTS: Post-treatment records show an intermolar width increase of 5 mm, bilateral Class I molar and canine relationships, upper and lower crowding resolution, coincident dental midlines and proper intercuspation. CONCLUSIONS: The MARPE is an effective treatment approach for managing arch-perimeter deficiencies related to maxillary transverse discrepancies in adult patients.
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Affiliation(s)
- Amanda Carneiro da Cunha
- Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil)
| | | | - Lincoln Issamu Nojima
- Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil)
| | | | - Kee-Joon Lee
- Yonsei University,Department of Orthodontics, Seoul, Korea
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131
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Koo YJ, Choi SH, Keum BT, Yu HS, Hwang CJ, Melsen B, Lee KJ. Maxillomandibular arch width differences at estimated centers of resistance: Comparison between normal occlusion and skeletal Class III malocclusion. Korean J Orthod 2017; 47:167-175. [PMID: 28523243 PMCID: PMC5432438 DOI: 10.4041/kjod.2017.47.3.167] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the differences in maxillomandibular transverse measurements at either the crown or the estimated center of resistance (CR), and to compare values between normal occlusion and Class III malocclusion groups. METHODS Dental casts and computed tomography (CT) data from 30 individuals with normal occlusion and 30 with skeletal Class III malocclusions were evaluated. Using the casts, dental arch widths (DAWs) were measured from the cusp tips, and basal arch widths (BAWs-cast) were measured as the distance between the points at the mucogingival junction adjacent to the respective cusp tips. The BAWs determined from CT (BAWs-CT) images were measured from the estimated CRs of the teeth. RESULTS None of the DAW measurements or maxillomandibular DAW differences showed statistically significant intergroup differences. In contrast, the maxillary BAWs-CT and BAWs-cast were lesser in the Class III malocclusion group than in the normal occlusion group. The mandibular BAWs-CT were significantly greater in the Class III malocclusion group than in the normal occlusion group. Moreover, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. CONCLUSIONS The maxillomandibular DAW differences showed no significant intergroup differences. In contrast, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. The maxillomandibular BAW differences at the estimated CRs, measured using CT or casts, can reveal underlying transverse maxillary basal arch deficiencies in patients with skeletal Class III malocclusions.
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Affiliation(s)
- Yun-Jin Koo
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Byeong-Tak Keum
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Birte Melsen
- Department of Orthodontics, University of Aarhus, Aarhus, Denmark
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Park JJ, Park YC, Lee KJ, Cha JY, Tahk JH, Choi YJ. Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: A cone-beam computed tomography study. Korean J Orthod 2017; 47:77-86. [PMID: 28337417 PMCID: PMC5359634 DOI: 10.4041/kjod.2017.47.2.77] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion (MARPE) in young adults by cone-beam computed tomography (CBCT). Methods This retrospective study included 14 patients (mean age, 20.1 years; range, 16–26 years) with maxillary transverse deficiency treated with MARPE. Skeletal and dentoalveolar changes were evaluated using CBCT images acquired before and after expansion. Statistical analyses were performed using paired t-test or Wilcoxon signed-rank test according to normality of the data. Results The midpalatal suture was separated, and the maxilla exhibited statistically significant lateral movement (p < 0.05) after MARPE. Some of the landmarks had shifted forwards or upwards by a clinically irrelevant distance of less than 1 mm. The amount of expansion decreased in the superior direction, with values of 5.5, 3.2, 2.0, and 0.8 mm at the crown, cementoenamel junction, maxillary basal bone, and zygomatic arch levels, respectively (p < 0.05). The buccal bone thickness and height of the alveolar crest had decreased by 0.6–1.1 mm and 1.7–2.2 mm, respectively, with the premolars and molars exhibiting buccal tipping of 1.1°–2.9°. Conclusions Our results indicate that MARPE is an effective method for the correction of maxillary transverse deficiency without surgery in young adults.
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Affiliation(s)
- Jung Jin Park
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Chel Park
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Ji Hyun Tahk
- Graduate of Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Yoon Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Carvalho Trojan L, Andrés González-Torres L, Claudia Moreira Melo A, Barbosa de Las Casas E. Stresses and Strains Analysis Using Different Palatal Expander Appliances in Upper Jaw and Midpalatal Suture. Artif Organs 2016; 41:E41-E51. [DOI: 10.1111/aor.12817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/26/2016] [Accepted: 07/06/2016] [Indexed: 11/27/2022]
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Mathew A, Nagachandran KS, Vijayalakshmi D. Stress and displacement pattern evaluation using two different palatal expanders in unilateral cleft lip and palate: a three-dimensional finite element analysis. Prog Orthod 2016; 17:38. [PMID: 27800592 PMCID: PMC5116441 DOI: 10.1186/s40510-016-0150-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
Background In this finite element (FE) study, the stress distribution and displacement pattern was evaluated in the mid-palatal area and around circum-maxillary sutures exerted by bone-borne palatal expander (BBPE) in comparison with conventional HYRAX rapid palatal expander in unilateral cleft lip and palate. Methods Computed tomography scan images of a patient with unilateral cleft palate was used to create a FE model of the maxillary bone along with circum-maxillary sutures. A three-dimensional model of the conventional HYRAX (Hygienic Rapid Expander) expander and custom-made BBPE was created by laser scanning and programmed into the FE model. Results With the BBPE, the maximum stress was observed at the implant insertion site, whereas with the conventional HYRAX expander, it was at the dentition level. Among the circum-maxillary sutures, the zygomaticomaxillary suture experienced maximum stress followed by the zygomaticotemporal and nasomaxillary sutures. Displacement in the X-axis (transverse) was highest on the cleft side, and in the Y-axis (antero-posterior), it was highest in the posterior region in the BBPE. Conclusions The total displacement was observed maximum in the mid-palatal cleft area in the BBPE, and it produced true skeletal expansion at the alveolar level without any dental tipping when compared with the conventional HYRAX expander.
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Affiliation(s)
- Anoop Mathew
- Department of Orthodontics, Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry, 605402, India
| | - K S Nagachandran
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College & Hospital, Meenakshi University (MAHER), Alapakkam Main Road, Maduravoyal, Chennai, Tamilnadu, 600095, India.
| | - Devaki Vijayalakshmi
- Department of Orthodontics and Dentofacial Orthopedics, Meenakshi Ammal Dental College & Hospital, Meenakshi University (MAHER), Alapakkam Main Road, Maduravoyal, Chennai, Tamilnadu, 600095, India
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135
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Jang HI, Kim SC, Chae JM, Kang KH, Cho JW, Chang NY, Lee KY, Cho JH. Relationship between maturation indices and morphology of the midpalatal suture obtained using cone-beam computed tomography images. Korean J Orthod 2016; 46:345-355. [PMID: 27896208 PMCID: PMC5118213 DOI: 10.4041/kjod.2016.46.6.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/10/2016] [Accepted: 05/30/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to determine whether predicting maturation of the midpalatal suture is possible by classifying its morphology on cone-beam computed tomography (CBCT) images and to investigate relationships with other developmental age indices. Methods The morphology of the midpalatal suture was assessed by using CBCT images of 99 patients. Axial plane images of the midpalatal suture were classified into five stages according to the classification scheme. To make the assessment more accurate, the morphology and fusion of the midpalatal suture were additionally investigated on coronal cross-sectional planar images and volume-rendered images. Bone age was evaluated using the hand and wrist method (HWM) and cervical vertebrae method (CVM); dental age (Hellman's index), sex, and chronological age were also assessed. To evaluate relationships among variables, Spearman's rho rank test was performed along with crosstabs using contingency coefficients. Results The HWM and CVM showed strong correlations with the maturation stage of the midpalatal suture, while other indices showed relatively weak correlations (p < 0.01). Through crosstabs, the HWM and CVM showed high association values with CBCT stage; the HWM demonstrated slightly higher values (p < 0.0001). Based on the HWM, the midpalatal suture was not fused until stage 6 in both sexes. Conclusions Among developmental age indices, the HWM and CVM showed strong correlations and high associations, suggesting that they can be useful in assessing maturation of the midpalatal suture.
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Affiliation(s)
- Hong-Ik Jang
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Sang-Cheol Kim
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Wonkwang Dental Research Institute, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Jong-Moon Chae
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Department of Orthodontics, Wonkwang University Daejeon Dental Hospital, Daejeon, Korea
| | - Kyung-Hwa Kang
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Wonkwang Dental Research Institute, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Jin-Woo Cho
- Department of Orthodontics, Wonkwang University Daejeon Dental Hospital, Daejeon, Korea
| | - Na-Young Chang
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Wonkwang Dental Research Institute, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Keun-Young Lee
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Wonkwang Dental Research Institute, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Jin-Hyoung Cho
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea.; Wonkwang Dental Research Institute, School of Dentistry, Wonkwang University, Iksan, Korea
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Choi SH, Shi KK, Cha JY, Park YC, Lee KJ. Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. Angle Orthod 2016; 86:713-720. [PMID: 26938955 PMCID: PMC8600851 DOI: 10.2319/101415-689.1] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/01/2016] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To evaluate the stability of nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults with a transverse maxillary deficiency. MATERIALS AND METHODS From a total of 69 adult patients who underwent MARME followed by orthodontic treatment with a straight-wire appliance, 20 patients (mean age, 20.9 ± 2.9 years) with follow-up records (mean, 30.2 ± 13.2 months) after debonding were selected. Posteroanterior cephalometric records and dental casts were obtained at the initial examination (T0), immediately after MARME removal (T1), immediately after debonding (T2), and at posttreatment follow-up (T3). RESULTS Suture separation was observed in 86.96% of subjects (60/69). An increase in the maxillary width (J-J; 1.92 mm) accounted for 43.34% of the total expansion with regard to the intermolar width (IMW) increase (4.43 mm; P < .001) at T2. The amounts of J-J and IMW posttreatment changes were -0.07 mm (P > .05) and -0.42 mm (P = .01), respectively, during retention. The postexpansion change in middle alveolus width increased with age (P < .05). The postexpansion change of interpremolar width (IPMW) was positively correlated with the amount of IPMW expansion (P < .05) but not with IMW. The changes of the clinical crown heights in the maxillary canines, first premolars, and first molars were not significant at each time point. CONCLUSIONS Nonsurgical MARME can be a clinically acceptable and stable treatment modality for young adults with a transverse maxillary deficiency.
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Affiliation(s)
- Sung-Hwan Choi
- Fellow, Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Keun Shi
- Postgraduate student, Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Associate Professor, Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Chel Park
- Professor Emeritus, Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Professor, Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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137
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Differential treatment effects of two anchorage systems for rapid maxillary expansion: a retrospective cephalometric study. J Orofac Orthop 2016; 77:314-24. [DOI: 10.1007/s00056-016-0037-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
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Abstract
INTRODUCTION This article represents a new design of expander-spike expander-to correct transverse maxillary deficiency. This new type appliance is easy to fabricate, more hygienic, and less soft-tissue irritation because of elimination of acrylic plate. In addition, because of the position of mini-implant, it can provide a relatively parallel alveolar expansion, compared with other types of expander. MATERIALS AND METHODS The spike expander consists of 2 parts: 4 spike screws and an expansion screw. Four spike screws were placed on the palatal slope. After installation of the spike screws, based on the position of spike screw, the extension arms of expansion screw were bended on the cast model, and connected to the spike screws by adding resin. The expansion screw was turned once a day (0.25 mm/d), and the process was terminated at 6 weeks. RESULTS The stability and design of the spike screw enable widening of maxilla easier. Compared with other expander, spike expander reduces the forces being placed directly on teeth, which can maximize skeletal expansion, minimize dental tipping, produce a relatively parallel expansion, and reduce soft-tissue irritation caused by acrylic pads. Furthermore, the teeth can be aligned and leveled simultaneously using the fixed appliance because teeth are free of contact by the expander. And the best point for spike expander is that it is simply fabricated and removed. CONCLUSIONS The design of spike expander is combining spike screws and an expansion screw, which can provide a good and easy treatment method for transverse maxillary deficiency.
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Mosleh MI, Kaddah MA, Abd ElSayed FA, ElSayed HS. Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders. Am J Orthod Dentofacial Orthop 2016; 148:599-607. [PMID: 26432315 DOI: 10.1016/j.ajodo.2015.04.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purposes of this study were to evaluate and compare the dentoskeletal changes concurrent with 4-point bone-borne and tooth-borne rapid maxillary expanders in growing children. METHODS The study was conducted with 20 growing girls (ages, 12 ± 0.6 years) with posterior crossbite. They were divided into 2 equal groups; patients in one group were treated with a tooth-borne maxillary hyrax expander (TBME), and those in the other group received a bone-borne maxillary hyrax expander (BBME) anchored directly to the palatal bone. Changes were assessed using cone-beam computed tomography. Images were taken before and immediately after expansion. RESULTS Superimpositions of the 3-dimensional palatal images showed significant increases in skeletal widths at the canine, first premolar, and first molar areas in both groups. The TBME group had greater nasal width expansion. Regarding the transverse dentolinear measurements, significant increases were seen in both groups, whereas the TBME group showed a greater increase than the BBME group. Significant increases in the dentoangular measurements were seen in the TBME group only and were significantly greater than in the BBME group at the first premolars. CONCLUSIONS There were significant increases in facial and maxillary widths for the BBME group and in nasal width for the TBME group. Both expanders produced basal bone expansion at the level of the hard palate. The TBMEs produced more dental expansion, buccal rolling, and a greater increase in nasal width than did the BBMEs.
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Affiliation(s)
- Mennatallah Ihab Mosleh
- Research assistant, Orthodontics and Pediatric Dentistry, National Research Centre, Cairo, Egypt.
| | - Mohamed Amgad Kaddah
- Chairman and professor, Department of Orthodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Fatma Abdou Abd ElSayed
- Professor, Department of Orthodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Hend Salah ElSayed
- Researcher, Orthodontics and Pediatric Dentistry, National Research Centre, Cairo, Egypt
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140
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Strategic camouflage treatment of skeletal Class III malocclusion (mandibular prognathism) using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy. Am J Orthod Dentofacial Orthop 2016; 149:114-26. [PMID: 26718385 DOI: 10.1016/j.ajodo.2014.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
Abstract
This case report presents the camouflage treatment that successfully improved the facial profile of a patient with a skeletal Class III malocclusion using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy. The patient was an 18-year-old woman with chief complaints of crooked teeth and a protruded jaw. Camouflage treatment was chosen because she rejected orthognathic surgery under general anesthesia. A hybrid type of bone-borne rapid maxillary expander with palatal mini-implants was used to correct the transverse discrepancy, and a mandibular anterior subapical osteotomy was conducted to achieve proper overjet with normal incisal inclination and to improve her lip and chin profile. As a result, a Class I occlusion with a favorable inclination of the anterior teeth and a good esthetic profile was achieved with no adverse effects. Therefore, the hybrid type of bone-borne rapid maxillary expander and a mandibular anterior subapical osteotomy can be considered effective camouflage treatment of a skeletal Class III malocclusion, providing improved inclination of the dentition and lip profile.
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141
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Effect of maxillary expansion on orthodontics. ASIAN PAC J TROP MED 2015; 8:944-951. [PMID: 26614995 DOI: 10.1016/j.apjtm.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the effect of maxillary expansion on orthodontics. METHODS Eight beagle dogs were randomly divided into two groups, with 4 dogs in each group. Dogs in group 1 were executed immediately and received the direct physical measurement. The magnetic expansion appliance was used in group 2 for the maxillary expansion. After the expansion, the model was taken again and they were executed after cone beam CT (CBCT) scanning. The model measurement method was adopted in group 1 to measure the dental measurement indicators and width of base bone arch. The CBCT measurement method was employed to measure the above dental indicators and bone indicators. The difference in the indicators measured by different methods was compared and analyzed. RESULTS Before the expansion, there was no significant difference in the bone measurement indicators between the CBCT measurement method and direct physical measurement method. After the expansion, there was no significant difference in indicators between the CBCT measurement method and direct physical measurement. But there was significant difference among the model measurement method, CBCT measurement method and direct physical measurement method. There was the significant difference in the dental indicators between the CBCT measurement method and model measurement, as well as the bone indicators of posterior marginal spacing of greater palatine foramen, posterior marginal spacing of incisive foramen, width of base bone arch and spacing of implant anchorage. CONCLUSIONS There is no significant difference between the effect of CBCT measurement method and direct physical measurement method, but CBCT is significantly better than the model measurement.
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Vassar JW, Karydis A, Trojan T, Fisher J. Dentoskeletal effects of a temporary skeletal anchorage device-supported rapid maxillary expansion appliance (TSADRME): A pilot study. Angle Orthod 2015; 86:241-9. [PMID: 25993250 DOI: 10.2319/013015-76.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To quantitatively evaluate maxillary skeletal expansion using cone-beam computed tomography (CBCT) images and propose a novel way to quantify the dental tipping effects of temporary skeletal anchorage device-supported rapid maxillary expansion appliance (TSADRME). MATERIALS AND METHODS Images from 25 patients receiving rapid maxillary expansion with incorporated temporary skeletal anchorage devices (TSADs) before activation (T1) and after removal (T2) were analyzed to detect dentoskeletal changes. RESULTS A significant increase from T1 to T2 was found for all linear measurements except buccal maxillary width at the canines. The greatest buccal expansion was at the first molar, decreasing anteriorly. However, the greatest palatal expansion was at the first premolar. All younger subjects (8-16 years old) exhibited less dental tipping and greater expansion overall compared with the older subjects. There was great variability in dental tipping of first molars (mean = 4.31°), with some subjects demonstrating mild uprighting of these teeth. CONCLUSIONS The TSADRME appliance is an effective, clinically useful device that results in mild molar tipping and may positively affect expansion in the area of TSAD placement.
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Affiliation(s)
- Jason William Vassar
- a Resident, Department of Orthodontics, University of Tennessee Health Science Center, College of Dentistry, Memphis, Tenn
| | - Anastasios Karydis
- b Assistant Professor, Department of Periodontics, University of Tennessee Health Science Center, College of Dentistry, Memphis, Tenn
| | - Terry Trojan
- c Associate Professor and Department Chair, Department of Orthodontics, University of Tennessee Health Science Center, College of Dentistry, Memphis, Tenn
| | - Jack Fisher
- d Assistant Professor, Department of Orthodontics, University of Tennessee Health Science Center, College of Dentistry, Memphis, Tenn
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Lin L, Ahn HW, Kim SJ, Moon SC, Kim SH, Nelson G. Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence. Angle Orthod 2015; 85:253-262. [PMID: 25490552 PMCID: PMC8631879 DOI: 10.2319/030514-156.1] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 05/01/2014] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE To evaluate the immediate effects of rapid maxillary expansion (RME) on the transverse skeletal and dentoalveolar changes with bone-borne (C-expander) and tooth-borne type expanders using cone-beam computed tomography (CBCT) in late adolescents. MATERIALS AND METHODS A sample of 28 female late-adolescent patients was divided into two groups according to the type of expander: bone-borne (C-expander, n = 15, age = 18.1 ± 4.4 years) and tooth-borne (hyrax, bands on premolars and molars, n = 13, age = 17.4 ± 3.4 years). CBCT scans were taken at 0.2-mm voxel size before treatment (T1) and 3 months after RME (T2). Transverse skeletal and dental expansion, alveolar inclination, tooth axis, vertical height of tooth, and buccal dehiscence were evaluated on maxillary premolars and molars. Paired t-test, independent t-test, one-way analysis of variance, and Scheffé post hoc analysis were performed. RESULTS The C-expander group produced greater skeletal expansion, except in the region of the first premolar (P < .05 or < .01), which showed slight buccal tipping of the alveolar bone. The Hyrax group had more buccal tipping of the alveolar bone and the tooth axes, except in the region of the second molar (P < .05 or < .01 or < .001). Dental expansion at the apex level was similar in the banded teeth (the first premolar and the first molar). Vertical height changes were apparent on the second premolar in the hyrax group (P < .05 or < .01). Significant buccal dehiscence occurred at the first premolar in the hyrax group (P < .01 or < .001). There were no significant differences between tooth types for any variables in the C-expander group. CONCLUSIONS For patients in late adolescence, bone-borne expanders produced greater orthopedic effects and fewer dentoalveolar side effects compared to the hyrax expanders.
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Affiliation(s)
- Lu Lin
- Postgraduate Student, Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Won Ahn
- Assistant Professor, Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Su-Jung Kim
- Associate Professor, Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sung-Chul Moon
- Clinical Associate Professor, Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea
| | - Seong-Hun Kim
- Associate Professor and Chairman, Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Gerald Nelson
- Clinical Professor and Chair, Division of Orthodontics, Department of Orofacial Science, University of California–San Francisco, San Francisco, Calif
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Mini-implants: new possibilities in interdisciplinary treatment approaches. Case Rep Dent 2015; 2014:140760. [PMID: 25580307 PMCID: PMC4279878 DOI: 10.1155/2014/140760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
The introduction of mini-implants has broadened the range of tooth movements possible by fixed appliance therapy alone. The limits of fixed orthodontic treatment have become more a matter of facial appearance than anchorage. Many complex cases which would previously have required surgery or functional appliances can now be treated with fixed appliance therapy using mini-implants. A mutilated dentition case where mini-implants were used to provide anchorage for intrusion of molars and retraction of anterior teeth is reported here to illustrate this point.
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145
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Yılmaz A, Arman-Özçırpıcı A, Erken S, Polat-Özsoy Ö. Comparison of short-term effects of mini-implant-supported maxillary expansion appliance with two conventional expansion protocols. Eur J Orthod 2015; 37:556-64. [PMID: 25564504 DOI: 10.1093/ejo/cju094] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study evaluates the dentoskeletal effects of a mini-implant-supported maxillary expansion (MISME) appliance in comparison with two types of conventional expansion methods. METHODS Records of 42 patients with bilateral or unilateral posterior crossbite were included in this study. The patients were divided into three groups. In group 1, four miniscrews were placed to the palatal region and an acrylic expansion device was bonded on these screws. A bonded maxillary expansion appliance was used in group 2, while a banded expansion appliance was used in group 3. Measurements from cephalometric, postero-anterior radiographs, and dental casts taken before and after expansion were evaluated statistically. RESULTS ANB angle increased significantly in group 1 and 3. MISME group also showed an increase of SNA angle. Measurements regarding the vertical dimension did not change with MISME but significant posterior rotation was found in group 2 and 3. Overbite value showed a significant decrease in group 2 and 3, but remained stable in group 1. The nasal, maxillary, maxillary intermolar widths showed significant increases in all groups. The difference between MISME group and other groups in maxillary width was significant indicating more skeletal expansion in MISME group. The maxillary molars showed significant buccal tipping in group 2 and 3, while lingual tipping of molars was found in MISME group. CONCLUSIONS MISME can be a better alternative to bonded expansion particularly in patients with vertical growth patterns and lack of anchorage teeth.
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Affiliation(s)
- Alev Yılmaz
- *Department of Orthodontics, Faculty of Dentistry, Adnan Menderes University, Aydın,
| | | | | | - Ömür Polat-Özsoy
- Department of Orthodontics, Faculty of Dentistry, Başkent University, Ankara, Turkey
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146
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Cha JY, Hwang CJ, Kwon SH, Jung HS, Kim KM, Yu HS. Strain of bone-implant interface and insertion torque regarding different miniscrew thread designs using an artificial bone model. Eur J Orthod 2014; 37:268-74. [PMID: 25296728 DOI: 10.1093/ejo/cju037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the initial stability of dual-thread miniscrews by analyzing the strain at the bone-implant interface and insertion torque during implantation in artificial bone models with different cortical bone thicknesses. MATERIALS AND METHODS Insertion torque, and strain, measured with a five-element strain gauge in 1.0, 1.5, and 2.0-mm artificial cortical bone, during insertion of single- (OAS-T1507) and dual-thread (MPlant-U3) type self-drilling miniscrews were assessed. RESULTS Both dual- and single-thread miniscrews showed greater than 7790 μstrain for all cortical bone thicknesses, and dual-thread miniscrews reached up to 19580 μstrain in 2.00 m m cortical bone. The strain of dual-thread miniscrews increased with increasing cortical bone thicknesses of 1.0-2.0mm. For single-thread miniscrews, the maximum insertion torque was relatively constant, but maximum insertion torque increased significantly in dual-thread groups with increasing cortical bone thicknesses (P < 0.0001). The maximum insertion torque with all cortical bone thicknesses was significantly lower with single- than dual-thread types (P < 0.0001). CONCLUSIONS Self-drilling dual-thread miniscrews provide better initial mechanical stability, but may cause strain over the physiological bone remodelling limit at the bone-implant interface in thick cortical bone layers.
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Affiliation(s)
- Jung-Yul Cha
- *Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- *Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | | | - Han-Sung Jung
- ***Department of Oral Biology, Division in Anatomy and Developmental Biology, Research Center for Orofacial Hard Tissue Regeneration and
| | - Kwang-Mahn Kim
- ****Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung Seog Yu
- *Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea,
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147
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Seo YJ, Chung KR, Kim SH, Nelson G. Camouflage treatment of skeletal class III malocclusion with asymmetry using a bone-borne rapid maxillary expander. Angle Orthod 2014; 85:322-34. [PMID: 25032737 DOI: 10.2319/031314-189.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This case report presents the successful use of palatal mini-implants for rapid maxillary expansion and mandibular distalization in a skeletal Class III malocclusion. The patient was a 13-year-old girl with the chief complaint of facial asymmetry and a protruded chin. Camouflage orthodontic treatment was chosen, acknowledging the possibility of need for orthognathic surgery after completion of her growth. A bone-borne rapid expander (BBRME) was used to correct the transverse discrepancy and was then used as indirect anchorage for distalization of the lower dentition with Class III elastics. As a result, a Class I occlusion with favorable inclination of the upper teeth was achieved without any adverse effects. The total treatment period was 25 months. Therefore, BBRME can be considered an alternative treatment in skeletal Class III malocclusion.
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Affiliation(s)
- Yu-Jin Seo
- a Clinical Fellow, Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, South Korea
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148
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Effect of bone-borne rapid maxillary expanders with and without surgical assistance on the craniofacial structures using finite element analysis. Am J Orthod Dentofacial Orthop 2014; 145:638-48. [PMID: 24785928 DOI: 10.1016/j.ajodo.2013.12.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of this study was to analyze stress distribution and displacement of the craniofacial structures resulting from bone-borne rapid maxillary expanders with and without surgical assistance using finite element analysis. METHODS Five designs of rapid maxillary expanders were made: a tooth-borne hyrax expander (type A); a bone-borne expander (type B); and 3 bone-borne surgically assisted modalities: separation of the midpalatal suture (type C), added separation of the pterygomaxillary sutures (type D), and added LeFort I corticotomy (type E). The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacement. RESULTS The surgical types C, D, and E demonstrated more transverse movement than did the nonsurgical types A and B. The amounts of expansion were greater in the posterior teeth in types A and B, but in types C, D, and E, the amounts of expansion were greater in the anterior teeth. At the midpalatal suture, the nonsurgical types showed more anterior expansion than did the posterior region, and higher stresses than with the surgical types. Type B showed the highest stresses at the infraorbital margin, anterior and posterior nasal spines, maxillary tuberosity, and pterygoid plate and hamulus. CONCLUSIONS The 3 surgical models showed similar amounts of stress and displacement along the teeth, midpalatal sutures, and craniofacial sutures. Therefore, when using a bone-borne rapid maxillary expander in an adult, it is recommended to assist it with midpalatal suture separation, which requires minimal surgical intervention.
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149
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Wiechmann D, Grauer D, Swift EJ. Current status of skeletal anchorage dental applications in orthodontics, part II. J ESTHET RESTOR DENT 2014; 26:79-87. [PMID: 24589364 DOI: 10.1111/jerd.12094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dirk Wiechmann
- Department of Orthodontics, Hannover Medical School, Hannover, Germany; Bad Essen, Germany
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150
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Arman-Özçırpıcı A, Yılmaz A, Polat-Özsoy Ö. Maxillary Expansion Via Palatal Mini-Implants: A Preliminary Study. Turk J Orthod 2014. [DOI: 10.13076/tjo-d-13-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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