1
|
Marañón-Vásquez GA, de Andrade ACDV, Maia LC, Dos Santos RL, Tanaka OM, Paranhos LR, Oliveira DD, Pithon MM. Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: complementary results for a controlled clinical trial. Clin Oral Investig 2024; 28:525. [PMID: 39269644 DOI: 10.1007/s00784-024-05902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 08/25/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE To evaluate the effect of rapid palatal expansion (RPE) using Haas-type expanders on children's oral health-related quality of life (OHRQOL) and compare said effect with that previously reported for the use of Hyrax-type expanders. MATERIALS AND METHODS Forty participants aged 8-10 years with transverse maxillary deficiency were treated using Haas appliances. OHRQOL was measured using the CPQ8 - 10 before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after appliance removal (T3). Generalized mixed models were fitted to assess the effect of the Haas-type expander compared to previously collected data (a nontreated and a Hyrax-type expander-treated group). RESULTS RPE with Haas-type appliances had a negative impact on overall OHRQOL at T1 and T2 (P = 0.001), and a positive impact at T3 (P = 0.001). The Haas-type expander had a significantly greater negative impact on OHRQOL than the Hyrax-type appliance during RPE. At T1, overall scores using the Haas-type expander were 1.08 times the scores using the Hyrax-type expander (i.e., 8% increase; 95% CI, 1.01-1.17; P = 0.033). Patients using the Haas appliance had 1.24 times the scores of those using Hyrax-type devices for the oral symptoms domain at T1 (i.e., 24% increase; 95% CI, 1.06-1.46; P = 0.009). CONCLUSIONS Correction of the transverse maxillary deficiency by RPE using the Haas appliance in children 8-10 years improves OHRQOL. The Haas- and Hyrax-type devices temporarily worsen OHRQOL during treatment, however, the negative impact is less with the Hyrax-type expander than with the Haas-type expander, because it causes fewer negative oral symptoms. CLINICAL RELEVANCE From a patient-centered perspective, the use of the Hyrax over the Haas appliance may be suggested as it causes less negative oral symptoms during use.
Collapse
Affiliation(s)
- Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rodolpho Paulo Rocco, 325 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil.
| | - Ana Carolina Dias Viana de Andrade
- Department of Health II, School of Medicine, Southwest Bahia State University, Av. José Moreira Sobrinho, s/n, Jequiezinho, Jequié, BA, 45206190, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rodolpho Paulo Rocco, 325 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Rogério Lacerda Dos Santos
- School of Dentistry, Federal University of Juiz de Fora, Rua. São Paulo, 745 - Centro, Gov., Valadares, MG, 35010-180, Brazil
| | - Orlando Motohiro Tanaka
- School of Life Sciences, Pontifical Catholic University of Paraná, Rua. Imac. Conceição, 1155 - Bloco 3 - 1º andar - Prado Velho, Bloco 9, Curitiba, PR, 80215- 182, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Social Dentistry, Federal University of Uberlândia, Av. Pará, 1720 - Anexo B - Bairro Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Dauro Douglas Oliveira
- School of Life Sciences, Pontifical Catholic University of Minas Gerais, Av. D. José Gaspar, 500 - Prédio 46 - Sala 101 - Coração Eucarístico, Belo Horizonte, MG, 30535901, Brazil
| | - Matheus Melo Pithon
- Department of Health I, School of Dentistry, Southwest Bahia State University, Av. José Moreira Sobrinho, s/n, Jequiezinho, Jequié, BA, 45206190, Brazil.
| |
Collapse
|
2
|
Cannatà D, Galdi M, Scelza C, Simeon V, Giordano F, Martina S. Impact of maxillary expansion on the sagittal skeletal and dental parameters of growing Class II patients: A systematic review with meta-analysis. Orthod Craniofac Res 2024. [PMID: 39244738 DOI: 10.1111/ocr.12852] [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: 04/04/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024]
Abstract
A "spontaneous" correction of the Class II malocclusion has been described after maxillary expansion (ME) treatment. The aim of the present review was to systematically summarize changes in the sagittal dentoskeletal parameters of growing Class II patients after ME. The study protocol was developed according to the PRISMA statement and registered in PROSPERO before literature search, data extraction and analysis. The PICO model was followed in the definition of the research question, search strategies and study selection criteria. Randomized and non-randomized studies on the sagittal effects of ME published in English language without date restrictions were electronically searched across the Cochrane Library, Scopus and MEDLINE/PubMed databases. Changes in sagittal dentoskeletal cephalometric parameters were analysed. The risk of bias in randomized and nonrandomized studies was assessed using the Rob2 and ROBINS-I tools, respectively. A narrative synthesis was performed, focusing on the investigated population, intervention, comparison, and main outcomes. Pairwise meta-analyses were used to compare the outcomes assessed in subjects who underwent ME versus untreated subjects. Ten studies met the inclusion criteria, four were included in the pairwise meta-analyses due to the presence of a control group. Slight but significant improvements in OVJ (MD: -0.36; 95%; CI [-0.69 to -0.01]; p = .04) and 6/6 molar relation (MD: 1.5; 95%; CI [0.69 to 1.61]; p < .0001) were found in patients who underwent ME compared with untreated subjects, whereas no improvement in skeletal parameters was observed. However, the limitations of a small body of moderate-quality evidence and possible confounding factors should be considered. Evidence on the sagittal skeletal and dental effects of ME in Class II patients is still ambiguous, suggesting the need for more clinical trials, including appropriate control subjects, randomization and blinding during outcome assessment.
Collapse
Affiliation(s)
- Davide Cannatà
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Marzio Galdi
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Carmine Scelza
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Mental Health and Public Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| |
Collapse
|
3
|
Barreneche-Calle LM, Marín-Arboleda RD, Gómez-Gómez SL, Agudelo-Suárez AA, Ramírez-Ossa DM. Dentoalveolar, periodontal and skeletal effects of maxillary expansion techniques assisted by temporary anchorage devices compared with conventional protocols in growing patients with transverse maxillary deficiency: A systematic review and meta-analysis. Int Orthod 2024; 22:100891. [PMID: 38865748 DOI: 10.1016/j.ortho.2024.100891] [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: 11/18/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To synthesise the dentoalveolar, periodontal and skeletal changes that occur when using maxillary expansion techniques assisted by temporary anchorage devices compared to conventional protocols. METHODS Five databases and grey literature were consulted, up to December 2023, focusing on intervention designs and excluding other type of studies. The quality assessment was conducted by using the adaptation for orthodontics of the CONSORT statement, the guidelines for reporting non-randomised studies, the RoB-2 tool, and the ROBINS-I tool. A descriptive summary and meta-analysis using RevMan 5.4 were performed. RESULTS Nine clinical trials were included (n=377 patients, mean age 13.2±0.6) with a diagnosis of transverse maxillary deficiency. The analysed studies showed qualitative dentoalveolar and periodontal changes after expansion, which were greater on the maxillary first premolars in tooth-borne appliances. Meta-analyses for some effects were included from two studies (n=64); patients who used tooth-borne appliances had greater effects of buccal intercoronal width between the premolars with statistically significant differences (Std Mean difference 2.34; 95% CI: 0.04-4.65 p=0.05). Conversely, those patients who used bone-borne or hybrid appliances had greater effects of buccal intercoronal width between molars with statistically significant differences (Std Mean difference -0.64; 95% CI: -1.38-0.10; p=0.09). CONCLUSIONS According to the studies analysed, all measurements increased in the intervention groups after expansion. Quantitative analyses show different findings at dentoalveolar level when tooth-borne, bone-borne or hybrid appliances are considered. Nevertheless, the results should be taken with caution due to the heterogeneity of the studies. The protocol was registered at PROSPERO (CRD42021283170), with no funding to report.
Collapse
Affiliation(s)
| | - Rober David Marín-Arboleda
- DDS, Posgraduate Orthodontic Program Student, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Sandra Liliana Gómez-Gómez
- DDS, Orthodontist, MSc in Epidemiology, Titular Professor and Department Chair, Department of Orthodontics, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Andrés A Agudelo-Suárez
- DDS, Public Health PhD, Titular Professor and Senior Researcher, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Diana Milena Ramírez-Ossa
- DDS, Orthodontist, Professor, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
4
|
Machado Pasqua BDP, Sendyk M, Barros André C, Batista de Paiva J, Wilmes B, Rino Neto J. Periodontal evaluation after maxillary expansion with a tooth-bone-borne expander in growing patients : A randomized clinical trial. J Orofac Orthop 2024:10.1007/s00056-024-00536-z. [PMID: 39102072 DOI: 10.1007/s00056-024-00536-z] [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: 09/04/2023] [Accepted: 05/21/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE This two-arm parallel randomized controlled trial aimed to evaluate and compare periodontal changes due to rapid maxillary expansion (RME) using tooth-bone-borne and tooth-borne devices in growing patients via clinical examinations and cone-beam computed tomography (CBCT). MATERIALS AND METHODS Forty-two eligible patients (aged 11-14 years; transverse maxillary deficiency, posterior crossbite) were screened and divided into two groups based on the treatment received (randomization was performed using computer-generated numeric sequences): hybrid hyrax tooth-bone-borne group (TBB) and hyrax tooth-borne group (TB). The primary outcome was the change in cortical bone thickness (by CBCT). In addition, the clinical attachment level (CAL), gingival recession, and bleeding were assessed. Both examinations were performed before and 3 months after the activation phase. Intergroup comparisons were performed using analysis of covariance (ANCOVA; P < 0.05). RESULTS Twenty-one patients (12 girls and 9 boys; mean initial age, 13.3 years) were included in the TBB group and 21 (5 girls and 16 boys; mean initial age, 13.2 years) were included in the TB group. The TB group exhibited a decrease in buccal bone thickness in the first premolars and first molars at all three evaluated levels. Specifically, tooth 14 at 3 mm from the enamel-cement junction showed a significant width reduction (0.7 mm; p < 0.001), accompanied by a notable increase in palatal cortical thickness at 6 mm of enamel-cement junction (1.13 mm; p < 0.001). CONCLUSIONS RME resulted in buccal bone thickness reduction at the first premolar with hyrax treatment. In the molar region, both devices resulted in cortical bone alterations that were less pronounced in the TBB group.
Collapse
Affiliation(s)
| | - Michelle Sendyk
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
| | - Cristiane Barros André
- Technology Research Center, University of Mogi das Cruzes, Reverendo Henrique de Oliveira Camargo Street 374, 18090-170, Mogi das Cruzes, Brazil
| | - João Batista de Paiva
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - José Rino Neto
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
| |
Collapse
|
5
|
Okuhashi S, Kobayashi M, Tanaka E. Severe Maxillary Protrusion Treated with Surgically Assisted Rapid Maxillary Expansion. J Clin Med 2024; 13:4149. [PMID: 39064189 PMCID: PMC11278214 DOI: 10.3390/jcm13144149] [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: 06/20/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
In this case, surgically assisted rapid maxillary expansion (SARME) was successfully adopted to treat a skeletal maxillary protrusion with large overjet and severe crowding. The female patient, aged 25 years and 11 months, was diagnosed with skeletal maxillary protrusion with severe crowding and excessive overjet associated with labially inclined maxillary central incisors. After achieving sufficient space for surgical incision between bilateral maxillary central incisors, the SARME was performed. A total of 8.0 mm lateral expansion of the maxilla was completed. At 48 days after surgery, the Hyrax appliance was replaced with an Anchor-Lock system used as an external surgical stent and skeletal anchorage for maxillary group distalization, and the distal movement of the maxillary molars was initiated without waiting for bone healing of the separated midpalatal suture by SARME. Twenty-five months' treatment, including surgical preparation, achieved an acceptable and stable occlusion with adequate interincisal relationship. The occlusion was much more stable with a little relapse through more than 4 years' retention period. In conclusion, SARME followed by the Anchor-Lock system might lead to favorable occlusal outcome in the long term without any relapses.
Collapse
Affiliation(s)
- Sonoko Okuhashi
- Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental University, Yokosuka 238-8580, Japan;
- Private Practice of Orthodontics, Sagamihara 252-0303, Japan
| | - Masaru Kobayashi
- Department of Oral and Maxillofacial Surgery, Kanagawa Dental University, Yokosuka 238-8580, Japan;
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8504, Japan
| |
Collapse
|
6
|
Qi J, Matsumoto Y, Xie C, Rashed F, Ono T, Aoki K. Prevention of bone dehiscence associated with orthodontic tooth movement by prophylactic injection of bone anabolic agents in mice. Sci Rep 2024; 14:15749. [PMID: 38977767 PMCID: PMC11231170 DOI: 10.1038/s41598-024-66617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Although bone dehiscence may occur during orthodontic tooth movement into the narrow alveolar ridge, a non-invasive prevention method is yet to be fully established. We show for the first time prevention of bone dehiscence associated with orthodontic tooth movement by prophylactic injection of bone anabolic agents in mice. In this study, we established a bone dehiscence mouse model by applying force application and used the granular type of scaffold materials encapsulated with bone morphogenetic protein (BMP)-2 and OP3-4, the receptor activator of NF-κB ligand (RANKL)-binding peptide, for the prophylactic injection to the alveolar bone. In vivo micro-computed tomography revealed bone dehiscence with decreased buccal alveolar bone thickness and height after force application, whereas no bone dehiscence was observed with the prophylactic injection after force application, and alveolar bone thickness and height were kept at similar levels as those in the control group. Bone histomorphometry analyses revealed that both bone formation and resorption parameters were significantly higher in the injection with force application group than in the force application without the prophylactic injection group. These findings suggest that the prophylactic local delivery of bone anabolic reagents can prevent bone dehiscence with increased bone remodelling activity.
Collapse
Affiliation(s)
- Jia Qi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshiro Matsumoto
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Cangyou Xie
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Fatma Rashed
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Oral Biology, Faculty of Dentistry, Damanhour University, Damanhour, 22511, Egypt
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuhiro Aoki
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| |
Collapse
|
7
|
Silva I, Miranda F, Bastos JCDC, Garib D. Comparison of alveolar bone morphology after expansion with hybrid and conventional Hyrax expanders. Angle Orthod 2024; 94:414-420. [PMID: 39229946 PMCID: PMC11210521 DOI: 10.2319/092623-650.1] [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: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To compare the buccal and palatal bone changes of maxillary posterior teeth produced by hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients. MATERIAL AND METHODS A sample of 32 patients with posterior crossbites in the late mixed dentition was recruited and randomly allocated into two groups. Group HH was composed of 18 individuals with a mean age of 10.7 years (six female, 12 male) treated with a hybrid expander with two anterior parasagittal miniscrews. Group CH was composed of 14 individuals with a mean age of 11.4 years (six female, eight male) treated with a conventional Hyrax expander. Cone-beam computed tomography (CBCT) exams were obtained before expansion (T1) and after 11 months when the expander was removed (T2). Buccal and palatal bone plate thickness and height of maxillary posterior teeth were measured. Intergroup comparisons were performed using t or Mann-Whitney tests (P < .05). RESULTS The CH group showed greater decreases of the buccal bone plate height (mean change: 1.27 mm) at the maxillary first premolars compared to the HH group (mean change: 0.11 mm, P = .001). No intergroup difference was found for changes in the buccal and palatal bone thickness. CONCLUSIONS Hybrid expanders showed a tendency to cause less negative impact on the buccal bone plate height of first premolars compared to conventional Hyrax expanders. However, the difference was not clinically significant. Both hybrid and conventional Hyrax expanders are safe for the alveolar bone morphology in the late mixed dentition.
Collapse
Affiliation(s)
- Ivan Silva
- Corresponding author: Dr Ivan Silva, Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil (e-mail: )
| | | | | | | |
Collapse
|
8
|
Ahmed AS, Al-Nimri KS, Ahmed WS. Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial. Clin Oral Investig 2024; 28:338. [PMID: 38797781 DOI: 10.1007/s00784-024-05724-0] [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: 12/31/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. MATERIALS AND METHODS Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. RESULTS Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. CONCLUSIONS Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. CLINICAL RELEVANCE Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.
Collapse
Affiliation(s)
- Amgad S Ahmed
- Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Kazem S Al-Nimri
- Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Wesam S Ahmed
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
| |
Collapse
|
9
|
Echarri-Nicolás J, González-Olmo MJ, Echarri-Lobiondo P, Lagravère M, Romero M. Tooth-Bone-Borne vs Bone-Borne Rapid Maxillary Expanders on Dentoskeletal Changes. J Multidiscip Healthc 2024; 17:1877-1886. [PMID: 38706502 PMCID: PMC11068038 DOI: 10.2147/jmdh.s433693] [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: 01/21/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose This study compared the insertion and thickness of the cortical bone, the parallelism of the midpalatal suture, and the skeletal transverse dimension using a microimplant-assisted rapid palatal expansion (MARPE) with those produced by bone-anchored maxillary expander (BAME) in adults. Patients and Methods The sample comprised 18 patients (mean age, 29.9±9.4 years) selected for the MARPE group and 18 (mean age 24.8±6.8 years) selected for the BAME group. Cone-Beam computed tomography scans taken just before and after the expansion. Results After treatment, there was a significant palatal depth decrease. In addition, maxillary and mandibular width were increased in both groups. Regarding the cortical bone insertion and cortical bone width, it is shown an increase in both groups but those changes are not significant. However, the anterior suture opening effect occurs more frequently in the BAME than in the MARPE device. There are no differences in the frequency of opening of the midpalatal suture in the cases treated with MARPE and BAME, in both cases the most frequent opening morphology is parallel, independently of midpalatal suture maturation. Conclusion There are no differences in the use of MARPE or BAME in the parallelism of the middle palatal suture, the cortical bone insertion, and thickness according to the maturation stages of the midpalatal suture but significantly increases the transverse dimensions of the maxillary skeleton.
Collapse
Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Móstoles, Madrid, Spain
| | | | | | - Manuel Lagravère
- Division of Orthodontics, Faculty of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Alcorcón, Madrid, Spain
| |
Collapse
|
10
|
Ugolini A, Abate A, Donelli M, Gaffuri F, Bruni A, Maspero C, Lanteri V. Spontaneous Mandibular Dentoalveolar Changes after Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander-A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:501. [PMID: 38671718 PMCID: PMC11049362 DOI: 10.3390/children11040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander. METHODS The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed. RESULTS A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated. CONCLUSIONS SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.
Collapse
Affiliation(s)
- Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Margherita Donelli
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Francesca Gaffuri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Valentina Lanteri
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
| |
Collapse
|
11
|
Patiño AMB, Rodrigues MDP, Pessoa RS, Rubinsky SY, Kim KB, Soares CJ, Almeida GDA. Biomechanical behavior of three maxillary expanders in cleft lip and palate: a finite element study. Braz Oral Res 2024; 38:e010. [PMID: 38597509 PMCID: PMC11376606 DOI: 10.1590/1807-3107bor-2024.vol38.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/09/2023] [Indexed: 04/11/2024] Open
Abstract
This study evaluated the stress distribution in the dentoalveolar and palatal bone structures during maxillary expansion in a 17-year-old male patient with bilateral cleft lip and palate (BCLP) using expanders with dental (HYRAX) and skeletal anchorage (MARPE). For the generation of the specific finite element models, cone-beam computed tomography was used, and the DICOM files were exported to Mimics 3-Matic (Materialise) and Patran (MSC Software) software. Three specific three-dimensional models were generated: A) HYRAX: conventional four-banded hyrax screw (9 mm); B) MARPE-DS: 3 miniscrews (1.8 mm diameter - 5.4 mm length) and four-banded dental anchorage; and C) MARPE-NoDS: 3 miniscrews without dental anchorage. Maxillary expansion was simulated by activating the expanders transversely 1 mm on the "X" axis. HYRAX resulted in higher levels of deformation predominantly in the dentoalveolar region. MARPE-DS showed stress in the dentoalveolar region and mainly in the center of the palatal region, at approximately 4,000 με. MARPE-NoDS exhibited evident stress only in the palatal region. High stress levels in the root anchoring teeth were observed for HYRAX and MARPE-DS. In contrast, MARPE-NoDS cause stress on the tooth structure. The stress distribution from the expanders used in the BLCP showed asymmetric expansive behavior. During the initial activation phase of expansion, the HYRAX and MARPE-DS models produced similarly high strain at the dentoalveolar structures and upper posterior teeth displacement. The MARPE-NoDS model showed restricted strain on the palate.
Collapse
Affiliation(s)
- Angela Maria Bautista Patiño
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Uberlândia, MG, Brazil
| | - Monise de Paula Rodrigues
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Roberto Sales Pessoa
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Uberlândia, MG, Brazil
| | - Salomón Yezioro Rubinsky
- Universidad Nacional de Colombia, School of Dentistry, Department of Orthodontics, Bogotá, Colombia
| | - Ki Beom Kim
- Saint Louis University, Center for Advanced Dental Education, Department of Orthodontics, Saint Louis, MI, USA
| | - Carlos José Soares
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Operative Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Guilherme de Araújo Almeida
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Uberlândia, MG, Brazil
| |
Collapse
|
12
|
Zhong X, Wang H. Dentoperiodontal and skeletal changes induced by miniscrew-assisted rapid maxillary expansion (C-expander) treatment in adults: A retrospective clinical trial. Am J Orthod Dentofacial Orthop 2024; 165:303-313. [PMID: 37921730 DOI: 10.1016/j.ajodo.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the dental periodontal and skeletal response to ≥5 mm of expansion width achieved by C-expander treatment with posterior miniscrews placed between the first and second molars in adults. METHODS A total of 28 patients aged 21.91 ± 3.20 years with maxillary transverse deficiency underwent C-expander treatment. Anterior miniscrews were positioned between the first and second premolars, whereas posterior miniscrews were positioned between the first and second molars. Cone-beam computed tomography records were obtained before expansion and 3 months after expansion. The dental periodontal and skeletal changes for all patients were recorded. RESULTS The C-expander treatment expanded the palatal suture with slight buccal alveolar bone inclination. An increase in the nasal cavity width and a greater increase in the maxillary base bone width were observed after maxillary expansion. The expansion at the posterior nasal spine (3.78 mm) was approximately 85.7% of that at the anterior nasal spine (4.41 mm). No significant buccal dehiscence occurred after expansion, whereas the mesiobuccal alveolar bone thickness of the first molars was decreased at the 8 mm level with respect to the cementoenamel junction. The first molar showed decreased inclination (right, -0.45°; left, -0.38°, P >0.05), whereas the expansion at the apical level was less than that at the crown level. Age and the skeletal/dental expansion ratio had no discernible relationship. CONCLUSIONS Miniscrew-assisted C-expander treatment can be effective for adults with maxillary transverse deficiency. Rearward placement of the miniscrews may create an approximately parallel expansion. Most maxillary expansion was derived from skeletal expansion with slight alveolar bone buccal inclination.
Collapse
Affiliation(s)
- Xiaohuan Zhong
- Department of Orthodontics, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huixin Wang
- Department of Orthodontics, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
13
|
Ferrillo M, Daly K, Pandis N, Fleming PS. The effect of vertical skeletal proportions, skeletal maturation, and age on midpalatal suture maturation: a CBCT-based study. Prog Orthod 2024; 25:4. [PMID: 38311670 PMCID: PMC10838892 DOI: 10.1186/s40510-023-00504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Midpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation. METHODS In this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations. RESULTS A total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P < 0.001); however, no association between FMA and MPS maturation was observed (OR: 1.01; 95% CI 0.964; 1.051; P = 0.76). A strong correlation between MPS maturation and CVM stage was not reported. Males had a higher probability of belonging to a lower MPS maturation stage (OR: 0.24; 95% CI 0.136; 0.415; P < 0.001). CONCLUSIONS Based on this cross-sectional analysis, midpalatal sutural maturation classification is associated with chronological age and occurs later in males. Neither CVM staging nor variation in vertical skeletal proportions were useful predictors of midpalatal maturation stage.
Collapse
Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Dublin Dental University Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School, Medical Faculty, University of Bern, Bern, Switzerland
| | - Padhraig S Fleming
- Dublin Dental University Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| |
Collapse
|
14
|
Wang C, Liu C, Mao Q, Zhou L, Xiang X. Skeletal and dentoalveolar modifications in adults with different sagittal facial patterns after personalized miniscrew-assisted rapid palatal expansion: A prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2023; 164:843-854. [PMID: 37632488 DOI: 10.1016/j.ajodo.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION This study aimed to compare the skeletal and dental modifications in adults with different sagittal facial patterns by a personalized miniscrew-assisted rapid palatal expander (pMARPE). METHODS Forty subjects (aged 18-28 years; 15 females and 25 males) with maxillary transverse deficiency were assigned to 1 of 3 groups (Class I, II, and III relationship) on the basis of their sagittal facial patterns. Each patient was treated with an individually customized expander. A similar expansion protocol was used for all patients. Cone-beam computed tomography scans were obtained before and after expansion. One-way analysis of variance was used to analyze differences among 3 groups in skeletal, dentoalveolar, and periodontal changes (P <0.05). RESULTS The success rates of expansion were higher in patients with a Class I or II relationship than those with a Class III relationship. Patients with a Class I or II relationship had greater changes in the anterior nasal spine and maxillary basal bone widths. A more parallel sutural opening in the anteroposterior direction was seen in those with a Class II relationship. The tipping of the maxillary first molar increased, and the buccal alveolar bone thickness decreased in all groups after expansion, especially in patients with a Class III relationship. CONCLUSIONS The pMARPE effectively split the midpalatal suture among adults. However, midpalatal suture expansion was more difficult, and there were more dentoalveolar side effects and fewer orthopedic effects in patients with a Class III relationship than in those with Class I or II relationships.
Collapse
Affiliation(s)
- Chunlin Wang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Conghua Liu
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Qin Mao
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Lishu Zhou
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaosong Xiang
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China.
| |
Collapse
|
15
|
Gupta V, Rai P, Tripathi T, Kanase A. Stress distribution and displacement with four different types of MARPE on craniofacial complex: A three-dimensional finite element analysis. Int Orthod 2023; 21:100813. [PMID: 37776697 DOI: 10.1016/j.ortho.2023.100813] [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: 07/12/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Various designs of mini-implants assisted rapid palatal expander (MARPE) appliances can impact treatment effectiveness through their biomechanical effects. The purpose of the study was to study the stress distribution and displacement with four different designs of the MARPE appliance on the craniofacial complex. METHODS A 3D finite element model of the craniofacial complex was created from CBCT DICOM data, comprising four distinct groups. Each group consisted of one 4-hole expansion screw positioned between the second premolar and first molar in all models. Group 1 used four single-cortical mini-implants (1.5×8mm) engaging only the palatal cortex. Group 2 employed four mini-implants (1.5×11mm) engaging both the palatal and nasal cortices. Group 3 had monocortical implants on the palatal slopes, while Group 4 was similar to group 3 with implants in the acrylic wings. Comparisons between groups were made for anchorage (groups 1 and 2), mini-implant position (groups 1 and 3) and surface effect (groups 3 and 4). Von Mises stresses and displacements at various skeletal and dental points were evaluated using ANSYS software. RESULTS The highest stresses were observed in the maxillary, pterygoid and zygomatic bones, as well as in the mid- palatal suture in all four groups. Downward and forward rotation of the craniofacial complex was noted. Group 2 showed greater skeletal expansion than group 1. Among groups 1 and 3, group 3 showed a better stress distribution. Group 4 showed less dentoalveolar rotation than group 3. CONCLUSIONS The MARPE appliances had an impact on the craniofacial complex with stresses on the mid-palatal suture, maxillary bone, pterygoid bones and anterior teeth. Clockwise rotation of the maxilla, zygomatic bones and dentition was noted, while the pterygoid bones and pterygoid suture were displaced backwards. MARPE with bicortical anchorage produces better skeletal expansion. Placing implants on the palatal slopes with acrylic wings results in better skeletal expansion with less clockwise rotation of the dentition.
Collapse
Affiliation(s)
- Veenita Gupta
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India.
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
| | - Anup Kanase
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
| |
Collapse
|
16
|
Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders. BMC Oral Health 2023; 23:714. [PMID: 37794400 PMCID: PMC10552363 DOI: 10.1186/s12903-023-03461-6] [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: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.
Collapse
Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Madrid, Spain
| | - María José González-Olmo
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain.
| | | | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain
| |
Collapse
|
17
|
Chen R. Effects of rapid maxillary expansion on anchorage alveolar bone meta-analysis. Acta Odontol Scand 2023; 81:499-507. [PMID: 37074788 DOI: 10.1080/00016357.2023.2199862] [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: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Rapid maxillary expansion (RME) is a routine method for correcting transverse maxillary deficiency. This paper investigated the effect of RME on anchorage alveolar bone and examined the differences between micro-implant-assisted RME and conventional RME. METHODS Relevant articles were selected from the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Review Manager software (v.5.3) was used for the pooled analysis and Cochran Q and I2 statistic tests were used to assess the heterogeneity. RESULTS Following conventional RME, the distal buccal alveolar bone thickness and the mesiobuccal alveolar thickness of the maxillary first molars were significantly reduced. Hyrax (standard mean difference [SMD]: -0.93, 95% confidence interval [CI]: -1.20-0.66) and Haas procedures (SMD: -0.88, 95% CI: -1.40-0.36) significantly reduced the buccal vertical alveolar height of the maxillary first molars. Similar results were obtained for the maxillary first premolars following RME. The thickness of the buccal alveolar bone decreased with conventional RME compared to when using the method assisted by micro-implants. CONCLUSIONS Conventional RME can reduce the thickness and vertical height of maxillary alveolar bone, and there is less loss of alveolar bone when using micro-implant-assisted RME. Further research is needed to validate the findings.
Collapse
Affiliation(s)
- Ruijun Chen
- Department of Orthodontic, Beijing Daxing Xingye Dental Hospital, Beijing, China
| |
Collapse
|
18
|
Li K, Sun P, Sun J, Wang T. Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report. Dent Traumatol 2023; 39:495-508. [PMID: 37283243 DOI: 10.1111/edt.12859] [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: 02/02/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Abstract
Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.
Collapse
Affiliation(s)
- Kun Li
- Department of Orthodontics, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, China
| | - Peng Sun
- Department of Orthodontics, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, China
| | - Jing Sun
- Wolong Division, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, China
| | - Tiejun Wang
- Department of Orthodontics, Yantai Stomatological Hospital Affiliated to Binzhou Medical College, Yantai, China
| |
Collapse
|
19
|
Pasqua BDPM, André CB, Paiva JBD, Rino Neto J. Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial. Dental Press J Orthod 2023; 28:e2322220. [PMID: 37729286 PMCID: PMC10508049 DOI: 10.1590/2177-6709.28.4.e2322220.oar] [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: 09/21/2022] [Accepted: 04/22/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. METHODS Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. RESULTS Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. CONCLUSIONS Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.
Collapse
Affiliation(s)
| | | | | | - José Rino Neto
- University of São Paulo, Department for Orthodontics (São Paulo/SP, Brazil)
| |
Collapse
|
20
|
Huh J, Liu J, Yu JH, Choi YJ, Ahn HK, Chung CJ, Cha JY, Kim KH. Three-dimensional evaluation of a virtual setup considering the roots and alveolar bone in molar distalization cases. Sci Rep 2023; 13:14955. [PMID: 37696835 PMCID: PMC10495328 DOI: 10.1038/s41598-023-41480-z] [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: 05/23/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023] Open
Abstract
We aimed to evaluate root parallelism and the dehiscence or fenestrations of virtual teeth setup using roots isolated from cone beam computed tomography (CBCT) images. Sixteen patients undergoing non-extraction orthodontic treatment with molar distalization were selected. Composite teeth were created by merging CBCT-isolated roots with intraoral scan-derived crowns. Three setups were performed sequentially: crown setup considering only the crowns, root setup-1 considering root alignment, and root setup-2 considering the roots and surrounding alveolar bone. We evaluated the parallelism and exposure of the roots and compared the American Board of Orthodontics Objective Grading System (ABO-OGS) scores using three-dimensionally printed models among the setups. The mean angulation differences between adjacent teeth in root setups-1 and -2 were significantly smaller than in the crown setup, except for some posterior teeth (p < 0.05). The amount of root exposure was significantly smaller in root setup-2 compared to crown setup and root setup-1 except when the mean exposure was less than 0.6 mm (p < 0.05). There was no significant difference in ABO-OGS scores among the setups. Thus, virtual setup considering the roots and alveolar bone can improve root parallelism and reduce the risk of root exposure without compromising occlusion quality.
Collapse
Affiliation(s)
- Jaewook Huh
- Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea
| | - Jing Liu
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae-Hun Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Hee-Kap Ahn
- Graduate School of Artificial Intelligence, Department of Computer Science and Engineering, Pohang University of Science and Technology, Pohang, Korea
- Institute for Convergence Research and Education in Advanced Technology, Yonsei University, Seoul, Korea
| | - Chooryung J Chung
- Department of Orthodontics, Institute of Craniofacial Deformity, Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Institute for Innovation in Digital Healthcare, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Kyung-Ho Kim
- Department of Orthodontics, Institute of Craniofacial Deformity, Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul, Korea.
| |
Collapse
|
21
|
Naveda R, Dos Santos AM, Miranda F, da Cunha Bastos JC, Garib D. Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults. Am J Orthod Dentofacial Orthop 2023; 164:416-422. [PMID: 37041098 DOI: 10.1016/j.ajodo.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.
Collapse
Affiliation(s)
- Rodrigo Naveda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | | | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | | | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil; Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| |
Collapse
|
22
|
Zhou Z, Sun L, Zhang F, Xu Y. Three-dimensional evaluation of alveolar bone and pharyngeal airway dimensions after mandibular dentition distalization in patients with Class III malocclusion: a retrospective study. Head Face Med 2023; 19:41. [PMID: 37649064 PMCID: PMC10466725 DOI: 10.1186/s13005-023-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND To three-dimensionally evaluate changes of the alveolar bone around the mandibular anterior teeth and pharyngeal airway dimensions in adults with Class III malocclusion before and after orthodontic treatment of mandibular dentition distalization. METHODS In this retrospective study, cone-beam computed tomography (CBCT) scans of 20 patients with Class III malocclusion who underwent mandibular dentition distalization were obtained both before and after treatment. Three-dimensional changes of the thickness and vertical marginal bone levels around mandibular incisors and canines were assessed and compared. And airway volumes of the palato-, glosso-, laryngopharynx and the minimum axial area were measured and compared before and after treatment. RESULTS A significant decrease of lingual bone thickness of mandibular incisors, partial labial and lingual bone thickness of canines were observed (P < 0.05). The reduction in root length of incisors and canines, labial and lingual vertical marginal bone levels were significant after orthodontic treatment. No significant correlations between mandibular dentition distalization and pharyngeal airway dimensions were observed. CONCLUSIONS Mandibular dentition distalization could result in the loss of alveolar bone around anterior teeth in Class III malocclusion, especially for the cervical marginal bone. Pharyngeal airway dimensions were not affected to a high extent after distalization. TRIAL REGISTRATION Retrospctively registered.
Collapse
Affiliation(s)
- Zhijie Zhou
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomotology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Liangyan Sun
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomotology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Fan Zhang
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomotology, Fudan University, Shanghai, China.
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
| | - Yan Xu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomotology, Fudan University, Shanghai, China.
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
| |
Collapse
|
23
|
Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Changes in Molar Tipping and Surrounding Alveolar Bone with Different Designs of Skeletal Maxillary Expanders. Biomedicines 2023; 11:2380. [PMID: 37760821 PMCID: PMC10525421 DOI: 10.3390/biomedicines11092380] [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: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This study compared the buccolingual angulation (BLA) of the upper and lower first permanent molars before and after using the different methods of microimplant-assisted expansion in adults and its influence on bone insertion loss. METHODS Cone-beam computed tomography scans taken before and after the expansion in 36 patients (29.9 ± 9.4 years) were used to assess dental and periodontal changes and compare changes between the groups. RESULTS This research shows a statistically significant increase in the BLA of the upper first molars. An increase of the BLA of the lower molars is also observed in MARPE. Regarding the comparison between cases treated with MARPE (4.42° ± 10.25°; 3.67° ± 9.56°) and BAME (-0.51° ± 4.61°; 2.34° ± 4.51°), it was observed that upper molar torque increased significantly less in cases treated with BAME. In cases with CWRU < 96° at T0, a slight bone insertion gain was observed at T1, whereas if CWRU ≥ 96°, a slight bone insertion loss was observed. Regarding the labial cortical bone loss, a slight gain of CBW was observed in all cases. This labial cortical enlargement (T0-T1) is greater in cases where the CWRU < 96° at T0. CONCLUSIONS Patients treated with MARPE show torque increase in the teeth selected to support the expansion appliance compared to cases treated with BAME. In cases where the BLA at T0 < 96°, an increase in thickness and cortical insertion is observed in the upper molars after treatment with disjunction appliances assisted with microscrews.
Collapse
Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), 28922 Alcorcón, Spain;
| | | | | | - Martín Romero
- Department of Orthodontics, Rey Juan Carlos University, 28922 Alcorcón, Spain;
| |
Collapse
|
24
|
Chamberland S. Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update. J World Fed Orthod 2023; 12:173-183. [PMID: 37344295 DOI: 10.1016/j.ejwf.2023.04.005] [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: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/22/2023] [Indexed: 06/23/2023]
Abstract
Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.
Collapse
|
25
|
Savoldi F, Fung KKF, Mak WS, Kan EYL, Yang Y, Kwok KL, Gu M. Are the severity of obstruction and the apnea-hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study. Dentomaxillofac Radiol 2023; 52:20220422. [PMID: 37192022 PMCID: PMC10304841 DOI: 10.1259/dmfr.20220422] [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: 12/13/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction. METHODS MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). RESULTS As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = -0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = -0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). CONCLUSIONS In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
Collapse
Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Kevin KF Fung
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Elaine YL Kan
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| |
Collapse
|
26
|
Darawsheh AF, Kolarovszki B, Hong DH, Farkas N, Taheri S, Frank D. Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation. J Clin Med 2023; 12:4189. [PMID: 37445223 DOI: 10.3390/jcm12134189] [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: 04/19/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The treatment of transversal maxillary deficiency usually aims at skeletal expansion. The treatment option highly depends on the maturation stage of the midpalatal suture (MPS), which may vary between individuals at the same chronological age. Therefore, the individual determination of the MPS maturation is crucial. AIMS Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation. METHODS Nine experienced orthodontists were asked to evaluate the MPS maturation on 51 cone beam computed tomography (CBCT) scans according to the Angelieri classification method. Intra- and inter-examiner reliability was measured using Cohen's Kappa coefficient. The stages were agreed upon according to the results of the examiners with the highest strength of agreement. Fractal analysis was then performed on the CBCTs and the correlation between the fractal dimension values and maturation stages was then evaluated. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. RESULTS The cut-off point was found at 1.073, at which the use of fractal dimension for predicting MPS maturation showed 100% sensitivity, 93.7% specificity, 9.5% false positive, 0% false negative rate. CONCLUSION Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage.
Collapse
Affiliation(s)
- Ali Farid Darawsheh
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Béla Kolarovszki
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Da Hye Hong
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Soroush Taheri
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Dorottya Frank
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| |
Collapse
|
27
|
Özden S, Uslu F, Dedeoğlu N. Evaluation of bone area in the posterior region for mandibular molar distalization in class I and class III patients. Clin Oral Investig 2023; 27:2041-2048. [PMID: 36964793 DOI: 10.1007/s00784-023-04965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/19/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the bone area in the posterior region, which is important for mandibular molar distalization in skeletal class I and class III individuals with normodivergent and hyperdivergent vertical growth patterns. MATERIALS AND METHODS In this retrospective study, cone-beam computed tomography (CBCT) scans of 120 individuals divided into 4 groups as class I normodivergent (group-I), class I hyperdivergent (group-II), class III normodivergent (group-III), and class III hyperdivergent (group-IV). Retromolar area at crown level measurements was performed on CBCT-derived panoramic radiographs and axial sections. Retromolar area at the root level was measured 2 mm, 4 mm, 6 mm, 8 mm, and 10 mm apical to cemento-enamel junction at CBCT axial sections. RESULTS Retromolar area decreased towards the root apex in all groups and smallest retromolar area was level of CEJ10mm in all groups. At any root level, the distal root of the mandibular second molar tooth was in contact with the mandibular inner or outer lingual cortex; 50% in group-I, 46.7% in group-II, 23% in group-III, and 23% in group-IV. CONCLUSIONS In normodivergent individuals, the retromolar area length at the root level is observed to be higher in class III than in class I at almost every level. In hyperdivergent individuals, on the other hand, only at CEJ10mm level, it is higher in length in class III than in class I. Vertical growth pattern has no effect on the root and crown level retromolar area in class I and class III individuals. CLINICAL RELEVANCE CBCT provides more useful information than panoramic radiographs for patients who are scheduled for large mandibular molar distalization.
Collapse
Affiliation(s)
| | - Filiz Uslu
- Department of Orthodontics, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Numan Dedeoğlu
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, 44280, Malatya, Turkey
| |
Collapse
|
28
|
Bistaffa AGI, Belomo-Yamaguchi L, Almeida MRD, Conti ACDCF, Oltramari PVP, Fernandes TMF. Immediate skeletal effects of rapid maxillary expansion at midpalatal suture opening with Differential, Hyrax and Haas expanders. Dental Press J Orthod 2023; 27:e2220525. [PMID: 36790245 DOI: 10.1590/2177-6709.27.6.e2220525.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/24/2021] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to test the null hypothesis that there is no difference at the midpalatal suture opening after rapid maxillary expansion (RME) using Expander with Differential Opening (EDO), Hyrax-type and Haas-type expanders. METHODS Occlusal radiographs of 52 patients (19 males and 33 females; average age= 9.46?1.20 years) treated with RME were divided into three groups, according to the expander used: EDO (n=17), Hyrax-type (n=21) and Haas-type (n=14). The evaluated variables were: A) Distance between the maxillary central incisors at the incisal edge; B) Distance between the alveolar ridges at the midpalatal suture; C) Suture opening at 10-mm distance from the crest to posterior, at the midpalatal suture; D) Suture opening at 20-mm distance from the crest to posterior, at the midpalatal suture; and E) Suture opening at 30-mm distance from the crest to posterior, at the midpalatal suture. To assess the normality of variables, the Shapiro-Wilk test was performed. For intergroup comparison, ANOVA with a significance level of 5% was used. RESULTS At the region A, Hyrax-type (4.66 mm) and EDO (4.87 mm) groups presented larger openings than the Haas-type group (3.43 mm). In regions B and C, EDO showed a statistically significant greater opening than the Haas-type group. In region D, a smaller opening of the midpalatal suture was observed in the Haas-type group, compared to the Hyrax-type and EDO groups. CONCLUSIONS EDO and Hyrax-type produced greater immediate skeletal effects, compared with Haas-type, but these differences were about 1 mm and might not be clinically significant.
Collapse
|
29
|
Assessment of mandibular retromolar space in adults with regard to third molar eruption status. Clin Oral Investig 2023; 27:671-680. [PMID: 36374353 DOI: 10.1007/s00784-022-04782-6] [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: 01/05/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the difference in length and width of the mandibular retromolar space (RMS) stratified by the different eruption and impaction statuses of the third molars in patients with skeletal Class I malocclusion. MATERIALS AND METHODS The right mandibular RMS in 186 adult patients categorized according to the different statuses of the third molar was analyzed by using cone-beam computed tomography (CBCT). The shortest distances between the inner lingual cortex of the mandibular body and second molar root were measured parallel to the posterior occlusal line (POL) at depths of 2, 4, 6, 8, and 10 mm (mandibular retromolar space length in root level, RLin2,4,6,8,10) on the axial slices with the cementoenamel junction (CEJ) as the reference level. The width of the RMS and second molar root was measured vertical to the POL at the terminal point of the molar distalization at depths of 2, 4, 6, 8, and 10 mm (width of the mandibular retromolar space, BW2,4,6,8,10/ width of the second molar distal root, TW2,4,6,8,10) from the CEJ. RESULTS RL in different measurement planes was 2.72 ± 2.22 ~ 3.74 ± 2.26 for Group A, 5.27 ± 1.68 ~ 9.10 ± 2.04 for Group B, 1.94 ± 2.34 ~ 5.71 ± 4.37 for Group C, 1.83 ± 2.95 ~ 5.05 ± 4.24 for Group D, and 5.93 ± 3.97 ~ 10.52 ± 2.16 for Group E. The BW measurement results for A ~ E group were 9.71 ± 1.41 ~ 10.51 ± 1.81, 9.83 ± 1.39 ~ 12.55 ± 2.11, 9.96 ± 1.21 ~ 12.17 ± 1.62, 9.82 ± 1.47 ~ 12.28 ± 2.77, and 10.02 ± 1.20 ~ 12.75 ± 0.82, respectively. There was no significant difference between men and women in any measurements (P > 0.05). Patients with normal third molars erupted and those vertically impacted possessed larger RMS lengths than those in which the third molars were missing, horizontally impacted or mesially impacted (P < 0.05). In each measurement plane, TW was significantly smaller than BW (P < 0.05). CONCLUSIONS Sex had no effect on the length or width of the mandibular RMS. Different statuses of third molars can also differentially affect the mandibular RMS. The mandibular RMS width is not a limit for mandibular molar distalization. CLINICAL RELEVANCE When considering the distalization of mandibular molars, more attention should be directed to the lingual cortex of the mandible, and CBCT scans are recommended for patients who require significant mandibular molar distalization. The mandible buccal shelf and retromolar area maybe a safe zone to insert the miniscrew for molar distalization.
Collapse
|
30
|
Abdelsalam R, Nucci L, Carrino R, Shahen S, Abdelaziz F, Fahim F, Perillo L. Comparison of palatal volume and surface changes between bone-borne and tooth-tissue-borne maxillary expansion on cone beam computed tomography digital cast models. Angle Orthod 2023; 93:490508. [PMID: 36719265 PMCID: PMC10117217 DOI: 10.2319/040922-278.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To compare the changes of palatal volume and area in patients treated with tooth-tissue-borne palatal expanders (conventional Haas) and miniscrew-supported palatal expanders (modified Haas). MATERIALS AND METHODS The sample included casts of 22 patients treated as part of a clinical study at the Department of Orthodontics, Al-Azhar University, to correct their crossbite malocclusion. Patients were divided equally into two groups upon arrival. The first group, with a mean age of 12 years and 6 months, received the miniscrew-supported palatal expander. The second group, with a mean age of 12 years and 2 months, received the Haas design-palatal expansion appliance. Pre- and post-expansion dental casts were cone beam computed tomography scanned and the slices were constructed into 3D volumes. Fully automated superimposition was done for pre- and post-expansion 3D models. Palatal volume and area were determined, and all measurements were carried out blindly. Paired t-test was used to assess the mean differences within each group and Welch's t-test was applied to assess the mean changes between the two groups. Shapiro-Wilk test was used to test for the normality of the data. RESULTS There were no statistical differences in volume changes either within each group or between the groups. Although area changes were statistically significant within each group, the difference between the groups was not significant. CONCLUSIONS Changes that result from the use of either method to expand the upper arch occur primarily in the shape of the palate, but not in its size.
Collapse
|
31
|
Goh S, Dreyer C, Weir T. The predictability of the mandibular curve of Wilson, buccolingual crown inclination, and transverse expansion expression with Invisalign treatment. Am J Orthod Dentofacial Orthop 2023; 163:109-116. [PMID: 36208968 DOI: 10.1016/j.ajodo.2021.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION This study aimed to provide an initial investigation into the mandibular curve of Wilson (COW) handling using the Invisalign appliance (Align Technology, Santa Clara, Calif). Individual buccolingual crown inclinations and transverse expansions were also investigated to detect any regions of ineffectiveness in the dental arch. METHODS A retrospective sample of patients treated by an experienced Invisalign provider in private practice was used. All adult patients with Class I or II Angle malocclusions and mild to moderate crowding treated using a minimum of 14 Invisalign aligners without intermaxillary elastics, bite ramps, or auxiliaries and a nonextraction mandibular arch from 2013-2019 were selected. Dental models at the initial scan, the ClinCheck prediction, and the outcome after the initial series of aligners were analyzed with Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). The COW, buccolingual crown inclination relative to the occlusal plane and cusp tip expansion were compared between ClinCheck changes and achieved changes. RESULTS Forty-two subjects met the selection criteria. 74% of subjects experienced a flatter COW than ClinCheck predictions, and the mean difference was 0.76 mm (P = 0.0149). The first molars encountered 0.52 mm (P <0.001) more buccal crown inclination than ClinCheck predictions. No other teeth experienced statistically significant buccolingual inclination differences to ClinCheck. The second molars were the only teeth to experience significantly more arch expansion than ClinCheck at 0.68 mm (P = 0.0046). CONCLUSIONS The Invisalign appliance tended to over-flatten the mandibular COW compared with ClinCheck because of the lack of buccal root torque in the mandibular first molars during expansion. The mandibular second molars were the only teeth to experience more expansion than ClinCheck.
Collapse
Affiliation(s)
- Shaun Goh
- Department of Orthodontics, School of Dentistry, the University of Adelaide, Adelaide, South Australia, Australia.
| | - Craig Dreyer
- Department of Orthodontics, School of Dentistry, the University of Adelaide, Adelaide, South Australia, Australia
| | - Tony Weir
- Department of Orthodontics, School of Dentistry, the University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
32
|
Wilmes B, Drescher D. CAD-CAM workflows for palatal TAD anchored appliances. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
33
|
Benhamour S, Brezulier D. Hyrax versus Leaf expander in growing patients, what about adverse dental effects? A retrospective study. Int Orthod 2022; 20:100684. [PMID: 36180336 DOI: 10.1016/j.ortho.2022.100684] [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: 06/20/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Transverse discrepancy is a Common problem in young patients. Many devices are employed to expand the palatal dimension, with different characteristics and biomechanical aspects. The Leaf expander, a new-born appliance containing nickel-titanium springs, free from activation by parents. We compared the maxillary and mandibular dental effects of Leaf expander to conventional Hyrax in growing patients. METHODS All patients who met the eligibility criteria between the period from January 2017 to December 2019 were included. The patients had transverse inter-arch discrepancy of at least 5mm and were treated with Hyrax expander (HEX) or Leaf expander (LEX). All patients had complete follow-up of expansion by remote monitoring. An algorithm established distances between the teeth. It was also used to measure the change in dental axes. RESULTS In the maxilla, LEX caused more tipping on the canines and premolars but significantly less on the molars compared to HEX: -0.154̊ vs. 3.05̊ (P<0.001). In the mandible, LEX caused a greater increase in arch widths and tipping (P<0.02) in the molars and second premolars, but not in the other teeth. No correlation was demonstrated between mandibular dental movements and increased maxillary arch widths. Alternatively, for the two devices, expansion and tipping were correlated within each dental arch (r>0.4). CONCLUSIONS The LEX produced more tooth movement on average than the HEX, except for the maxillary first molars. Several correlations exist between the movements within each arch for the two devices, most often between tipping and expansion.
Collapse
Affiliation(s)
- Sacha Benhamour
- Pôle odontologie, CHU Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - Damien Brezulier
- Pôle odontologie, CHU Rennes, 2, rue Henri Le Guilloux, 35000 Rennes, France; ISCR, CNRS-UMR 6226, université de Rennes, 2, avenue Léon Bernard, bâtiment 15, 35043 Rennes, France.
| |
Collapse
|
34
|
Ma HM, Lyu HM, Xu L, Hou JX, Wang XX, Li WR, Li XT. Effect of augmented corticotomy-assisted presurgical orthodontic treatment on alveolar bone fenestration and dehiscence in skeletal class III patients. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
35
|
Sennimalai K, Selvaraj M. Buccal bone changes after rapid maxillary expansion in patients with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:e216. [PMID: 37830538 DOI: 10.1016/j.ajodo.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
|
36
|
Kapetanović A, Odrosslij BMMJ, Baan F, Bergé SJ, Noverraz RRM, Schols JGJH, Xi T. Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: a prospective clinical cohort study. Clin Oral Investig 2022; 26:6253-6263. [PMID: 35731323 PMCID: PMC9525423 DOI: 10.1007/s00784-022-04577-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED). MATERIALS AND METHODS D-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed. RESULTS Thirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (- 0.31 ± 0.49 mm M1; - 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated. CONCLUSIONS MARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults. CLINICAL RELEVANCE Higher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.
Collapse
Affiliation(s)
- Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, Dentistry 309, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | | | - Frank Baan
- Radboudumc 3D Lab, 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
| | - René R M Noverraz
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, Dentistry 309, 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, Radboudumc, Dentistry 309, 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
| |
Collapse
|
37
|
Investigation of the role of midpalatal and circummaxillary sutures in bone-anchored rapid maxillary expansion using a verified finite-element model. Am J Orthod Dentofacial Orthop 2022. [DOI: 10.1016/j.ajodo.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
38
|
Venugopal A, Manzano P, Vaid NR. TAD driven Class III camouflage: Eight point protocol to optimize efficiency, aesthetics and stability. Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
39
|
Effects of miniscrew location on biomechanical performances of bone-borne rapid palatal expander to midpalatal suture: A finite element study. Med Eng Phys 2022; 107:103872. [DOI: 10.1016/j.medengphy.2022.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022]
|
40
|
Tavares A, Braga E, Neves FS. Influence of the palatal plane cant and skeletal patterns in the hard palate thickness? Orthod Craniofac Res 2022; 26:224-230. [PMID: 36047667 DOI: 10.1111/ocr.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of the present study was to evaluate the thickness of the hard palate at the different angles formed by the palatal plane and the Frankfort horizontal line using computed tomography in patients with different facial patterns for planning the installation of MARPE. MATERIALS AND METHODS The measurements were analysed in the hard palate of 106 patients. Four regions were selected passing through the mesial face, tangent at the level of the cemento-enamel junction of the premolars and molars. The bone thickness was measured from the floor of the nasal cavity to the cortical bone of the hard palate, 02 measurements with a distance of 05 mm between them (2.5 mm on each side starting from the midsagittal line) and 2 more with a distance of 7 mm between measurements (3.5 mm on each side starting from the midsagittal line). The palatal plane cant was determined based on the palatal plane and the Frankfort horizontal plane. The sagittal skeletal pattern was determined based on the ANB angle and the vertical skeletal pattern based on the SN.Go.Gn angle. RESULTS Palatal bone thickness was greater in males than in females. Regarding the sagittal skeletal pattern, patients with Class II were found to have a thinner hard palate than Class I and Class III patients. No difference in the vertical skeletal pattern was observed between groups. Regarding the palatal plane cant, bone thickness was greater in patients with clockwise rotation. CONCLUSIONS Careful planning should be considered in the case of female patients; patients with greater angles of the palatal plane cant and Class II patients have a smaller bone thickness.
Collapse
Affiliation(s)
- Alana Tavares
- Program in Dentistry and Health School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
- Avenida Alphaville, 635, apt 1103, Alphaville Salvador 1 Salvador /Bahia Brazil
| | - Emanuel Braga
- Department of Orthodontics School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
| | - Frederico Sampaio Neves
- Division of Dentomaxillofacial Radiology School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
| |
Collapse
|
41
|
Solano Mendoza P, Aceytuno Poch P, Solano Reina E, Solano Mendoza B. Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography. J Clin Med 2022; 11:jcm11164652. [PMID: 36012886 PMCID: PMC9410327 DOI: 10.3390/jcm11164652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.
Collapse
|
42
|
Fan Z, Zhang Q, Jiang Y, Qin Q, Huang S, Guo J. Mandibular retromolar space in adults with different sagittal skeletal patterns. Angle Orthod 2022; 92:483764. [PMID: 35849081 PMCID: PMC9374353 DOI: 10.2319/112021-854.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyze the mandibular retromolar space among normal-divergent adult patients with different sagittal skeletal patterns by cone-beam computed tomography (CBCT). MATERIALS AND METHODS CBCTs of a total of 120 normal-divergent adult patients were investigated. Patients were categorized into the following three groups according to their ANB angle: skeletal Class I (48 patients), skeletal Class II (36 patients), and skeletal Class III (36 patients). Four different planes parallel to the mandibular occlusal plane were used to measure the retromolar space. The retromolar space was measured by two reference lines and then compared between different sagittal skeletal patterns groups. The incidence of root contact with the inner lingual cortex was compared among the three groups. RESULTS The retromolar space of the Class III patients was significantly larger than that of Class I patients and Class II patients. Compared with Class I and Class III patients, Class II patients had a smaller retromolar space and higher incidence of contact with the inner cortex of the mandible. CONCLUSIONS Class III patients had a larger retromolar space than Class I patients and Class II patients in four different planes. The mandibular retromolar space should be evaluated by CBCT in patients who need mandibular molar distalization.
Collapse
|
43
|
Huang X, Han Y, Yang S. Effect and stability of miniscrew-assisted rapid palatal expansion: A systematic review and meta-analysis. Korean J Orthod 2022; 52:334-344. [PMID: 35844097 PMCID: PMC9512629 DOI: 10.4041/kjod21.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to systematically analyze the effect and stability of miniscrew-assisted rapid palatal expansion (MARPE) to provide a reference for the clinical treatment of patients with maxillary transverse deficiency (MTD). Methods We searched PubMed, Science Direct, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Database for relevant studies published before February 18, 2021 and selected them according to the eligibility criteria. The Cochrane Handbook for Systematic Reviews (version 5.1.0) criteria were used for the quality assessment of randomized controlled trials, while the scoring protocol of the methodological index for non-randomized studies was used for non-randomized controlled trials. Statistical analysis was performed using the RevMan5.3 software. Results All the included studies showed a relatively high success rate of expansion. The changes in both the intermolar and alveolar widths after MARPE were statistically significant. MARPE exhibited greater skeletal expansion effects than did conventional RPE. The midpalatal suture was opened in parallel after MARPE. A small amount of relapse was observed 1 year after expansion. MARPE caused tooth inclination and a decrease in alveolar height, but it was less significant than in conventional RPE. Conclusions MARPE may be an effective treatment modality for patients with MTD. It causes great transverse skeletal expansion in late adolescence. In comparison to conventional RPE, MARPE has lower detrimental periodontal effects and has certain clinical advantages.
Collapse
Affiliation(s)
- Xinyi Huang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jin
| | - Yu Han
- Department of Orthodontics, Hangzhou Dental Hospital, Hangzhou, China
| | | |
Collapse
|
44
|
Skeletal expansion using a miniscrew-assisted rapid palatal expansion in a 50-year-old patient. Am J Orthod Dentofacial Orthop 2022; 162:568-579. [PMID: 35811187 DOI: 10.1016/j.ajodo.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
This case report illustrates a nonsurgical treatment plan using a miniscrew-assisted rapid palatal expander (MARPE) in a 50-year-old patient with maxillary transverse deficiency. The MARPE appliance consisted of a conventional Hyrax expander anchored to 4 orthodontic miniscrews. The exact locations of the miniscrews were determined with virtual planning software. Cone-beam computed tomography (CBCT) scans were superimposed on the maxillary digital model, and 3-dimensional-printed surgical guides were used to accurately position the mini-implants. A slow expansion protocol was used, and the appliance was held in place during the entire treatment (almost 20 months). Pretreatment, postexpansion, and posttreatment CBCT scans show the parallel expansion obtained without dental torque compensation or bite opening. The posttreatment scan showed that a long period is required to complete the midpalatal suture mineralization. MARPE has proven effective in correcting transverse discrepancies, even in adults. However, posttreatment CBCT imaging showed incomplete ossification of the midpalatal suture, demonstrating that the retention period should be extended in some adult patients.
Collapse
|
45
|
Gokce G, Basoglu OK, Veli I. Polygraphic evaluation of the effects of different rapid maxillary expansion appliances on sleep quality: A randomized clinical trial. Sleep Breath 2022; 27:651-659. [DOI: 10.1007/s11325-022-02677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
|
46
|
Yacout YM, Abdalla EM, El Harouny NM. Skeletal and dentoalveolar effects of slow vs rapid activation protocols of miniscrew-supported maxillary expanders in adolescents: A randomized clinical trial. Angle Orthod 2022; 92:483292. [PMID: 35771652 PMCID: PMC9374350 DOI: 10.2319/112121-856.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare between skeletal and dentoalveolar effects of slow and rapid activation of miniscrew-supported expanders. MATERIALS AND METHODS A total of 30 patients were randomly allocated to two groups using block randomization and the allocation ratio 1:1. Both groups received maxillary expanders anchored using four miniscrews. Activation protocol was once every other day in the slow expansion (SME) group and twice daily in the rapid expansion (RME) group. Cone-beam computed tomography (CBCT) scans were obtained before expansion and after removal of the expanders. Transverse skeletal and dentoalveolar changes were measured using CBCT. RESULTS A total of 12 patients in the SME group (mean age, 14.30 ± 1.37 years) and 12 patients in the RME group (mean age, 15.07 ± 1.59 years) were analyzed. RME showed significantly greater widening of the mid-palatal suture at the level of first molars (mean difference [SME - RME] = -0.61 mm), and a greater increase in right and left molar buccal inclination (mean difference= -3.83° and -2.03°, respectively). Percentage of skeletal expansion relative to the jackscrew opening was not significantly different between the groups. Palatal inflammation was evident following appliance removal. Miniscrew mobility and bending were observed with RME. CONCLUSIONS Both SME and RME were effective in correcting skeletal transverse maxillary deficiency. However, RME resulted in more buccal tipping of maxillary molars and in miniscrew failures and bending.
Collapse
|
47
|
El-Beialy AR, El-Ashmawi NA, Abd El-Ghafour M. Canine root/cortical bone relation (CRCR) and the orthodontic tooth movement. Sci Rep 2022; 12:10714. [PMID: 35739156 PMCID: PMC9226186 DOI: 10.1038/s41598-022-14663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
This observational study evaluates three-dimensionally the relation between the root of maxillary canine and overlying labial cortical plate of bone during orthodontic canine retraction. Eighty-four bilateral maxillary canines in 42 patients were retracted in the extraction space of first premolars, using conventional orthodontic NiTi retraction spring delivering 150gm. Three-dimensional evaluation at the cusp tip, root apex, and the overlying cortical bone was done based on Classification of Root/Cortical bone relation (CRCR) before and after canine retraction. 168 observations of the canines pre- and post-retraction showed a mean distal movement of the canine cusp tip of 3.78(± 2.05) mm, while the canine root apex was almost stationary. Scarcely, 5.4% of the canine roots and root apices persisted in the medullary bone during retraction, while 16.1% contacted the overlying cortical bone. Fenestration of the overlying cortical bone by the canine roots or root apices occurred in 78.6% of the sample. The unembellished intimacy between the canine root and apex to the overlying thick dense cortical bone might have the decelerating effect on the maxillary canine retraction. The natural bone plate labial to the maxillary canine root did not yield infront nor enlarge due to canine retraction, but else defeated the current orthodontic biomechanical implementation.
Collapse
Affiliation(s)
- Amr R El-Beialy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt.
| | - Noha A El-Ashmawi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt
| | - Mohamed Abd El-Ghafour
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt
| |
Collapse
|
48
|
Romano FL, Sverzut CE, Trivellato AE, Saraiva MCP, Nguyen TT. Alveolar defects before and after surgically assisted rapid palatal expansion (SARPE): a CBCT assessment. Dental Press J Orthod 2022; 27:e2219299. [PMID: 35703612 PMCID: PMC9191858 DOI: 10.1590/2177-6709.27.2.e2219299.oar] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/28/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgically Assisted Rapid Palatal Expansion (SARPE) promote maxillary expansion in skeletally mature patients. This technique is effective; however, some side effects are still unknown. OBJECTIVES evaluate the presence of alveolar defects (dehiscences and fenestrations) in patients submitted to the SARPE. The null hypothesis tested was: SARPE does not influence the number of dehiscences and fenestrationss. METHODS A retrospective quasi-experiment study of a convenience sample of 279 maxillary teeth, in 29 patients evaluated with Cone Beam Computed Tomography (CBCT) at T1 (before SARPE), T2 (after expansion) and T3 (after retention), was performed. The examined teeth were: canines, first and second premolars, first and second molars. in axial, coronal, and cross-sectional views. The evaluations involved viewing slices from mesial to distal of the buccal roots. RESULTS All statistical analyses were performed using SAS 9.3 and SUDAAN softwares. Alpha used in the study was 0.05. Alveolar defects increased statistically from T1 (69.0%) to T2 (96.5%) and T3 (100%). Dehiscences increased 195% (Relative Risk 2.95) at the end of expansion (T2). After retention (T3), individuals were on average 4.34 times more likely to develop dehiscences (334% increase). Fenestrations did not increase from T1 to T2 (p = 0.0162, 7.9%) and decreased from T2 to T3 (p = 0.0259, 4.3%). Presence of fenestrations at T1 was a significant predictor for the development of dehiscences in T2 and T3. Dehiscences increased significantly in all teeth, except second molars. CONCLUSION The null hypothesis was rejected. After SARPE the number of dehiscences increased and fenestrations decreased. Previous alveolar defects were predictor for dehiscences after SARPE.
Collapse
Affiliation(s)
- Fábio Lourenço Romano
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Clínica Infantil, área de Ortodontia (Ribeirão Preto/SP, Brazil)
| | - Cássio Edward Sverzut
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial e Periodontia, área de Cirurgia (Ribeirão Preto/SP, Brazil)
| | - Alexandre Elias Trivellato
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial e Periodontia, área de Cirurgia (Ribeirão Preto/SP, Brazil)
| | - Maria Conceição Pereira Saraiva
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Clínica Infantil, área de Epidemiologia (Ribeirão Preto/SP, Brazil)
| | - Tung Tahan Nguyen
- University of North Carolina, School of Dentistry, Department of Orthodontics (Chapel Hill, USA)
| |
Collapse
|
49
|
McMullen C, Al Turkestani NN, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Angelieri F, Franchi L, Ngan P, He H, Cevidanes LHS. Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2022; 161:666-678. [PMID: 34980520 PMCID: PMC9050833 DOI: 10.1016/j.ajodo.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. METHODS The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P <0.05). RESULTS Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P = 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P = 0.004). CONCLUSIONS Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.
Collapse
Affiliation(s)
- Craig McMullen
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, W Va
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
50
|
Wilmes B. “Appliance First” or “Bone First” for miniscrew assisted rapid palatal expansion? APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_57_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|