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Colak O, Paredes NA, Elkenawy I, Torres M, Bui J, Jahangiri S, Moon W. Tomographic assessment of palatal suture opening pattern and pterygopalatine suture disarticulation in the axial plane after midfacial skeletal expansion. Prog Orthod 2020; 21:21. [PMID: 32686018 PMCID: PMC7370251 DOI: 10.1186/s40510-020-00321-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). MATERIALS AND METHODS Pre- and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. RESULTS After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (- 0.8° to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). CONCLUSIONS MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients.
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Affiliation(s)
- Ozge Colak
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA.
| | - Ney Alberto Paredes
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Islam Elkenawy
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Martha Torres
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Joseph Bui
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Sara Jahangiri
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Won Moon
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA.
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Differential assessment of skeletal, alveolar, and dental components induced by microimplant-supported midfacial skeletal expander (MSE), utilizing novel angular measurements from the fulcrum. Prog Orthod 2020; 21:18. [PMID: 32656601 PMCID: PMC7355053 DOI: 10.1186/s40510-020-00320-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background In order to assess skeletal expansion, alveolar bone bending, and dental tipping after maxillary expansion, linear and angular measurements have been performed utilizing different craniofacial references. Since the expansion with midfacial skeletal expander (MSE) is archial in nature, the aim of this paper is to quantify the differential components of MSE expansion by calculating the fulcrum locations and applying a novel angular measurement system. Methods Thirty-nine subjects with a mean age of 18.2 ± 4.2 years were treated with MSE. Pre- and post-expansion CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified by localizing the interfrontal distance and modified interfrontal distance. Based on the fulcrum, a novel angular measurement method is presented and compared with a conventional linear method to assess changes of the zygomaticomaxillary complex, dentoalveolar bone, and maxillary first molars. Results From 39 patients, 20 subjects have the rotational fulcrum of the zygomaticomaxillary complex at the most distant points of the interfrontal distance (101.6 ± 4.7 mm) and 19 subjects at the most distant points of the modified interfrontal distance (98.9 ± 5.7 mm). Linear measurements accounted for 60.16% and 56.83% of skeletal expansion, 16.15% and 16.55% of alveolar bone bending, and 23.69% and 26.62% of dental tipping for right and left side. Angular measurements showed 96.58% and 95.44% of skeletal expansion, 0.34% and 0.33% alveolar bone bending, and 3.08% and 4.23% of dental tipping for the right and left sides. The frontozygomatic, frontoalveolar, and frontodental angles were not significant different (P > 0.05). Conclusions In the coronal plane, the center of rotation for the zygomaticomaxillary complex was located at the most external and inferior point of the zygomatic process of the frontal bone or slightly above and parallel to the interfrontal distance. Due to the rotational displacement of the zygomaticomaxillary complex, angular measurements should be a preferred method for assessing the expansion effects, instead of the traditional linear measurement method.
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103
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Lagravère MO, Ling CP, Woo J, Harzer W, Major PW, Carey JP. Transverse, vertical, and anterior-posterior changes between tooth-anchored versus Dresden bone-anchored rapid maxillary expansion 6 months post-expansion: A CBCT randomized controlled clinical trial. Int Orthod 2020; 18:308-316. [DOI: 10.1016/j.ortho.2020.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
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Fox GC, Jones TA, Wilson JM, Claro WI, Williams RA, Trojan TM, Al Dayeh A. Sutural loading in bone‐ versus dental‐borne rapid palatal expansion: An ex vivo study. Orthod Craniofac Res 2020; 23:419-426. [DOI: 10.1111/ocr.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Gavin C. Fox
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Thomas A. Jones
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - John M. Wilson
- College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Wanda I. Claro
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Richard A. Williams
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Terry M. Trojan
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Ayman Al Dayeh
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
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Li N, Sun W, Li Q, Dong W, Martin D, Guo J. Skeletal effects of monocortical and bicortical mini-implant anchorage on maxillary expansion using cone-beam computed tomography in young adults. Am J Orthod Dentofacial Orthop 2020; 157:651-661. [DOI: 10.1016/j.ajodo.2019.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
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106
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Copello FM, Marañón-Vásquez GA, Brunetto DP, Caldas LD, Masterson D, Maia LC, Sant'Anna EF. Is the buccal alveolar bone less affected by mini-implant assisted rapid palatal expansion than by conventional rapid palatal expansion?-A systematic review and meta-analysis. Orthod Craniofac Res 2020; 23:237-249. [PMID: 32187843 DOI: 10.1111/ocr.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/29/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically review the existing literature comparing mini-implant assisted rapid palatal expansion (MARPE) and conventional rapid palatal expansion (RPE) regarding the effect on the buccal alveolar bone thickness (BT) and marginal bone level (BL). METHODS PubMed/MEDLINE, Scopus, Web of Science, The Cochrane Library, Virtual Health Library, Embase, Ovid, LIVIVO, CINAHL, the Portal de Periódicos da CAPES, Google Scholar and SIGLE were searched up to January 2020. Risk of bias (RoB) assessments were performed using the Cochrane Collaboration and ROBINS-I tools. Fixed-effects meta-analysis of standardized mean differences (SMD) was implemented to assess the pooled estimates for the BT outcome. The analyses were performed adopting a significance level of 5%. A narrative synthesis was performed to summarize the results on the BL. The GRADE tool was used to assess the quality of the evidence. RESULTS Three randomized clinical trials and one retrospective study were included. Only one study was rated as with low RoB, while the others were scored as with moderate to serious RoB. Limited evidence indicated that patients using conventional RPE had a greater loss of the BT compared to patients using MARPE (SMD = 0.55; 95% CI: 0.29-0.80; P < .0001). Subgroup analyses showed that differences were significant in both premolars' regions, right (SMD = 0.75; 95% CI: 0.24-1.25; P = .004) and left (SMD = 1.05; 95% CI: 0.52-1.57; P < .0001), and these were not significant for the molars' regions (P > .05) (Low quality of evidence). LIMITATIONS Limited amount of selected papers, methodological issues that could lead to bias and high clinical heterogeneity among the studies. Due to the statistical model applied for the quantitative synthesis of the results, no generalization to any other population is recommended. CONCLUSIONS Limited evidence suggests that MARPE could decrease the loss of the buccal alveolar bone when compared to conventional RPE.
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Affiliation(s)
- Flávio Mendonça Copello
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Luciana Duarte Caldas
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniele Masterson
- Central Library of the Health Science Center, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Franzotti Sant'Anna
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Lo Giudice A, Quinzi V, Ronsivalle V, Martina S, Bennici O, Isola G. Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander. MATERIALS 2020; 13:ma13081815. [PMID: 32290597 PMCID: PMC7215674 DOI: 10.3390/ma13081815] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient's anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (G.I.)
| | - Vincenzo Quinzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, L’Aquila, Italy;
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (G.I.)
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, SA, Italy;
| | | | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (G.I.)
- Correspondence: ; Tel.: +39-0953782453
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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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Root Canal Anatomy of Maxillary First Premolar by Microscopic Computed Tomography in a Chinese Adolescent Subpopulation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4327046. [PMID: 31828103 PMCID: PMC6881762 DOI: 10.1155/2019/4327046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/08/2023]
Abstract
Objectives To investigate the root morphology and root canal anatomy of maxillary first premolar using microscopic computed tomography (micro-CT). Methods 324 maxillary first premolars were collected and scanned. The root and canal diameter, canal wall thickness, root taper, and cross-sectional shapes were determined in the single root with 1 canal (SR1C), single root with 2 canals (SR2C), and 2 roots with 2 canals (2R2C) by micro-CT. Results The results showed that single-rooted maxillary premolars were more common than other types. The incidence of SR1C, SR2C, and 2R2C reached 25%, 26.39%, and 26.39%, respectively. Root and canal diameters and canal wall thickness were decreased from coronal third to apical foramen. The three parameters and canal taper showed increases from buccal and palatal (BP) to mesiodistal (MD) aspects. The root canal tapers were smallest of the middle third level. The findings showed the different variations in 2R2C teeth. The root canal cross-sectional morphology in maxillary first premolars is complicated, including round, oval, long oval, flat canal, and irregular canal shapes. The distribution varied in different aspects. Conclusion Root canal morphology showed a wide variation and complicated structure. The single-rooted teeth were more common in the Chinese adolescent population, and the majority of maxillary first premolars have two canals.
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110
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Moon HW, Kim MJ, Ahn HW, Kim SJ, Kim SH, Chung KR, Nelson G. Molar inclination and surrounding alveolar bone change relative to the design of bone-borne maxillary expanders: A CBCT study. Angle Orthod 2019; 90:13-22. [PMID: 31461306 DOI: 10.2319/050619-316.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the molar inclination and skeletal and alveolar bone changes when comparing tooth bone-borne (MSE) and tissue bone-borne type maxillary expanders (C-expander) using cone-beam computed tomography (CBCT) in late adolescence. MATERIALS AND METHODS A sample of 48 late-adolescent patients were divided into two groups according to the type of expander: MSE group (n = 24, age = 19.2 ± 5.9 years) and C-expander group (n = 24, age = 18.1 ± 4.5 years). CBCT scans were taken before treatment and 3 months after expansion. Transverse skeletal and dental expansion, alveolar inclination, tooth axis, buccal alveolar bone height, thickness, dehiscence, and fenestration were evaluated on the maxillary first molar. Paired t-test, independent t-test, Pearson's chi-square test, and Spearman correlation analysis were performed. RESULTS The MSE group produced greater dental expansion (P < .05), whereas skeletal expansion was similar in both groups (P = .859). The C expander group had more alveolar bone inclination change (P < .01), and the MSE group had more buccal tipping of the anchorage teeth (P < .01 or .001). Buccal alveolar bone height loss and thickness changes were greater in the MSE group (P < .01 or <.001). Formation of dehiscences was more frequent in the MSE group (P < .001), whereas for fenestrations, there were no significant differences between the two groups. Buccal bone height loss in the MSE group had a negative correlation with initial buccal bone thickness. CONCLUSIONS The incorporation of teeth into bone-borne expanders resulted in an increase in the severity of side effects. For patients in late adolescence, tissue bone-borne expanders offer comparable skeletal effects to tooth bone-borne expanders, with fewer dentoalveolar side effects.
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111
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Khosravi M, Ugolini A, Miresmaeili A, Mirzaei H, Shahidi-Zandi V, Soheilifar S, Karami M, Mahmoudzadeh M. Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review. Int Orthod 2019; 17:425-436. [PMID: 31280998 DOI: 10.1016/j.ortho.2019.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.
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Affiliation(s)
- Mahdieh Khosravi
- Orthodontic Department Dental Faculty, 17 Shahrivar boulevard, Seman, Iran
| | - Alessandro Ugolini
- University of Genoa, Orthodontic Department, Largo Rosanna Benzi 10, Genova, Italy
| | - Amirfarhang Miresmaeili
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Hamed Mirzaei
- Faculty of Management of University of Tehran, Tehran, Iran
| | - Vahid Shahidi-Zandi
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Sepideh Soheilifar
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Manoochehr Karami
- Hamedan University of medical sciences, Department of Epidemiology School of Health, Shahid Fahmide boulevard, Hamedan, Iran
| | - Majid Mahmoudzadeh
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran.
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Kim KA, Oh SH, Kim BH, Kim SJ. Asymmetric nasomaxillary expansion induced by tooth-bone-borne expander producing differential craniofacial changes. Orthod Craniofac Res 2019; 22:296-303. [PMID: 31066172 DOI: 10.1111/ocr.12320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate three-dimensional (3D) craniofacial changes induced by a non-surgical tooth-bone-borne rapid palatal expander (TBB-RPE) according to the symmetrical pattern of expansion, to investigate the 3D changes between the sides in patients with asymmetric expansion, and to identify the related factors of asymmetric expansion. SETTING AND SAMPLE POPULATION Sixty-six patients (mean age: 19.3 ± 5.7 years) treated with TBB-RPE were divided into a symmetric expansion group (Group S, n = 46) or asymmetric expansion group (Group A, n = 20). Group S was subdivided into Group Ss (n = 27), with bilateral frontomaxillary suture (FMS) split, and Group Sn (n = 19), with no FMS split. MATERIALS AND METHODS Pre- and post-expansion cone-beam computed tomography images were superimposed, and the common coordinated system was set. All landmarks were designated as coordinate pairs, and treatment changes were automatically calculated. Analysis of variance was conducted for intergroup comparison of craniofacial changes, and logistic regression analysis was performed to identify the related factors of asymmetric expansion. RESULTS The frequency of asymmetric expansion was 30.3%. Group A with unilateral FMS split showed less craniofacial changes than Group Ss and more changes than Group Sn. Group A exhibited different nasomaxillary displacement between the two halves, showing greater changes in the FMS-split side. Among the tested six variables (age, gender, Angle's classification, unilateral crossbite, maxillary cant and chin deviation), chin deviation was uniquely associated with asymmetric expansion. CONCLUSIONS Tooth-bone-borne rapid palatal expander had a risk of asymmetric expansion, especially in facial asymmetric patients with chin deviation, producing different craniofacial changes from symmetric expansion.
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Affiliation(s)
- Kyung-A Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Song-Hee Oh
- Department of Oral and Maxillofacial Radiology, Kyung Hee University School of Dentistry, Seoul, Korea
| | | | - Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
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Yoon S, Lee DY, Jung SK. Influence of changing various parameters in miniscrew-assisted rapid palatal expansion: A three-dimensional finite element analysis. Korean J Orthod 2019; 49:150-160. [PMID: 31149605 PMCID: PMC6533180 DOI: 10.4041/kjod.2019.49.3.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to analyze the effect of changing various parameters of the bone-borne rapid palatal expander (RPE) using the finite element method (FEM). Methods In eight experimental groups, we investigated the effect of the number, position, and length of miniscrews; positional changes of the expander; and changes in the hook length on maxillary expansion. In finite element analysis, we compared the magnitude and distribution of stress, and the displacement changes following expansion of the bone-borne RPE. Results When we compared the number and position of miniscrews, placing miniscrews in the anterior and posterior sides was advantageous for maxillary expansion in terms of stress distribution and displacement changes. Miniscrew length did not significantly affect stress distribution and displacement changes. Furthermore, anteroposterior displacement of the expander did not significantly affect transverse maxillary expansion but had various effects on vertical changes of the maxilla. The maxilla rotated clockwise when the miniscrews were placed in the anterior region. The hook length of the expander did not show consistent results in terms of changes in stress distribution and magnitude or in displacement changes. Conclusions The findings of this study suggest that changes in the location and length of the miniscrews and displacement of the bone-borne RPE could affect the pattern of the maxillary expansion, depending on the combination of these factors.
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Affiliation(s)
- Soungjun Yoon
- Department of Orthodontics, Graduate School of Clinical Dentistry, Korea University, Seoul, Korea
| | - Dong-Yul Lee
- Department of Orthodontics, Korea University Guro Hospital, Seoul, Korea
| | - Seok-Ki Jung
- Department of Orthodontics, Korea University Ansan Hospital, Ansan, Korea
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Storto CJ, Garcez AS, Suzuki H, Cusmanich KG, Elkenawy I, Moon W, Suzuki SS. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion. Angle Orthod 2019; 89:713-720. [PMID: 30896250 DOI: 10.2319/070518-504.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). MATERIALS AND METHODS Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. RESULTS There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. CONCLUSIONS Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.
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Oh H, Park J, Lagravere-Vich MO. Comparison of traditional RPE with two types of micro-implant assisted RPE: CBCT study. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zong C, Tang B, Hua F, He H, Ngan P. Skeletal and dentoalveolar changes in the transverse dimension using microimplant-assisted rapid palatal expansion (MARPE) appliances. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yildirim M, Akin M. Comparison of root resorption after bone-borne and tooth-borne rapid maxillary expansion evaluated with the use of microtomography. Am J Orthod Dentofacial Orthop 2019; 155:182-190. [PMID: 30712689 DOI: 10.1016/j.ajodo.2018.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Root resorption was compared between bone-borne and tooth tissue-borne rapid maxillary expansion patients with the use of microtomography. METHODS The study included 20 patients (ages 11-16 years) requiring fixed orthodontic treatment who underwent extraction of their first premolars after rapid maxillary expansion with the use of modified appliances. One side of the appliance covered the teeth with acrylic, while the other side was fixed to the palatal bone by means of a miniscrew. After 3 months' retention, the appliance was removed and teeth were extracted and examined with the use of microtomography. RESULTS When the apical, middle, and cervical thirds, as well as the buccal and lingual sides, were compared, the volume loss was significantly higher in the tooth tissue-borne group than in the bone-borne group (P <0.01). The least volume loss occurred on the cervical third lingual surface in the tooth tissue-borne group and on the middle third buccal surface in the bone-borne group. In the former group, least resorption occurred on the cervical third and highest resorption on the buccal side. In the latter group, surfaces showed no significant changes. CONCLUSIONS More root resorption occurred in the tooth tissue-borne group, mostly in the apical and middle thirds. The amount of resorption on the buccal surface was higher than that on the lingual surface.
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Affiliation(s)
- Mucahid Yildirim
- Department of Orthodontics, Faculty of Dentistry, Konya Necmettin Erbakan University, Konya, Turkey.
| | - Mehmet Akin
- Department of Orthodontics, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey
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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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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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Abedini S, Elkenawy I, Kim E, Moon W. Three-dimensional soft tissue analysis of the face following micro-implant-supported maxillary skeletal expansion. Prog Orthod 2018; 19:46. [PMID: 30450504 PMCID: PMC6240556 DOI: 10.1186/s40510-018-0243-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background Skeletal maxillary expander (MSE) is one of the more recent expander designs being utilized for skeletal expansion by splitting the midpalatal sutures applying forces through palatal micro-implants. Its effects on the soft tissue remain a question asked by both patients and clinicians. The aim of this study was to analyze and quantify soft tissue facial changes induced by MSE. Methods 3D facial images (3dMD) were used to capture face scans of 25 patients generating 3D soft tissue meshes before expansion (T0), right after expansion (T1), and 1 year in retention (T2). MATLAB was then used, utilizing non-rigid iterative closest point algorithm, to align all samples in vertex correspondence and generate averages. Surface mapping of each average, along with its variance, allows for quantification of changes between the three pools of samples in 3D space. Results The generated 3D p-maps between T0 and T1 demonstrate that statistically significant changes (p < 0.05 and p < 0.01) are localized in the circummaxillary area (paranasal, lips, and both cheeks). Vector map shows a mean displacement of 1.5 mm in the paranasal area. The right cheek showing a mean displacement magnitude of 2.5 mm while the left cheek has a mean of 2.9 mm. Direction of vectors are latero-anterior with more dominant anterior direction. Conclusions There are significant changes in paranasal, upper lip, and at both cheeks following expansion using MSE with greater magnitude at the cheeks area. Those changes do not relapse after 1 year (p < 0.05).
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Affiliation(s)
- Sara Abedini
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, CA, Los Angeles, 90095-1668, USA
| | - Islam Elkenawy
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, CA, Los Angeles, 90095-1668, USA
| | - Eric Kim
- Department of Computer Science, University of California, Los Angeles, 4732 Boelter Hall, Los Angeles, CA, 90095, USA
| | - Won Moon
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, CA, Los Angeles, 90095-1668, USA.
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Hartono N, Soegiharto BM, Widayati R. The difference of stress distribution of maxillary expansion using rapid maxillary expander (RME) and maxillary skeletal expander (MSE)-a finite element analysis. Prog Orthod 2018; 19:33. [PMID: 30280257 PMCID: PMC6168444 DOI: 10.1186/s40510-018-0229-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Maxillary skeletal expander (MSE) in combination with miniscrews was developed to overcome the drawbacks that may have resulted from the application of conventional rapid maxillary expander (RME). This research was conducted to analyze the difference of stress distribution of maxillary expansion using RME and MSE in the region of interests (ROIs): first molars (M1), palatal alveolar bones of M1, palatine sutures, zygomatic sutures, miniscrews, and their surrounding bones. Methods A dry skull was scanned using CBCT and rendered into a three-dimensional (3D) model of craniomaxillary structures. The data analysis was done both visually and numerically. Result The stress distributions in RME group were located at the palatal side of M1, mesial side of palatal alveolar of M1, pulp chamber of M1, and inferior cortex of palatine sutures. The stress distributions in the MSE group were located at the distopalatal cusp of M1, palatal side of palatal alveolar of M1, and inferior and superior cortex of palatine sutures. The stress distributions in zygomatic sutures on both groups were located at the zygomaticotemporal sutures, whereas in the miniscrews, the stress were located at the anterior miniscrews and palatal side of surrounding bones. Conclusions There were significant differences of stress distribution of maxillary expansion measured in the ROIs in the craniomaxillary 3D model using RME and MSE.
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Affiliation(s)
- Nathania Hartono
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia
| | - Benny M Soegiharto
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia.
| | - Retno Widayati
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia
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Taner L, Metin-Gürsoy G, Sarısu-Demircioğlu ND. Differential Benefit of Two Different Tooth-Borne Rapid Maxillary Expansion Appliances in Female Subjects. Turk J Orthod 2018; 31:67-72. [PMID: 30206564 DOI: 10.5152/turkjorthod.2018.17051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
Objective The aim of the present study was to evaluate the effects of tooth-borne acrylic-bonded rapid maxillary expansion (RME) appliances with or without the anterior teeth anchorage on the skeletal and dentoalveolar structures, as well as soft tissues. Methods This study included 44 patients who were treated with two different tooth-borne bonded acrylic RME appliances. Lateral cephalometric radiographs were taken before the treatment (T0) and in the post-retention (T1) phase of the RME treatment. The posterior-bonded RME appliance group and full-bonded RME appliance group were created as the two different groups of treatment. The following statistical analyses were performed: intra- and inter-group comparisons were made using the paired t-test, Wilcoxon test, independent t-test, and Mann-Whitney U-test for normal and non-normal distribution data. Results Significant increases were observed in R1-A, R1-ANS, R1-U1, R1-AR, R1-St, R1-Li, and R1-Pn in both groups. R1-PNS, R1-Ls, R1-Sn, and R1-B' were found to be significantly larger at T1 than at T0 in the posterior-bonded RME appliance group. R2-A, R2-ANS, R2-L1, R2-A', and R2-Pn were significantly larger at T1 than at T0 in the full-bonded RME appliance group. The R2-A' was significantly different between the groups. Conclusion The soft tissue A point appears to be the most important differing matter between the two different RME appliances, and a full acrylic-bonded RME appliance may be beneficial for subjects with a maxillary retrognathic profile.
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Affiliation(s)
- Lale Taner
- Department of Orthodontics, Gazi University University School of Dentistry, Ankara, Turkey
| | - Gamze Metin-Gürsoy
- Department of Orthodontics, Gazi University University School of Dentistry, Ankara, Turkey
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Cantarella D, Dominguez-Mompell R, Moschik C, Mallya SM, Pan HC, Alkahtani MR, Elkenawy I, Moon W. Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images. Am J Orthod Dentofacial Orthop 2018; 154:337-345. [PMID: 30173836 DOI: 10.1016/j.ajodo.2017.11.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our objectives were to evaluate midfacial skeletal changes in the coronal plane and the implications of circummaxillary sutures and to localize the center of rotation for the zygomaticomaxillary complex after therapy with a bone-anchored maxillary expander, using high-resolution cone-beam computed tomography. METHODS Fifteen subjects with a mean age of 17.2 ± 4.2 years were treated with a bone-anchored maxillary expander. Pretreatment and posttreatment cone-beam computed tomography images were superimposed and examined for comparison. RESULTS Upper interzygomatic distance increased by 0.5 mm, lower interzygomatic distance increased by 4.6 mm, frontozygomatic angles increased by 2.5° and 2.9° (right and left sides), maxillary inclinations increased by 2.0° and 2.5° (right and left sides), and intermolar distance increased by 8.3 mm (P <0.05). Changes in frontoethmoidal, zygomaticomaxillary, and molar basal bone angles were negligible (P >0.05). CONCLUSIONS A significant lateral displacement of the zygomaticomaxillary complex occurred in late adolescent patients treated with a bone-anchored maxillary expander. The zygomatic bone tended to rotate outward along with the maxilla with a common center of rotation located near the superior aspect of the frontozygomatic suture. Dental tipping of the molars was negligible during treatment.
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Affiliation(s)
- Daniele Cantarella
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif.
| | - Ramon Dominguez-Mompell
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Christoph Moschik
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Sanjay M Mallya
- Section of Oral and Maxillofacial Radiology, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Hsin Chuan Pan
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Mohammed R Alkahtani
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Islam Elkenawy
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Won Moon
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif.
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Celenk-Koca T, Erdinc AE, Hazar S, Harris L, English JD, Akyalcin S. Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: A prospective randomized clinical trial. Angle Orthod 2018; 88:702-709. [PMID: 30102085 DOI: 10.2319/011518-42.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES: To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents. MATERIALS AND METHODS: Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods. RESULTS: Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups. CONCLUSION: Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.
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Bone-borne accelerated sutural expansion: A microcomputed tomography study in rabbits. Am J Orthod Dentofacial Orthop 2018; 154:260-269. [PMID: 30075928 DOI: 10.1016/j.ajodo.2017.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/29/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In this study, we evaluated the effect of bone-borne accelerated expansion protocols on sutural separation and sutural bone modeling using a microcomputed tomography system. We also determined the optimum instant sutural expansion possible without disruption of bone modeling. METHODS Sixteen New Zealand white rabbits, 20 to 24 weeks old, were randomly divided into 4 experimental groups. Modified hyrax expanders were placed across their interfrontal sutures and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax appliances were activated as follows: group 1 (control), 0.5-mm per day expansion for 12 days; group 2, 1-mm instant expansion followed by 0.5 mm per day for 10 days; group 3, 2.5-mm instant expansion followed by 0.5 mm per day for 7 days, and group 4, 4-mm instant expansion followed by 0.5 mm per day for 4 days. After 6 weeks of retention, sutural separation and sutural bone modeling were assessed by microcomputed tomography and quantified. Statistical analysis was performed using Kruskal Wallis and Mann-Whitney U tests and the Spearman rho correlation (P <0.05). RESULTS Median amounts of sutural separation ranged from 2.84 to 4.41 mm for groups 1 and 4, respectively. Median bone volume fraction ranged from 59.96% to 69.15% for groups 4 and 3, respectively. A significant correlation (r = 0.970; P <0.01) was observed between the amounts of instant expansion and sutural separation. CONCLUSIONS Pending histologic verifications, our findings suggest that the protocol involving 2.5 mm of instant expansion followed by 0.5 mm per day for 7 days is optimal for accelerated sutural expansion. When 4 mm of instant expansion was used, the sutural bone volume fraction was decreased.
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Ngan P, Nguyen UK, Nguyen T, Tremont T, Martin C. Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study. APOS TRENDS IN ORTHODONTICS 2018. [DOI: 10.4103/apos.apos_27_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction
Microimplant-assisted rapid palatal expansion (MARPE) has recently been offered to adult patients for correcting maxillary transverse deficiency. However, there is limited information in the literature on the success of this appliance and its skeletal and dental effects on skeletally matured patients. The purpose of this study was to investigate the immediate skeletal, dentoalveolar, and periodontal response to MARPE appliance using cone-beam computed tomography in a skeletally matured patient as assessed by the cervical vertebral maturation method.
Materials and Methods
Eight consecutively treated patients (2 females, 6 males; mean age of 21.9 ± 1.5 years) treated with a maxillary skeletal expander were included in the study. Measurements were taken before and after expansion to determine the amount of midpalatal suture opening, upper facial bony expansion, alveolar bone bending, dental tipping, and buccal bone thickness (BBT). Data were analyzed using a one-way ANOVA and matched-pair t-test (α = 0.05).
Results
Midpalatal suture separation was found in 100% of the patients with no dislodged microimplants. Total maxillary expansion was attributed to 41% skeletal, 12% alveolar bone bending, and 48% dental tipping. Pattern of midpalatal suture opening was found to be parallel in both the coronal and axial planes. On average, the absolute dental tipping ranged from 4.17° to 4.96° and the BBT was reduced by an average of 39% measured at the premolars and molars.
Conclusions
The MARPE appliance can be a clinically acceptable, nonsurgical treatment option for correcting mild to moderate maxillary transverse discrepancies for skeletally matured adult patients with a healthy periodontium.
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Affiliation(s)
- Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
| | | | - Tung Nguyen
- Department of Orthodontics, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Timothy Tremont
- Department of Orthodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Martin
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
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Lo Giudice A, Galletti C, Gay-Escoda C, Leonardi R. CBCT assessment of radicular volume loss after rapid maxillary expansion: A systematic review. J Clin Exp Dent 2018; 10:e484-e494. [PMID: 29849974 PMCID: PMC5971075 DOI: 10.4317/jced.54745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/11/2018] [Indexed: 02/03/2023] Open
Abstract
Background The present systematic review analyzed the current literature to investigate whether rapid maxillary expansion (RME) causes radicular resorption, assessed by cone-beam computed tomography (CBCT). Material and Methods Eighteen electronic databases and reference lists of studies were searched up to November 2017. Grey literature was also screened. To be included, articles must be human studies on growing subjects with transversal maxillary deficiency treated with maxillary expansion protocol and with 3-D radiographic assessment of radicular volume by CBCT images. Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, teeth evaluated, CBCT settings), and study outcomes (radicular volume loss) were reported according to the PRISMA statement. Results Only 3 articles were considered eligible and an individual analysis of the selected articles was undertaken. The risk of bias assessment revealed low methodological quality for all the studies included. In all the considered studies, significant radicular volume loss was observed in posterior teeth, following RME. When reported in percentage, the radicular volumetric loss was similar between anchored (first molars and first premolars) and unanchored teeth (second premolars). Conclusions A preliminary evaluation of the patient-related risk factors for RR is warmly advisable when administering RME. Key words:RME, maxillary expansion, root resorption, external root resorption.
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Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging - Section of Orthodontics, School of Dentistry, University of Messina, Policlinico Universitario "G. Martino", Via Consolare Valeria - 98123 Messina, Italy
| | - Cosimo Galletti
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy
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Is there an optimal initial amount of activation for midpalatal suture expansion? : A histomorphometric and immunohistochemical study in a rabbit model. J Orofac Orthop 2018; 79:169-179. [PMID: 29644389 DOI: 10.1007/s00056-018-0134-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 01/31/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Accelerated bone-borne expansion protocols on sutural separation and sutural bone formation were evaluated via histomorphometry and immunohistochemistry to determine the optimal initial activation without disruption of bone formation. MATERIALS AND METHODS Sixteen New Zealand white rabbits were randomly divided into four groups. Modified Hyrax expanders were placed across the midsagittal sutures and secured with miniscrew implants with the following activations: group 1 (control), 0.5 mm expansion/day for 12 days; group 2, 1 mm instant expansion followed by 0.5 mm expansion/day for 10 days; group 3, 2.5 mm instant expansion followed by 0.5 mm expansion/day for 7 days; and group 4, 4 mm instant expansion followed by 0.5 mm expansion/day for 4 days. After 6 weeks, sutural expansion and new bone formation were evaluated histomorphometrically. Statistical analysis was performed using Kruskal-Wallis/Mann-Whitney U tests and Spearman's rho correlation (p < 0.05). RESULTS The smallest median sutural separation was observed in group 1 (3.05 mm) and the greatest in group 4 (4.57 mm). The lowest and highest amount of bone formation were observed in group 4 (55.82%) and in group 3 (66.93%), respectively. Immunohistochemical analysis revealed significant differences in median levels of alkaline phosphatase and osteopontin expression between all experimental groups. The highest level of these proteins was attained in group 3, followed by groups 2, 1, and 4, respectively. CONCLUSIONS Sutural appositional bone formation corresponded with the amount of initial expansion to a point. When initial expansion was increased to 4 mm, sutural bone remodeling was disturbed and new bone formation was decreased. The most effective sutural expansion was achieved with 2.5 mm initial activation followed by 0.5 mm expansion/day for 7 days.
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Le MHT, Lau SF, Ibrahim N, Noor Hayaty AK, Radzi ZB. Adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model. Korean J Orthod 2018; 48:98-106. [PMID: 29564219 PMCID: PMC5854887 DOI: 10.4041/kjod.2018.48.2.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to explore the usefulness of adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model using cone-beam computed tomography (CBCT). Methods Twelve adult sheep were randomly divided into two groups (each n = 6): a control group, where no treatment was administered, and a treatment group, where buccal and palatal corticotomy-assisted maxillary expansion was performed. CBCT scans were taken before (T1) and after (T2) treatment. Differences in all transverse dental and alveolar dimensions, alveolar width at crest level, hard palate level, horizontal bone loss, interdental cusp width and inter-root apex were assessed using Wilcoxon signed-rank and Mann-Whitney U-tests. Kruskal-Wallis tests and pairwise comparisons were used to detect the significance of differences among the inter-premolar and inter-molar widths. Results CBCT data revealed significant changes in all transverse dental and alveolar dimensions. The mean interpremolar alveolar width showed an increase of 2.29 to 3.62 mm at the hard palate level, 3.89 to 4.38 mm at the alveolar crest level, and 9.17 to 10.42 mm at the buccal cusp level. Dental changes in the vertical dimension were not significant. Conclusions Our findings based on an adult animal model suggest that adjunctive buccal and palatal corticotomy can allow for both skeletal and dental expansion, with the amount of dental expansion exceeding that of skeletal expansion at alveolar crest and hard palate levels by two and three folds, respectively. Therefore, this treatment modality is potential to enhance the outcomes of maxillary expansion in adults.
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Affiliation(s)
- My Huy Thuc Le
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng Fong Lau
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Selangor, Malaysia
| | - Norliza Ibrahim
- Department of Diagnostic and Intergrated Dental Practice, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Abu Kasim Noor Hayaty
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Zamri Bin Radzi
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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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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131
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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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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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133
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Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J, Moon W. Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod 2017; 18:34. [PMID: 29090368 PMCID: PMC5663987 DOI: 10.1186/s40510-017-0188-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/03/2017] [Indexed: 12/05/2022] Open
Abstract
Background Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture. Methods Fifteen subjects (mean age of 17.2 years; range, 13.9–26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher’s exact test was used. Results Regarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture opening was negligible (R2 range, 0.3–4.2%). Conclusions Midpalatal suture was successfully split by MSE in late adolescents, and the opening was almost perfectly parallel in a sagittal direction. Regarding the extent of transverse asymmetry of the split, on average one half of ANS moved more than the contralateral one by 1.1 mm. Pterygopalatine suture was split in its lower region by MSE, as the pyramidal process was pulled out from the pterygoid process. Patient gender and age had a negligible influence on suture opening for the age group considered in the study.
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Affiliation(s)
- Daniele Cantarella
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Ramon Dominguez-Mompell
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Sanjay M Mallya
- Division of Diagnostic and Surgical Sciences, Section of Oral and Maxillofacial Radiology, School of Dentistry, Center for Health Science, University of California, Room 53-068 B CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Christoph Moschik
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Hsin Chuan Pan
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Joseph Miller
- Division of Integrative Anatomy, Department of Pathology and Laboratory Medicine, Geffen School of Medicine, Center for Health Science, University of California, Room 52-068 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Won Moon
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA.
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134
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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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Lo Giudice A, Barbato E, Cosentino L, Ferraro CM, Leonardi R. Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review. Eur J Orthod 2017; 40:296-303. [DOI: 10.1093/ejo/cjx057] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antonino Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging—Section of Orthodontics, School of Dentistry, University of Messina, Italy
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences, School of Dentistry, “Sapienza” University of Rome, Italy
| | - Leandro Cosentino
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Claudia Maria Ferraro
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
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136
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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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137
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Isfeld D, Lagravere M, Leon-Salazar V, Flores-Mir C. Novel methodologies and technologies to assess mid-palatal suture maturation: a systematic review. Head Face Med 2017; 13:13. [PMID: 28615034 PMCID: PMC5471738 DOI: 10.1186/s13005-017-0144-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A reliable method to assess midpalatal suture maturation to drive clinical decision-making, towards non-surgical or surgical expansion, in adolescent and young adult patients is needed. The objectives were to systematically review and evaluate what is known regarding contemporary methodologies capable of assessing midpalatal suture maturation in humans. METHODS A computerized database search was conducted using Medline, PubMed, Embase and Scopus to search the literature up until October 5, 2016. A supplemental hand search was completed of references from retrieved articles that met the final inclusion criteria. RESULTS Twenty-nine abstracts met the initial inclusion criteria. Following assessment of full articles, only five met the final inclusion criteria. The number of subjects involved and quality of studies varied, ranging from an in-vitro study using autopsy material to prospective studies with in vivo human patients. Three types of evaluations were identified: quantitative, semi-quantitative and qualitative evaluations. Four of the five studies utilized computed tomography (CT), while the remaining study utilized non-invasive ultrasonography (US). No methodology was validated against a histological-based reference standard. CONCLUSIONS Weak limited evidence exists to support the newest technologies and proposed methodologies to assess midpalatal suture maturation. Due to the lack of reference standard validation, it is advised that clinicians still use a multitude of diagnostic criteria to subjectively assess palatal suture maturation and drive clinical decision-making.
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Affiliation(s)
- Darren Isfeld
- Orthodontic Graduate Program, School of Dentistry University of Alberta, Edmonton, AB, Canada
| | - Manuel Lagravere
- School of Dentistry, University of Alberta, Edmonton, 11405 - 87th avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Vladimir Leon-Salazar
- Division of Pediatric Dentistry, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, AB, Canada
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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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139
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Canan S, Şenışık NE. Comparison of the treatment effects of different rapid maxillary expansion devices on the maxilla and the mandible. Part 1: Evaluation of dentoalveolar changes. Am J Orthod Dentofacial Orthop 2017; 151:1125-1138. [DOI: 10.1016/j.ajodo.2016.11.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
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140
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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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Lombardo L, Sacchi E, Larosa M, Mollica F, Mazzanti V, Spedicato GA, Siciliani G. Evaluation of the stiffness characteristics of rapid palatal expander screws. Prog Orthod 2016; 17:36. [PMID: 27747528 PMCID: PMC5124561 DOI: 10.1186/s40510-016-0151-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study is to evaluate the mechanical properties of the screws used for rapid expansion of the upper jaw. Methods Ten types of expansion screw were assessed, seven with four arms: Lancer Philosophy 1, Dentaurum Hyrax Click Medium, Forestadent Anatomic Expander type “S”, Forestadent Anatomic Expander type “S” for narrow palates, Forestadent Memory, Leone A 2620-10 with telescopic guide, and Leone A 0630-10 with orthogonal arms; and three with two arms: Dentaurum Variety S.P., Target Baby REP Veltri, and Leone A 362113. A test expander with the mean dimensions taken from measurements on a sample of 100 expanders was constructed for each screw. The test expanders were connected to the supports of an Instron 4467 (Instron Corp., USA) mechanical testing machine equipped with a 500 N load cell, and the compression force exerted after each activation was measured. The mean forces expressed by the two- and four-arm expanders were then compared. Results After five activations, the forces expressed by the two-arm devices were double than those expressed by the four-arm devices on average (224 ± 59.9 N vs. 103 ± 32.9 N), and such values remained high after subsequent activations. Conclusions The expanders tested demonstrated stiffness characteristics compatible with opening of the palatine sutures in pre-adolescent patients. The stiffness of such devices can be further increased during the construction phase.
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Affiliation(s)
- Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy
| | | | - Maria Larosa
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy.
| | - Francesco Mollica
- Department of Engineering, University of Ferrara, Via Saragat 1, 44122, Ferrara, Italy
| | - Valentina Mazzanti
- Department of Engineering, University of Ferrara, Via Saragat 1, 44122, Ferrara, Italy
| | | | - Giuseppe Siciliani
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy
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142
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Stepanko LS, Lagravère MO. Sphenoid bone changes in rapid maxillary expansion assessed with cone-beam computed tomography. Korean J Orthod 2016; 46:269-79. [PMID: 27668190 PMCID: PMC5033766 DOI: 10.4041/kjod.2016.46.5.269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Rapid maxillary expansion (RME) is used to expand the maxilla and increase arch perimeter; yet, there are few reports on its effects on the sphenoid bone. With cone-beam computed topography (CBCT), it is possible to visualize sphenoid bone changes. The purpose of this study was to investigate sphenoid bone changes observed in conjunction with RME treatments, using CBCT. METHODS Sixty patients (34 women and 26 men, aged 11-17 years) underwent RME as part of their orthodontic treatment. Patients were randomly assigned to one of three groups: a tooth-anchored group, a bone-anchored group, or a control group. Initial CBCT scans were performed preceding the RME treatment (T1) and again directly after the completion of expansion (T2). Statistical analysis included ANOVA, descriptive statistics, and the intraclass correlation coefficient (ICC). RESULTS The reliability of the landmark location was at least 0.783, and the largest ICC mean measurement error was 2.32 mm. With regard to distances, the largest change was 0.78 mm, which was not statistically significant (p > 0.05). Statistical significance was established in patient groups of the same sex and treatment type for the following distance measurements: right anterior lateral pterygoid plate to the right edge of the hypophyseal fossa (d2), anterior distance between the medial pterygoid plates (d4), and anterior distance between the left medial and lateral plates (d8). CONCLUSIONS In this study, there were no clinically significant changes in the sphenoid bone due to RME treatments regardless of sex or treatment type.
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Affiliation(s)
- Lucas S Stepanko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Manuel O Lagravère
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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143
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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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144
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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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Martins DC, Souki BQ, Cheib PL, Silva GAB, Reis IDG, Oliveira DD, Nunes E. Rapid maxillary expansion: Do banded teeth develop more external root resorption than non-banded anchorage teeth? Angle Orthod 2016; 86:39-45. [PMID: 25938174 PMCID: PMC8603965 DOI: 10.2319/011015-20.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/01/2015] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE To compare external root resorption (ERR) when bands and wires are used as orthodontic anchorage during rapid maxillary expansion (RME). MATERIALS AND METHODS Histologic analysis was performed on 108 sites from 18 maxillary first premolars and on 36 sites from six mandibular first premolars in nine subjects (mean age = 15.2 ± 1.4 years) 3 months after RME. Maxillary teeth were pooled into two groups (n = 54 each) according to the type of orthodontic anchorage (band group [BG] vs wire group [WG]). Anchorage type was randomly chosen in a split-mouth design. Mandibular first premolars, which were not subjected to orthodontic forces, were used as the control group (CG). RESULTS All premolars in the BG and WG showed ERR at the level of the cementum and dentin. Repair with cementum cells was observed in all resorption areas, but complete repair was rarely found. No statistically significant difference was found between the BG and WG with regard to the ERR. No association was found between the root height position (middle or cervical third) and the incidence of ERR. Buccal root surfaces showed a higher amount of ERR compared with the palatal and interproximal surfaces. ERR was not found in any teeth in the CG. CONCLUSION All maxillary first premolars subjected to RME showed ERR and partial cementum repair. Banded teeth did not develop more ERR than nonbanded anchorage teeth.
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Affiliation(s)
- Débora C Martins
- a Currently serving the Brazilian Army Dental Service, Manaus, Brazil; Former Orthodontic Resident, Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo Q Souki
- b Associate Professor of Orthodontics, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Paula L Cheib
- a Currently serving the Brazilian Army Dental Service, Manaus, Brazil; Former Orthodontic Resident, Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Gerluza A B Silva
- c Associate Professor of Histology, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Igor D G Reis
- d Biomedicine undergraduate student, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Dauro D Oliveira
- b Associate Professor of Orthodontics, Graduate Program in Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Eduardo Nunes
- e Associate Professor of Endodontics, Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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147
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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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