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Ateş EM, Pamukçu H, Koç O, Altıparmak N. Effects of different expansion appliances and surgical incisions on maxillary expansion: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101936. [PMID: 38849083 DOI: 10.1016/j.jormas.2024.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE This study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures. METHODS Seven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD. RESULTS The largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD. CONCLUSION SARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD.
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Affiliation(s)
- Ece Mersan Ateş
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey
| | - Hande Pamukçu
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey.
| | - Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Nur Altıparmak
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey
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Hassan Alzahrani F, Devanna R, Althomali Y, Hassan Felemban N, Manjunath Battepati P, Holenarasipur AV. Impact of digital orthodontics on maxillary protraction with implants in children with skeletal class III: A systematic review and meta-analysis. Saudi Dent J 2024; 36:240-248. [PMID: 38420003 PMCID: PMC10897631 DOI: 10.1016/j.sdentj.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024] Open
Abstract
Objective The objective of this systematic review is to assess the effectiveness of digital orthodontics in utilizing implants for maxillary protraction as a treatment for skeletal class III malocclusion in children. Materials and Methods The study was registered with PROSPERO with the number CRD42023407406 on 23/03/2023. We conducted an extensive comprehensive literature search in nine electronic databases, including PubMed, PubMed Central, Scopus, Cochrane databases, Google Scholar, MEDLINE, EMBASE, LILACS, and the Web of Sciences databases. The studies were evaluated for their methodology, the intervention technology used, the outcomes, and their quality. Publication bias assessment was conducted using the Jadad scale and the ROBINS-I assessment tool. Results We included a total of 17 studies that comprised a total of 376 patients in this analysis. The number of patients and participants fluctuated between 1 and 71, with > 60 % being female. The patients were aged between 1.1 and 19.2 years. We included only nine studies in the meta-analysis, in which we observed a success rate between 71.4 % and 100 % with a 95 % CI of 17.4 ± 2.988 (±17.2 %) [14.412-20.388]. The failure rates, although minimal, ranged from 5.9 % to 28.6 %, with a 95 % CI of 2.3 ± 1.480 (±64.3 %) [0.820-3.780]. Conclusion The evidence suggests that digital orthodontics is a promising approach for treating children with skeletal class III malocclusion using implants for maxillary protraction. However, further high-quality studies are required for validating our current observations and regulating the stability of treatment outcomes on a long-term basis.
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Affiliation(s)
| | - Raghu Devanna
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Yousef Althomali
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Nayef Hassan Felemban
- Orthodontic Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Prashant Manjunath Battepati
- Pediatric Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Amith V. Holenarasipur
- Community Dentistry Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
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Chen H, Kapetanović A, Piao Z, Xi T, Schols JGJH. Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors. Clin Oral Investig 2023; 27:6007-6014. [PMID: 37597004 PMCID: PMC10560192 DOI: 10.1007/s00784-023-05214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES To evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors. MATERIALS AND METHODS Patients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record. RESULTS Twenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02). CONCLUSIONS One and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession. CLINICAL RELEVANCE Clinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.
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Affiliation(s)
- Hao Chen
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aldin Kapetanović
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zhengguo Piao
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 10, 6500, HB, Nijmegen, The Netherlands.
| | - Jan G J H Schols
- Department of Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Krijt LL, Kapetanović A, Sijmons WJL, Bruggink R, Baan F, Bergé SJ, Noverraz RRM, Xi T, Schols JGJH. What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study. Clin Oral Investig 2023; 27:5343-5351. [PMID: 37507601 PMCID: PMC10492756 DOI: 10.1007/s00784-023-05154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS 3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS. RESULTS Twenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06). CONCLUSIONS Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited. CLINICAL RELEVANCE MARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.
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Affiliation(s)
- Laura L Krijt
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands.
| | - Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Wouter J L Sijmons
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Robin Bruggink
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - René R M Noverraz
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jan G J H Schols
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
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Kapetanović A, Noverraz RRM, Listl S, Bergé SJ, Xi T, Schols JGJH. What is the Oral Health-related Quality of Life following Miniscrew-Assisted Rapid Palatal Expansion (MARPE)? A prospective clinical cohort study. BMC Oral Health 2022; 22:423. [PMID: 36138473 PMCID: PMC9502924 DOI: 10.1186/s12903-022-02444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical orthodontic treatment for transverse maxillary deficiency. This study aimed to investigate the Oral Health-related Quality of Life (OHRQoL) and pain perception of patients undergoing MARPE treatment. Methods 42 consecutive patients (9 men, 33 women) from the age of 16 onwards (mean: 27.4 ± 9.3 years; range 17.1–55.7 years) who received a MARPE treatment were included. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. Patients filled out the questionnaire at baseline (T0) and weekly during the expansion phase (P1) and in the post-expansion phase (P2). Pain intensity was assessed with a Visual Analogue Scale (VAS) questionnaire and filled out daily during expansion, along with a question on the intake of analgesics. The mean weekly and total OHIP-score and OHIP-score per domain were calculated at T0, P1 and P2, as well as mean weekly and total VAS-scores for average pain, maximum pain and analgesics intake during P1. Kruskal–Wallis tests were used to test for differences in OHIP between T0, P1 and P2. The level of significance was set at 0.05. Results The mean OHIP-score was 10.86 ± 9.71 at T0 and increased to 17.18 ± 10.43 during P1 (p < 0.001), after which it returned to pre-expansion levels, 9.27 ± 7.92 (p = 0.907) during P2. At the domain level, there was a statistically significant increase in OHIP-score at P1 for functional limitation, physical pain, psychological discomfort and social disability. The mean VAS-score for average pain during expansion was 16.00 ± 19.73 mm. Both OHIP-score (25.00 ± 10.25), average pain (33.72 ± 16.88 mm), maximum pain (44.47 ± 17.99 mm) and analgesics intake (59%) were highest at initiation of the expansion and decreased by the end of expansion. Conclusions MARPE is a generally well-tolerated expansion treatment. A temporary decline in OHRQoL and moderate pain are present at the start of expansion, followed by a recovery of OHRQoL and very mild pain during the rest of treatment. Clinicians should be aware of the effects of MARPE on patients’ quality of life and manage the expected discomfort and impediments with adequate communication and patient education.
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Affiliation(s)
- Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - René R M Noverraz
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan G J H Schols
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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