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Ateş EM, Pamukçu H, Koç O, Altıparmak N. Effects of different expansion appliances and surgical incisions on maxillary expansion: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101936. [PMID: 38849083 DOI: 10.1016/j.jormas.2024.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE This study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures. METHODS Seven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD. RESULTS The largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD. CONCLUSION SARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD.
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Affiliation(s)
- Ece Mersan Ateş
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey
| | - Hande Pamukçu
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey.
| | - Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Nur Altıparmak
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey
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Mehta S, Arqub SA, Vishwanath M, Upadhyay M, Yadav S. Biomechanics of conventional and miniscrew-assisted rapid palatal expansion. J World Fed Orthod 2024; 13:105-112. [PMID: 38697910 DOI: 10.1016/j.ejwf.2024.03.002] [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: 11/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
Posterior Crossbite is a common condition resulting because of transverse maxillary deficiency. The growth of the craniofacial complex finishes first in the transverse dimension, followed by sagittal and vertical dimensions. Conventional rapid palatal expansion (RPE) appliances are commonly used to correct transverse maxillary deficiency. Although RPE is efficient in correcting posterior crossbite, it results in dental side effects such as buccal tipping of maxillary molars, root resorption, bone dehiscence, and relapse. Mini-implant-assisted RPE has been introduced to increase the skeletal effects of expansion especially in patients with increased maturation and greater interdigitation of midpalatal suture. This article will review the biomechanics of RPE and mini-implant-assisted RPE. Additionally, the different designs of MARPE and the long-term clinical effects of expansion appliances will also be discussed in detail.
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Affiliation(s)
- Shivam Mehta
- Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, Texas
| | - Sarah Abu Arqub
- Division of Orthodontics, University of Florida Health, Gainesville, Florida
| | - Meenakshi Vishwanath
- Program Director, Orthodontic Section, Department of Growth and Development, UNMC College of Dentistry, Lincoln, Nebraska
| | - Madhur Upadhyay
- Division of Orthodontics, Program Director, Orthodontic Fellowship Program, University of Connecticut Health, Farmington, Connecticut
| | - Sumit Yadav
- Henry and Anne Cech Professor of Orthodontics, UNMC College of Dentistry and Children's Hospital and Medical Center, Lincoln, Nebraska.
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Villarroel T, Yagnam S, Vicuña D, Concha G, Oyonarte R. Midpalatal suture maturation in 15- to 35-year-olds: morphological assessment in the coronal plane using CBCT-an exploratory study. Odontology 2024; 112:647-656. [PMID: 37851186 DOI: 10.1007/s10266-023-00861-6] [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: 09/27/2022] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Rapid maxillary expansion (RME) is used in patients presenting transverse maxillary deficiency. However, RME may be unpredictable after late adolescence if the midpalatal sutural maturation stage (MPMS) is in late stage. Since MPMS evaluation is influenced by the expertise of the operator and image quality, this classification method could be complemented. Therefore, this study aimed to analyze the morphology of the midpalatal suture (MPS) and its surrounding bone in the coronal plane using cone beam computed tomography (CBCT) images of adolescents and young adults and to correlate the findings with their respective MPMS status. CBCT scans of 200 patients aged 15-35 years of both sexes were evaluated. MPS and surrounding bone tissue characteristics in the coronal and axial sections were analyzed, and MPMS was evaluated (A to E). Six categories were identified for the coronal evaluation, analyzing it in 2 standardized locations. Sutural morphology: I, hypodense sutural line limited by 2 hyper-dense para-sutural lines; II, hypodense sutural line; and III, suture not visible. The presence of para-sutural cancellous bone: CB0, compact bone; CB1, dense cancellous tissue; CB2, spaced cancellous bone. Midpalatal bone thickness (MBTh) was also measured. ANOVA-Bonferroni, chi-square, logistic regression and t-tests were used. MPMS increased with age. Sutural morphology I and CB0 bone were the most prevalent. Here we show that sutural morphology, para-sutural bone characteristics, and MPSM were significantly associated. The coronal evaluation of the MPS can complement the information from the MPSM assessment, allowing the identification of patent MPS even in the presence of late MPSM.
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Affiliation(s)
- Tannia Villarroel
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile
- Private Practice, Curicó, Chile
| | - Sharime Yagnam
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile
| | - Daniela Vicuña
- Graduate Program in Oral and Maxillofacial Radiology, Faculty of Odontology, Universidad de los Andes, Santiago, Chile
| | - Guillermo Concha
- Graduate Program in Oral and Maxillofacial Radiology, Faculty of Odontology, Universidad de los Andes, Santiago, Chile
| | - Rodrigo Oyonarte
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile.
- Health Sciences Doctoral Program, Universidad Internacional de Cataluña, Barcelona, Spain.
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Koç O, Koç N, Jacob HB. Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis. Dental Press J Orthod 2024; 29:e2423195. [PMID: 38451569 PMCID: PMC10914319 DOI: 10.1590/2177-6709.29.1.e2423195.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: 08/29/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. OBJECTIVE The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. MATERIAL AND METHODS Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. RESULTS Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). CONCLUSIONS Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.
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Affiliation(s)
- Osman Koç
- Yildiz Technical University, Department of Mechanical Engineering (Yildiz, Istanbul/Turkey)
| | - Nagihan Koç
- Independent researcher (Yildiz, Istanbul/Turkey)
| | - Helder Baldi Jacob
- The University of Texas Health Science Center Houston School of Dentistry, Department of Orthodontics (Houston/TX, USA)
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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.
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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.
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Bruni A, Abate A, Maspero C, Castroflorio T. Comparison of Mechanical Behavior of Clear Aligner and Rapid Palatal Expander on Transverse Plane: An In Vitro Study. Bioengineering (Basel) 2024; 11:103. [PMID: 38391589 PMCID: PMC10886082 DOI: 10.3390/bioengineering11020103] [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: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: This study aims to investigate, within a controlled laboratory environment, the magnitude of the transversal load and the force decay over time produced by clear aligners in comparison to a Rapid Palatal Expander (RPE). (2) Methods: Resin models of a dental maxillary arch, additively manufactured from an intraoral scan, were inserted in a testing machine with uniaxial load cells to measure the force trend over time expressed by RPE and clear aligners. The mechanical load was recorded during a certain timeframe for both appliances. (3) Results: The force expressed by the RPE ranged from 30 to 50 N for each activation, decreasing with a nonlinear pattern over time. The force expressed by the clear aligner ranged from 3 to 5 N, decreasing with a linear pattern over time. In contrast, the force generated by the clear aligner fell within the range of 3 to 5 N, showing a linear reduction in force magnitude over the observed period of time. (4) Conclusions: The RPE exerted a force magnitude approximately ten times greater than that generated by clear aligners. Nevertheless, it is essential to acknowledge that the oral environment can significantly influence these results. These limitations underscore the need for caution when applying these findings to clinical settings.
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Affiliation(s)
- Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16126 Genova, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Koç O, Bolat Gumus E. Effects of different distractor positions on the formation of expansion, stress and displacement patterns in surgically assisted rapid maxillary expansion without pterygomaxillary disjunction: a finite element analysis study. Comput Methods Biomech Biomed Engin 2024; 27:56-66. [PMID: 36724781 DOI: 10.1080/10255842.2023.2170712] [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: 03/14/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient's anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.
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Affiliation(s)
- Osman Koç
- Department of Mechanical Engineering, Yildiz Technical University, Yildiz, Istanbul, Turkey
| | - Esra Bolat Gumus
- Faculty of Dentistry, Department of Orthodontics, Akdeniz University, Antalya, Turkey
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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.
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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
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Abate A, Ugolini A, Maspero C, Silvestrini-Biavati F, Caprioglio A, Lanteri V. Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni-Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation. Clin Oral Investig 2023; 27:5249-5262. [PMID: 37466717 PMCID: PMC10492880 DOI: 10.1007/s00784-023-05144-6] [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: 06/18/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars. METHODS Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes. RESULTS The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group. CONCLUSIONS According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.
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Affiliation(s)
- Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, Genoa, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
| | | | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Valentina Lanteri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
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Balakrishnan R, Sengottuvel N, Altaf SK, Bhandari PK, Kumaragurubaran P, Antony M. Three-Dimensional Finite Element Analysis of Maxillary Protraction Using Diverse Modes of Rapid Palatal Expansion. Cureus 2023; 15:e36328. [PMID: 37077604 PMCID: PMC10108977 DOI: 10.7759/cureus.36328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Three-dimensional finite elemental analysis (FEA) is a contemporary research instrument for the numeric simulation of a real physical system's mechanical process. FEA can be used as a very effective tool to analyze and compare various aspects of rapid palatal expanders and to determine the stress distribution in maxillofacial bones and displacement and the biomechanical effects it has on the circummaxillary sutures. This study evaluates the effects of different modes of rapid palatal expansion on maxillary protraction as a treatment modality in skeletal Class III malocclusion by determining the stress and displacement along the circummaxillary sutures using the FEA. MATERIALS AND METHODS Initially, a three-dimensional finite element simulation of the maxillofacial skeleton and sutures was obtained by Mimics software (Leuven, Belgium) from the cone-beam computed tomography (Dentsply Sirona, USA) images of a 30-year-old adult with normal occlusion. A geometrical preparation of the three expansion appliances, (A) hybrid MARPE (miniscrew-assisted rapid palatal expander) appliance (Fav anchor, India), (B) tooth-borne HYRAX (hygenic rapid expander) appliance (Welcare orthodontics, Kerela), and (C) bone-borne modified MARPE appliance (Biomaterials, Korea), was transferred to ANSYS WORKBENCH, 2020 R1 software (ANSYS, Inc., USA), and three finite element models with each appliance were prepared. A protraction force of 500g was applied to the occlusal plane that is directed 20 degrees inferiorly. The tensile stress, compressive stress, and the amount of displacement on the circummaxillary sutures were assessed and compared in all the three appliances. Young's modulus (kg/mm2) and Poisson's ratio (V) were used to calculate the stress and displacement in sutures adjacent to the maxilla in different aspects. RESULTS On analyzing the stress distribution, the tensile stress was found to be maximum in the medial aspect of the frontomaxillary suture of the bone-borne modified MARPE appliance (C), and the minimum tensile stress was found in the lateral aspect of the sphenozygomatic suture in hybrid MARPE (A). Again, the compressive stress distribution was found to be maximum in the medial aspect of the frontomaxillary suture in all three simulations and the minimum compressive stress in the superior aspect of the internasal suture in hybrid MARPE (A) along with the frontonasal suture at its medial aspect for tooth-borne HYRAX (B) and bone-borne modified MARPE (C). Displacement of the maxilla in all the planes was observed to be the largest for the bone-borne modified MARPE (C) appliance. On the contrary, the minimum displacement was found in the tooth-borne HYRAX (B) appliance. Conclusion: The findings reveal that all three modes of rapid palatal expanders produced stress and displacement along the circummaxillary sutures on the application of protraction force with bone-borne modified MARPE being more effective in treating posterior crossbites thereby correcting the skeletal Class III malocclusions successfully.
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Somaskandhan A, Kumar NMV, Vijayalakshmi RD. Stress distribution and displacement in the maxillofacial complex during intrusion and distalization of the maxillary arch using miniplates versus mini-implants: a 3-dimensional finite element study. Prog Orthod 2023; 24:8. [PMID: 36854939 PMCID: PMC9975133 DOI: 10.1186/s40510-023-00455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES To three-dimensionally analyse the stress distribution and displacement pattern in the maxillofacial complex following intrusion and distalization of the maxillary arch using finite element analysis in skeletal class II malocclusion with prognathic maxilla and vertical maxillary excess using miniplates and mini-implants. MATERIALS AND METHODS Finite Element models of a skull, Y-shaped stainless steel miniplate, mini-implant and a posted arch were generated. Three force levels (1) 200 g (2) 300 g and (3) 500 g per side were applied to the assembly. The models were pre-processed and the analysis was performed using ANSYS version 18.1 software. Alterations in von mises stress, principal maximum stress, principal minimum stress and compressive stress were analysed around the sutures and surface landmarks. RESULTS With miniplates, there was a maximum stress concentration at the zygomatic buttress with even stress distribution at the fronto-maxillary, zygomatico-temporal, zygomatico-frontal and pterygomaxillary sutures along with anatomical landmarks such as frontal process of maxilla, ANS, Point A, prosthion and maxillary process of zygoma. First molars experienced greater distalization effects with buccal flaring when miniplates were used. With mini-implants, canine and premolars also exhibited greater distalization effects. In the root apices, lateral incisors showed increased lingual root movement with mini-implants. CONCLUSION Miniplates provide a greater distalizing effect while mini-implants produce increased intrusive effect. The distalizing effect is greater when 500 g of force is applied using miniplates with significantly even stress distribution and displacement pattern.
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Affiliation(s)
- Abinaya Somaskandhan
- Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India.
| | - N M. Vijay Kumar
- grid.415239.80000 0004 1767 5012Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu India
| | - R. Devaki Vijayalakshmi
- grid.415239.80000 0004 1767 5012Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu India
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Keser M, Gulnar B, Baser B. Evaluation of dental and skeletal effects of the asymmetric rapid maxillary expansion appliance: A three-dimensional finite element study. Technol Health Care 2022; 31:1039-1050. [PMID: 36617801 DOI: 10.3233/thc-220538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Transverse maxillary deficiency is one of the most common skeletal anomalies. The incidence of posterior crossbite caused by maxillary deficiency is between 2.7% and 23.3%. Unilateral posterior crossbite is more common than bilateral crossbite. The most common treatment for skeletal posterior crossbite is rapid maxillary expansion (RME), in which the base of the maxillary bone is expanded by separating the midpalatal suture. OBJECTIVE This study compares the biomechanical effects of three different RME appliances, especially the effects on the midline, and evaluates the usability of the modified asymmetric RME (ARME) appliance for treating unilateral crossbites. METHODS Three scenarios were created with skull models using three different appliances: (1) conventional-bonded RME appliance; (2) full-cap splint RME appliance, with all teeth covered with acrylic; and (3) ARME, with all teeth on the right side and premolars and molars on the left side covered with acrylic. The finite element method was used to assess stress levels and displacements in all models after applying a 5-mm horizontal displacement to the RME screw. RESULTS The lateral transverse movement of the first molars was greater with the conventional RME appliance than with the full-cap splint RME appliance. The lateral transverse movement of the first molar was greater on the left than on the right side with the ARME. The lateral transverse movement of the central incisors was greater with the full-cap splint RME appliance than with the conventional RME appliance. The lateral transverse movement of the central incisor was greater on the right than on the left side with the ARME. CONCLUSION Asymmetrical RME appliance increases unilateral expansion compared to other appliances. Therefore, it should be used in cases of unilateral posterior crossbite. This appliance can also successfully treat posterior crossbite with upper midline deviation, since it corrects the shifted midline.
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13
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Koç O, Jacob HB. Surgically assisted rapid palatal expansion: is the pterygomaxillary disjunction necessary? A finite element study. Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.10.017] [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: 11/05/2022]
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14
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Baser B, Bolukbasi M, Uzlu D, Ozbay AD. Does MARPE therapy have effects on intracranial pressure? a clinical study. BMC Oral Health 2022; 22:450. [PMID: 36261817 PMCID: PMC9583475 DOI: 10.1186/s12903-022-02482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background We aimed to evaluate possible intracranial pressure (ICP) changes caused by screw activations during active microimplant-assisted rapid palatal expansion (MARPE) therapy of post-pubertal individuals by measuring the optic nerve sheath diameter (ONSD) under ultrasonography (US) guidance. Methods This study’s participants comprised 15 patients (7 males, 8 females) with posterior crossbite and a mean age of 16.7 years (14.25–20.08 years). The Maxillary Skeletal Expander (MSE) appliance was used to perform MARPE in all patients. Their vital signs (heart rate, mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2)) were recorded. The ONSD was measured by US immediately before the first screw activation (T0), and the measurements were repeated 1 min (T1) and 10 min (T2) after the first activation. In the last session of active MARPE therapy, the same measurement protocol was performed as in the first activation session (T3, T4, and T5). The patients’ perceptions of pain during the screw activation were also noted at T1 and T4 using a four-category verbal rating scale (VRS-4). The significant differences among different time intervals performed with the Friedman test (for all tested variables; SpO2, MAP, Heart Rate, VRS-4 and ONSD). Spearman correlation test was used for VRS-4 and ONSD comparisons. The statistical significance level was accepted as p < 0.05. Results The ONSD values (T1 and T4) relatively increased within 1 min after screw activation but did not reach a statistically significant level (p > 0.05). There was also no significant difference between the initial (T0) and the final (T5) ONSD values during the active MARPE therapy (p > 0.05). Conclusion There is no changes or alterations in intracranial pressure in late adolescents during active MARPE therapy. Supplementary information The online version contains supplementary material available at 10.1186/s12903-022-02482-x.
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Affiliation(s)
- Baris Baser
- Department of Orthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
| | - Merve Bolukbasi
- Department of Orthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Dilek Uzlu
- Department of Ophtalmology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Duhan Ozbay
- Department of Ophtalmology, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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15
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Hoque T, Srinivasan D, Chakravarthi S, Kannan R. Evaluation and comparison of stresses and displacements generated by four different types of asymmetric maxillary expansion appliances in true unilateral crossbite using finite element method. Int Orthod 2022; 20:100668. [DOI: 10.1016/j.ortho.2022.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
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16
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Tian T, Huang HY, Wang W, Shi B, Zheng Q, Li CH. Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate. Biomed Eng Online 2022; 21:31. [PMID: 35596229 PMCID: PMC9123812 DOI: 10.1186/s12938-022-01000-y] [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: 09/30/2021] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate). METHODS Maxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software. RESULTS Under corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model. CONCLUSIONS For UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.
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Affiliation(s)
- Tao Tian
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Han-Yao Huang
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Wei Wang
- Urumql DW Innovation InfoTech Co., Ltd., Urumqi, 830000, Xinjiang Uygur Autonomous Region, The People's Republic of China
| | - Bing Shi
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Qian Zheng
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
| | - Cheng-Hao Li
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
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17
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Kendre B, Kumar A, Shetty KN, Hedge G, Umale V, Kulshrestha R. Evaluation of stress changes in the maxilla with fixed functional appliances-A 3D FEM study. J Orthod Sci 2021; 10:10. [PMID: 34568206 PMCID: PMC8423154 DOI: 10.4103/jos.jos_33_20] [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: 06/20/2020] [Revised: 08/07/2020] [Accepted: 02/26/2021] [Indexed: 12/02/2022] Open
Abstract
AIM: To evaluate the stress changes in the maxilla during fixed functional appliance use using three-dimensional finite element method (FEM) stress analysis. SETTINGS AND SAMPLE POPULATION: A three-dimensional finite element model of the maxilla was constructed using the images generated from the cone-beam computed tomography of a patient treated for Class II malocclusion with a fixed functional orthodontic appliance. The FEM was used to study the stress changes seen in the maxilla, which were evaluated in the form of highest von Mises stress and maximum principal stress before and after the application of fixed functional appliance. RESULTS: Higher areas of stress were seen in the model of the maxilla with the fixed functional appliance (140 MPa) compared to that in the resting stage (58.99 MPa). CONCLUSIONS: An increase in the maximum principal stress and von Mises stress in the posterior regions of the maxilla and maxillary teeth was seen. The stresses seen were double than that without the appliance. A high distalization force on the maxilla was seen with the fixed functional appliance.
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Affiliation(s)
- Balaji Kendre
- Department of Orthodontics and Dentofacial Orthopedics, Yogita Dental College, Khed, Maharashtra, India
| | - Anil Kumar
- Department of Orthodontics and Dentofacial Orthopedics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - K Nillian Shetty
- Department of Orthodontics and Dentofacial Orthopedics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Gautham Hedge
- Department of Orthodontics and Dentofacial Orthopedics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Vinay Umale
- Department of Orthodontics and Dentofacial Orthopedics, Yogita Dental College, Khed, Maharashtra, India
| | - Rohit Kulshrestha
- Department of Orthodontics and Dentofacial Orthopedics, Terna Dental College, Navi Mumbai, Maharashtra, India
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18
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Three-dimensional zygomatic changes after rapid maxillary expansion in growing patients. J Orofac Orthop 2021; 84:147-156. [PMID: 34542641 DOI: 10.1007/s00056-021-00348-5] [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: 03/30/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the effects of rapid maxillary expansion (RME) treatment on the zygomatic bone complex (ZBC). METHODS In this single-center retrospective study, pre- and posttreatment cone-beam computed tomography (CBCT) images of 38 patients treated with RME were analyzed to investigate changes in the coordinates of the ZBC landmarks. At the start of treatment (T0), the patients' mean age was 11.1 ± 3.8 years (range 8.3-14.9 years). Cohen's d test was used to evaluate statistical differences. RESULTS There were statistically significant differences between T0 and T1 (P < 0.01) in the measurement values for the maxillary transverse width (ΔT: 3.18 ± 2.58, d: 1.23), frontozygomatic sutures (ΔT: 1.09 ± 0.56, d: 0.43), lowest point of the zygomaticomaxillary sutures (ΔT: 3.16 ± 1.78, d: 0.78), frontomaxillary angular parameter (right side ΔT: 2.81 ± 1.63, d: 1.73; left side ΔT: 2.52 ± 1.20, d: 2.10), frontozygomatic angular parameter (right side ΔT: 2.81 ± 1.63 d: 1.07; left side ΔT: 2.21 ± 2.79, d: 0.61), anterior intermaxillary distance (ΔT: 2.11 ± 1.42, d: 0.99), interzygomaticotemporal distance (ΔT: 2.00 ± 2.42, d: 0.99), and zygomatic angular parameter (right side ΔT: 2.06 ± 1.29, d: 1.6; left side ΔT: 2.02 ± 1.86, d: 1.09). CONCLUSIONS After RME in growing patients, the zygomatic bone showed pyramidal expansion in the coronal plane and parallel palatal expansion in the axial plane. In addition, significant lateral relocation of the zygomatic bone occurred. The zygomatic bone tended to rotate outward in conjunction with the maxilla, with a typical center of rotation close to the superior side of the frontozygomatic suture. These results shed light on the patterns of skeletal expansion in the zygomatic bone associated with RME in growing patients.
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19
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Gökçe G, Akan B, Veli İ. A postero-anterior cephalometric evaluation of different rapid maxillary expansion appliances. J World Fed Orthod 2021; 10:112-118. [PMID: 34031017 DOI: 10.1016/j.ejwf.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate dental and skeletal changes induced by tooth-bone-borne, tooth-tissue-borne, and tooth-borne rapid maxillary expansion (RME) appliances using postero-anterior (PA) cephalometric radiographs. METHODS A total of 54 patients' (25 boys, 29 girls) PA cephalometric radiographs who had bilateral posterior crossbite and RME treatment were included and divided into three groups according to the type of appliance used during treatment: tooth-bone-borne RME appliance (hybrid Hyrax) (7 boys, 11 girls, mean age 13.28 ± 1.20 years), tooth-tissue-borne RME appliance (TTB) (8 boys, 10 girls, mean age 13.08 ± 1.06 years) and tooth-borne RME appliance (Hyrax) (10 boys, 8 girls, mean age 12.05 ± 1.35 years). Pretreatment (T0) and posttreatment (T1) PA cephalometric radiographs were analyzed with Dolphin software v. 11.7 (Chatsworth, CA). The comparisons of the groups were performed with Two-way analysis of variance. P < 0.05 was considered statistically significant. RESULTS Significant and equal increase of right molar relationship and upper intermolar molar widths occurred in all groups. Dental midline discrepancy showed significant increase in only hybrid Hyrax group between T0 and T1. Significant increases were reported for lateronasal width in hybrid Hyrax and tooth-tissue-borne groups (P < 0.05). CONCLUSIONS Both skeletal and dental changes were observed after RME in all groups. However, the greatest skeletal changes were seen in hybrid Hyrax and tooth-tissue-borne groups.
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Affiliation(s)
- Gökçenur Gökçe
- Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey.
| | - Burçin Akan
- Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - İlknur Veli
- Associate Professor, Department of Orthodontics, Izmir Katip Celebi University, Izmir, Turkey
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20
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Sucu M, Yilmaz B, Ramoğlu Sİ. Evaluation of Initial Stress Distribution and Displacement Pattern of Craniofacial Structures with 3 Different Rapid Maxillary Expansion Appliance Models: A 3-dimensional Finite Element Analysis. Turk J Orthod 2021; 34:18-25. [PMID: 33828874 DOI: 10.5152/turkjorthod.2021.20006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to describe the displacement of anatomical structures and the stress distributions caused by the Hyrax, fan-type, and double-hinged expansion screws via the 3-dimensional (3D) finite element method (FEM). Methods The 3D FEM was based on the computed tomography data of a 12-year-old patient with a constricted maxilla. The Hyrax model included 1,800,981 tetrahedral elements with 2,758,217 nodes. The fan-type model included 1,787,558 tetrahedral elements with 2,737,358 nodes. The double-hinged model included 1,777,080 tetrahedral elements with 2,722,771 nodes. The von Mises stress distributions after 0.2 mm of expansion and displacement patterns after 5 mm of expansion were evaluated. Results The highest stress accumulation was observed in the sutura zygomatico maxillaris area with all 3 appliances. An increase in stress was noted at the pterygomaxillary fissure, the medial and lateral pterygoid process of the sphenoid bone, and the nasal areas. The wedge-shaped skeletal opening was observed with all 3 appliances. In the transverse plane, maximum posterior expansion was achieved with the Hyrax appliance, whereas the maximum anterior expansion was observed with the double-hinged appliance. The maxilla moved inferiorly and anteriorly with all the 3 appliances. The greatest inferior displacement of the maxilla was recorded with the Hyrax appliance, whereas anterior maxillary displacement was the greatest with the double-hinged appliance. Conclusion All the appliances showed similar stress distributions. The use of double-hinged screw caused a slight anterior displacement of point A. The fan-type and double-hinged appliances were shown to be more effective on anterior maxillary constriction, whereas the Hyrax appliance might be chosen for resolving maxillary posterior constriction.
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Affiliation(s)
- Merve Sucu
- Specialist in Orthodontics, Private practice, Istanbul, Turkey
| | - Berza Yilmaz
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Sabri İlhan Ramoğlu
- Department of Orthodontics, Faculty of Dentistry, Altinbas University, Istanbul, Turkey
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21
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Thierens LAM, Manalili L, De Roo N, Verdonck A, De Llano-Pérula MC, De Pauw GAM. Assessment of craniofacial maturation in preadolescents with cleft lip and/or palate using the cervical vertebral maturation method. Clin Oral Investig 2021; 25:4851-4859. [PMID: 33483870 DOI: 10.1007/s00784-021-03790-2] [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: 12/09/2019] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Aberrant growth of the maxillomandibular complex in patients with cleft lip and/or palate (CL/P) can be managed with dentofacial orthopaedics. However, no consensus has been reached regarding timing and evolution of the maturational stages. Therefore, the aim of this study is to determine if patients with CL/P have an increased risk for delayed craniofacial maturation. MATERIALS AND METHODS A sample of 246 cleft patients and 210 non-affected individuals was retrospectively compiled. Cephalometric radiographs taken between the ages of 10 and 14 years (girls) and 12 and 16 years (boys) were collected and assessed with the cervical vertebral maturation (CVM) method. RESULTS In boys, no significant association between the presence of CL/P and a CVM score of CS3 or higher was observed in any age subsample. This was similar for a CVM score of CS5 or higher. Girls in the CL/P group had a significant lower probability of having a CVM score of at least CS3 in the subsample with age 11 to 12 (p = 0.001) and a borderline non-significant lower probability of having a CVM score of at least CS5 in the subsample with age 12 to 13 (p = 0.055). CONCLUSIONS The current study demonstrated a discrete delay in skeletal maturation before the pubertal growth spurt of (pre)adolescents with CL/P, especially girls. This delay was less apparent at the end of the pubertal growth spurt. CLINICAL RELEVANCE This research suggests that the craniofacial maturational stages relevant for dentofacial orthopaedic treatment in cleft patients, especially girls, occur at higher chronological age. Further research must quantify this delay, investigate its clinical significance, and determine its effect on the timing of dentofacial orthopaedic treatment.
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Affiliation(s)
- Laurent A M Thierens
- Oral Health Sciences, Department of Orthodontics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium. .,Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Laura Manalili
- Oral Health Sciences, Department of Orthodontics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Noëmi De Roo
- Oral Health Sciences, Department of Orthodontics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - An Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Maria Cadenas De Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy A M De Pauw
- Oral Health Sciences, Department of Orthodontics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium
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22
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Lee DW, Park JH, Moon W, Seo HY, Chae JM. Effects of bicortical anchorage on pterygopalatine suture opening with microimplant-assisted maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2021; 159:502-511. [PMID: 33495061 DOI: 10.1016/j.ajodo.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate the effects of bicortical engagement by microimplants with maxillary skeletal expanders on pterygopalatine sutures opening and to analyze the postexpansion skeletal changes associated with it. METHODS Eighteen subjects treated with maxillary skeletal expanders were examined for pterygopalatine suture openings. Eight subjects who showed no evidence of the suture opening were assigned to the nonsplit group (NG), whereas 10 subjects with opened sutures were assigned to the split group (SG). Preexpansion and postexpansion cone-beam computed tomography images were superimposed for each group, and the changes in the 2 groups were compared. Finally, cone-beam computed tomography volumes were reoriented along the axis of each microimplant to check the bicortical engagement of the 4 microimplants. RESULTS There was a significant correlation between the bicortical engagement of the orthodontic microimplants and the pterygopalatine suture opening (P = 0.0003). In the NG, the average amount of transverse expansion measured at the center of resistance of the maxillary first molars, anterior nasal spine, and posterior nasal spine (PNS) was 4.33 mm, 2.22 mm, and 1.58 mm, respectively, whereas the transverse expansion in the SG was 5.29 mm, 2.21 mm, and 2.46 mm, respectively. The magnitude of transverse expansion at PNS was significantly higher in the SG than in the NG (P = 0.036). The PNS also showed a significant anterior displacement in the SG (0.89 mm) compared with the NG (0.06 mm) (P = 0.033). CONCLUSIONS Bicortical microimplant anchorage is essential for pterygopalatine suture opening in microimplant-assisted maxillary skeletal expansion, which may result in further skeletal expansion and forward movement in the posterior part of the palatomaxillary complex.
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Affiliation(s)
- Dong-Wook Lee
- Private Practice, Seoul, South Korea; Former Student, Predoctoral Program, College of Dentistry, University of Wonkwang, Iksan, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Won Moon
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Calif
| | - Hye Young Seo
- School of Big Data and Financial Statistics, College of Natural Sciences, Wonkwang University, Iksan, South Korea
| | - Jong-Moon Chae
- Department of Orthodontics, Wonkwang Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, South Korea; Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz.
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Sankar SG, Prashanth B, Rajasekhar G, Prasad M, Reddy GV, Priyanka JSY. A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study. Natl J Maxillofac Surg 2021; 12:171-180. [PMID: 34483573 PMCID: PMC8386258 DOI: 10.4103/njms.njms_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance. MATERIALS AND METHODS A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test. RESULTS Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05). CONCLUSIONS Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.
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Affiliation(s)
- Singaraju Gowri Sankar
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India,Address for correspondence: Prof. Singaraju Gowri Sankar, Department of Orthodontics, Narayana Dental College, Nellore - 524 003, Andhra Pradesh, India. E-mail:
| | - Bathini Prashanth
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Galli Rajasekhar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Mandava Prasad
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
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Lo Giudice A, Rustico L, Ronsivalle V, Nicotra C, Lagravère M, Grippaudo C. Evaluation of the changes of orbital cavity volume and shape after tooth-borne and bone-borne rapid maxillary expansion (RME). Head Face Med 2020; 16:21. [PMID: 32900389 PMCID: PMC7487642 DOI: 10.1186/s13005-020-00235-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
Objective To assess and compare volumetric and shape changes of the orbital cavity in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). Study design Forty adolescents with bilateral maxillary cross-bite received tooth-borne (TB group = 20; mean age 14.27 ± 1.36 years) or bone-borne (BB group = 20; mean age of 14.62 ± 1.45 years) maxillary expander. Cone-beam computed tomography (CBCT) were taken before treatment (T1) and 6-month after the expander activation (T2). Volumetric and shape changes of orbital cavities were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student’s t tests were used to 1) compare T1 and T2 volumes of orbital cavities in TB and BB groups, 2) compare volumetric changes and the percentage of matching of 3D orbital models (T1-T2) between the two groups. Results Both TB and BB groups showed a slight increase of the orbital volume (0.64 cm3 and 0.77 cm3) (p < 0.0001). This increment were significant between the two groups (p < 0.05) while no differences were found in the percentage of matching of T1/T2 orbital 3D models (p > 0.05). The areas of greater changes were detected in the proximity of the frontozygomatic and frontomaxillary sutures. Conclusion TB-RME and BB-RME would not seem to considerably affect the anatomy or the volume of the orbital cavity in adolescents.
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Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario "V. Emanuele,", Via Santa Sofia 78, 95123, Catania, Italy
| | | | - Vincenzo Ronsivalle
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario "V. Emanuele,", Via Santa Sofia 78, 95123, Catania, Italy
| | - Carmelo Nicotra
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario "V. Emanuele,", Via Santa Sofia 78, 95123, Catania, Italy
| | - Manuel Lagravère
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Grippaudo
- Dental and Maxillofacial Institute, Head and Neck Department, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart, 00168, Rome, Italy
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Zadi ZH, Bidhendi AJ, Shariati A, Pae EK. A clinically friendly viscoelastic finite element analysis model of the mandible with Herbst appliance. Am J Orthod Dentofacial Orthop 2020; 160:215-220.e2. [PMID: 32863087 DOI: 10.1016/j.ajodo.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION As a powerful numerical approximation tool, finite element analysis (FEA) has been widely used to predict stress and strain distributions in facial bones generated by orthodontic appliances. Previous FEA models were constructed on the basis of a linear elastic phase of the bone response (eg, elastic bone strains to loading). However, what is more useful for clinical understanding would be predicting long-term strains and displacements of bone-segments responding to loading, yet tissue responses are (1) not promptly observable and (2) hard to predict in nature. METHODS Viscoelastic property of the mandibular bone was incorporated into FEA models to visualize long-term, time-dependent stress and strain patterns in the mandible after being exposed to orthopedic stress. A mandible under loading by a Herbst appliance was modeled, and outcomes of the constructed elastic and viscoelastic models were compared. RESULTS Patterns and magnitudes of the displacement throughout the mandible predicted by the viscoelastic model were exhibited in accordance with previous clinical outcomes of Herbst appliance therapy. The elastic models exhibited similar displacement patterns; however, the magnitude of the displacements in the models was invariably small (approximately 1 per 100) compared with those outputs of corresponding viscoelastic models. The corresponding maximum stress level in our viscoelastic mandible subjected to the Herbst appliance with the same loading was considerably low and relaxed in various regions when compared with the elastic model. CONCLUSIONS We suggest that a viscoelastic model of the mandible mimics our general prediction of orthopedic treatment outcomes better than those by elastic models.
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Affiliation(s)
| | - Amir J Bidhendi
- Department of Plant Science, McGill University, Montreal, Québec, Canada
| | | | - Eung-Kwon Pae
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore, Md.
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26
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Hsu LF, Cheng YC, Peng HH, Yao CCJ. Simplified orthognathic surgical treatment using non-surgical asymmetric maxillary expansion: A case report. Int Orthod 2020; 18:839-849. [PMID: 32839141 DOI: 10.1016/j.ortho.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transverse problems can be exacerbated by highly compensated occlusion in patients with skeletal asymmetry, which makes pre-surgical decompensation harder to achieve. OBJECTIVE This case report describes a case of combined orthognathic surgery with facial asymmetry. We used pre-orthodontic surgical simulation to visualize the goal for presurgical orthodontics, planning for a one-jaw surgical treatment option. METHODS The planned asymmetric expansion was performed using a maxillary skeletal expander (MSE II) with surgical corticopuncture over only the left side before MSE activation. Surgery was performed to achieve mandibular left outward yaw rotation to correct the patient's facial asymmetry after the planned amount of expansion was reached. RESULTS The results showed substantial improvement of facial aesthetics as well as skeletal symmetry. Cooperation and communication between surgeon and orthodontist ensured that the final results were satisfactory.
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Affiliation(s)
- Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Cheng Cheng
- Department of Oral & Maxillofacial Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hui Peng
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan, Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan. Division of Orthodontics and Dentofacial Orthopaedics, Department of Dentistry, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
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Galli M, Federici FR, Di Nardo D, Yusef M, Morese A, Manenti RJ, Testarelli L. Surgical and orthodontic rapid palatal expansion in adults using a modified palatal partial osteotomy technique (ppot): Technique description and clinical experience. J Clin Exp Dent 2020; 12:e610-e614. [PMID: 32665823 PMCID: PMC7335607 DOI: 10.4317/jced.56313] [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: 09/18/2019] [Accepted: 04/26/2020] [Indexed: 11/20/2022] Open
Abstract
Transversal hypoplasia of the upper maxilla is a frequent condition between malocclusions. The rapid maxillary expansion (RME) is an already consolidated technique for these types of defects. This case report analyzes the outcome of a novel surgical technique that we named TOPP (Partial Palatal osteotomy technique) aiming to provide scientifically proven data over the percentage of relapse and the long-term stability of this type of surgical assisted palatal expansion. A 24 year old male patient with a hyperdivergent class III, presenting the absence of 1.1 due to a teenage trauma and a transversal contraction of the upper arch was selected for the surgery. The mucoperiosteal flap was performed at a palatal level with a paramarginal arch shape (from region 1.4 to 2.4) due to preserve the nasal-incisal vascular bundle and the mucoperiosteum was detached from the floor of the nose. A horizontal osteotomy was performed at 4-5 mm above the roots apexes; a sagittal osteotomy in a posterior direction was done at the level of the midline to divide the mesiopalatine suture and separate the maxilla in two halves. The only bony attachment that remained was represented by the perpendicular lamina of the palatal bone. The TOPP technique showed that it is possible to have a better control of both the intercanine and intermolar expansion, that is more difficult in the case of a conventional SARME. Other goals were a greater view and access to the site and the reduction of the risk of damaging the palatine fibromucosa. The incision of the archform paramarginal flap improves certainly the conditions of the palatal fibromucosa in the post operative and allows the reduction of the soft tissues’ elastic return. Key words:Rapid maxillary expansion, orthognatic surgery, maxillary osteotomy.
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Affiliation(s)
- Massimo Galli
- MD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | | | - Dario Di Nardo
- DDS, PhD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Marco Yusef
- MD, DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Antonio Morese
- DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Rebecca-Jewel Manenti
- DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Luca Testarelli
- DDS, PhD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
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Changes of Stress Distributions Around Pterygomaxillary Junction With Different Osteotome Angulations. J Craniofac Surg 2020; 31:1560-1562. [PMID: 32310867 DOI: 10.1097/scs.0000000000006397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to investigate how the alteration of the angulation of osteotome at pterygomaxillary junction affects lateral pterygoid plate, maxillary tuberosity, palatal surface of maxilla, palatine bone and body of sphenoid bone. Following reconstruction of 3D modelling of maxilla, Osteotomes' tip was angulated 45 and 90 to sagittal plane to simulate pterygomaxillary osteotomy. Finite element analyses (FEA) was performed and Von Misses stress distributions were analyzed for two different angulations. Independent sample t test was used to compare differences between 45 and 90 angulations. Von Misses stress values on lateral pterygoid plate were higher in 45 angulation (0.71 ± 0.21 MPa) than 90 angulation (0.54 ± 0.28 MPa). This difference was statistically significant (P < 0.01). Placement of osteotome's tip with 90 angulation had higher stress value than 45 angulation on maxillary tuberosity region. However; difference wasn't significant (P = 0.44). Stress values on body of sphenoid bone were 0.45 ± 0.17MPa for the case of 90 angulation and 0.19 ± 0.09MPa for 45 angulation. Difference between these values were statistically significant (P < 0.01). Possible risk of unfavourable lateral pterygoid plate fracture and complications related with body of sphenoid bone during pterygomaxillary osteotomy was remarkably increased in case of narrow angulation (45). Keeping osteotome at right angle with sagittal plane may avoid these complications.
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29
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Kato C, Kokai S, Ono T. Orthodontic movement of a contralateral maxillary central incisor across the midpalatal suture. APOS TRENDS IN ORTHODONTICS 2020. [DOI: 10.25259/apos_136_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There are several options for replacing a missing maxillary central incisor in orthodontic treatment. Substituting a missing central incisor with the contralateral one can be a useful approach to reduce the number of teeth that require extraction during the treatment. Normal tooth movement across an ossified midpalatal suture (MPS) has only been observed in an animal experiment. Herein, we describe the treatment of a 26-year-old woman who had lost multiple teeth on one side, including the maxillary right central incisor, which required extraction due to endodontic failure. The maxillary left central incisor was moved into the position of the maxillary right central incisor. All other left maxillary teeth were moved mesially to close the space. After completion of orthodontic treatment, acrylic build-up was performed on the maxillary left lateral incisor, which underwent morphological modification to replicate the morphology of a maxillary right incisor. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence of tooth movement across the MPS. Although the movement of the tooth across the MPS is feasible, the treatment plan should also take other treatment options into consideration.
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30
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Tong F, Miao Z, Zhou X, Xiao C, Wu J. Treatment and posttreatment effects of a novel magnetic palatal expansion appliance with reactivation system in dogs. Am J Orthod Dentofacial Orthop 2020; 157:194-204. [PMID: 32005471 DOI: 10.1016/j.ajodo.2019.03.020] [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: 08/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to compare the effects of a novel magnetic palatal expansion appliance (MPEA) during the expansion and maintenance period with that of a screw expansion appliance. METHODS Based on previous research, the MPEA had a reactivation system that was modified for a broader working range and more stable expansion. Thirty-six male beagle dogs were assigned to a magnetic expansion (ME; n = 12), screwed expansion (SE; n = 12) or control (n = 12) group. Half of the dogs from each group were evaluated only during 5 weeks of activation, whereas the rest were evaluated for 5 weeks of activation and 8 additional weeks of retention. Nonmagnetic metal marking implants were implanted on both sides of the midpalatal suture of all dogs. Three-dimensional assessment of treatment and posttreatment dental and skeletal effects were conducted using cone-beam computed tomography. The width of the midpalatal suture, mineralization and deposition rate of bone, and fluorescence integral optical density were calculated during the expansion and retention periods using tetracycline fluorescence labeling. RESULTS There were increases in the value of all cone-beam computed tomography parameters in the SE and ME groups during the expansion period, and the increase was significantly greater than that of the control group (P <0.01). However, there was no significant difference in the values of any parameters during the retention period. The width of the midline sutures, mineralization and deposition rate of bone, and integral optical density in the 2 experimental groups were significantly higher than those of the control group (P <0.01), and there was no significant difference between the SE and ME groups. After the retention period, the values of all tetracycline fluorescence evaluation parameters of the experimental groups decreased significantly. CONCLUSIONS The novel MPEA with a reactivation system was able to expand the midpalatal suture effectively. Dental and skeletal expansion effects are similar to those of the screw expansion appliance. Wearing the appliance as a retainer can effectively maintain the expansion effect. The new bone formation rate was accelerated during the expansion process and decreased to normal levels during the retention period.
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Affiliation(s)
- Fei Tong
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Stomatological and Biomedical Key Laboratory of Jiangxi Province, Nanchang, Jiangxi, China
| | - Zhanqi Miao
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Stomatological and Biomedical Key Laboratory of Jiangxi Province, Nanchang, Jiangxi, China
| | - Xingchen Zhou
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Stomatological and Biomedical Key Laboratory of Jiangxi Province, Nanchang, Jiangxi, China
| | - Chang Xiao
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Stomatological and Biomedical Key Laboratory of Jiangxi Province, Nanchang, Jiangxi, China
| | - Jianyong Wu
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Stomatological and Biomedical Key Laboratory of Jiangxi Province, Nanchang, Jiangxi, China.
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Dental and Skeletal Changes after Transpalatal Distraction. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5814103. [PMID: 32090098 PMCID: PMC6998753 DOI: 10.1155/2020/5814103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Maxillary constriction is a common skeletal craniofacial abnormality, and transverse maxillary deficiency affects 30% of patients receiving orthodontic and surgical treatment. The aim of the study was to analyse craniofacial skeletal changes in adults with maxillary constriction after transpalatal distraction. The study group consisted of 36 patients (16 women) aged 17 to 42 years (M = 27.1; SD = 7.8) with a known complete skeletal crossbite and who underwent transpalatal distraction procedure. The measurements were obtained on diagnostic models, and cephalometric PA radiograms were obtained at time points, i.e., before treatment (T1) and after the completion of active distraction (T2). The analysis of diagnostic models involving the arch width measurement at different levels demonstrated a significant increase in L1, L2, L3, L4, L5, and L6 dimensions after transpalatal distraction. The largest width increase (9.5 mm) was observed for the L3 dimension (the intercanine distance). The analysis of frontal cephalograms displayed a significant increase in W1, W2, and W3 dimensions after transpalatal distraction. The largest width increase (4.9 mm) was observed for the W1 dimension at the level of the alveolar process of the maxilla. Transpalatal distraction is an effective treatment for transverse maxillary deficiency after the end of bone growth. The expansion observed on diagnostic models is close to a parallel segment shift mechanism, with a mild tendency towards a larger opening anteriorly. The maxillary segment rotation pattern analysed based on the frontal cephalograms is close to a hand fan unfolding with the rotation point at the frontonasal suture.
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Three-dimensional changes of the zygomaticomaxillary complex after mini-implant assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2019; 156:653-662. [PMID: 31677674 DOI: 10.1016/j.ajodo.2018.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to investigate 3-dimensional changes of the zygomaticomaxillary complex (ZMC) after mini-implant assisted rapid maxillary expansion (MARME). METHODS A total of 15 pairs of cone-beam computed tomography 3-dimensional images taken before expansion (T0) and after expansion (T1) were analyzed by measuring changes in the coordinates of the landmarks of the ZMC. RESULTS Changes in the x coordinates of the landmarks showed significant expansion (P <0.01) and greater expansion at the lower than upper portion of the ZMC (P <0.05) in the transverse dimension. All y coordinates of the landmarks except the jugal point (J) showed forward displacement (P <0.05), and the z coordinates of ANS, PNS, Alare, A, and ectocanine showed downward displacement (P <0.01) in the sagittal and vertical dimensions. Also, z coordinates of the landmarks that were closer to the midsagittal plane and in a more posterior portion of the ZMC displaced further downward (P <0.05). SNA and ANB angles increased (P <0.05 and P <0.001, respectively) and the SNB angle decreased (P <0.01). There was a significant correlation between changes in the x coordinates of the ectomolare and ectocanine and the amount of expansion measured from the center of resistance of the maxillary first molars (CR6; P <0.05). There was no significant correlation between the amount of CR6 expansion and changes in y and z coordinates of the landmarks. CONCLUSIONS 3-Dimensional changes of the ZMC after MARME showed expansion in a pyramidal shape from the coronal view, downward and forward displacement from the sagittal view, and parallel palatal expansion from the axial view. These findings might be useful for understanding skeletal expansion patterns using MARME.
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Shin H, Hwang CJ, Lee KJ, Choi YJ, Han SS, Yu HS. Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: A preliminary study. Korean J Orthod 2019; 49:360-371. [PMID: 31815104 PMCID: PMC6883215 DOI: 10.4041/kjod.2019.49.6.360] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We sought to determine the predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion (MARPE) in young adults. METHODS The following variables were selected as possible predictors: chronological age, palate length and depth, midpalatal suture maturation (MPSM) stage, midpalatal suture density (MPSD) ratio, the sella-nasion (SN)-mandibular plane (MP) angle as an indicator of the vertical skeletal pattern, and the point A-nasion-point B (ANB) angle for anteroposterior skeletal classification. For 31 patients (mean age, 22.52 years) who underwent MARPE treatment, palate length and depth, MPSM stage and MPSD ratio from the initial cone-beam computed tomography images, and the SN-MP angle and ANB angle from lateral cephalograms were assessed. The midpalatal suture opening ratio was calculated from the midpalatal suture opening width measured in periapical radiographs and the MARPE screw expansion. Statistical analyses of correlations were performed for the entire patient group of 31 subjects and subgroups categorized by sex, vertical skeletal pattern, and anteroposterior skeletal classification. RESULTS In the entire patient group, the midpalatal suture opening ratio showed statistically significant negative correlations with age, palate length, and MPSM stage (r = -0.506, -0.494, and -0.746, respectively, all p < 0.01). In subgroup analyses, a strong negative correlation was observed with the palate depth in the skeletal Class II subgroup (r = -0.900, p < 0.05). CONCLUSIONS The findings of this study indicated that age, palate length, and MPSM stage can be predictors of midpalatal suture expansion by MARPE in young adults.
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Affiliation(s)
- Hyerin Shin
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung Seog Yu
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
- Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Kumar A, Ghafoor H. The Analysis of Three-dimensional Effects of Nitanium Palatal Expander 2 and Hyrax Maxillary Expansion Appliances on Craniofacial Structures: A Finite Element Study. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2019. [DOI: 10.4103/jios.jios_213_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Avinash Kumar
- Prof., Department of
Orthodontics, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
| | - Hajra Ghafoor
- PG Student, Department of
Orthodontics, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
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35
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Changes in pulp blood flow and pulp sensibility resulting from surgically assisted rapid maxillary expansion: A clinical study. Am J Orthod Dentofacial Orthop 2019; 155:632-641. [PMID: 31053278 DOI: 10.1016/j.ajodo.2018.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aim of this work was to assess and compare changes in pulp blood flow (PBF) and pulp sensibility (PS) after surgically assisted rapid maxillary expansion (SARME) and rapid orthopedic maxillary expansion (OME). METHODS Ten patients requiring SARME and 10 requiring OME had the pulp status of their maxillary incisors and canines assessed with the use of laser Doppler flowmetry, electric pulp testing (EPT), and CO2 snow. The SARME group was assessed at T1-S (before surgery), T2-S (after surgery, before expansion), T3-S (after surgery, at completion of expansion), and T4-S (3 months after surgery). The OME group was assessed at T1-O (before expansion), T2-O (after rapid expansion), and T3-O (3 months after expansion commencement). Relationships between PBF/PS and the procedures, assessment times, and tooth types were evaluated. RESULTS In the SARME group, surgery did not cause significant (P ≥0.05) reduction in PBF, maxillary expansion did cause significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T4-S, and nonresponses to both EPT and CO2 peaked at T2-S. In the OME group, rapid expansion caused significant (P ≤0.05) reduction in PBF, pretreatment PBF was reestablished by T3-O, and all teeth responded to at least 1 of EPT or CO2 at each assessment time. CONCLUSIONS AND CLINICAL IMPLICATIONS Within the study's limitations, it can be concluded that both SARME and OME induce reduction but not elimination of PBF to maxillary anterior teeth and therefore do not cause loss of pulp vitality; surgery for SARME does not significantly reduce PBF to maxillary anterior teeth, rather it is the process of maxillary expansion that significantly reduces PBF in SARME patients; and caution when using CO2 and EPT tests alone to assess pulp status after SARME is warranted because the capacity for CO2 or EPT to provide negative sensibility responses despite the presence of PBF was observed.
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Esen A, Dolanmaz E, Dolanmaz D. Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis. J Craniomaxillofac Surg 2019; 47:431-437. [DOI: 10.1016/j.jcms.2018.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/12/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
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Zygomaticomaxillary modifications in the horizontal plane induced by micro-implant-supported skeletal expander, analyzed with CBCT images. Prog Orthod 2018; 19:41. [PMID: 30345476 PMCID: PMC6196147 DOI: 10.1186/s40510-018-0240-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background Miniscrew-assisted rapid palatal expansion (MARPE) has been adopted in recent years to expand the maxilla in late adolescence and adult patients. Maxillary Skeletal Expander (MSE) is a device that exploits the principles of skeletal anchorage to transmit the expansion force directly to the maxillary bony structures and is characterized by the miniscrews’ engagement of the palatal and nasal cortical bone layers. In the literature, it has been reported that the zygomatic buttress is a major constraint that hampers the lateral movement of maxilla, since maxilla is located medially to the zygomatic arches. The objective of the present study is to analyze the changes in the zygomatic bone, maxillary bone, and zygomatic arches and to localize the center of rotation for the zygomaticomaxillary complex in the horizontal plane after treatment with MSE, using high-resolution cone-beam computed tomography (CBCT) images. Methods Fifteen subjects with a mean age of 17.2 (± 4.2) years were treated with MSE. CBCT records were taken before and after miniscrew-assisted maxillary expansion; three linear and four angular parameters were identified in the axial zygomatic section (AZS) and were compared from pre-treatment to post-treatment using the Wilcoxon signed rank test. Results Anterior inter-maxillary distance increased by 2.8 mm, posterior inter-zygomatic distance by 2.4 mm, angle of the zygomatic process of the temporal bone by 1.7° and 2.1° (right and left side) (P < 0.01). Changes in posterior inter-temporal distance and zygomaticotemporal angle were negligible (P > 0.05). Conclusions In the horizontal plane, the maxillary and zygomatic bones and the whole zygomatic arch were significantly displaced in a lateral direction after treatment with MSE. The center of rotation for the zygomaticomaxillary complex was located near the proximal portion of the zygomatic process of the temporal bone, more posteriorly and more laterally than what has been reported in the literature for tooth-borne expanders. Bone bending takes place in the zygomatic process of the temporal bone during miniscrew-supported maxillary expansion.
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Hartono N, Soegiharto BM, Widayati R. The difference of stress distribution of maxillary expansion using rapid maxillary expander (RME) and maxillary skeletal expander (MSE)-a finite element analysis. Prog Orthod 2018; 19:33. [PMID: 30280257 PMCID: PMC6168444 DOI: 10.1186/s40510-018-0229-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Maxillary skeletal expander (MSE) in combination with miniscrews was developed to overcome the drawbacks that may have resulted from the application of conventional rapid maxillary expander (RME). This research was conducted to analyze the difference of stress distribution of maxillary expansion using RME and MSE in the region of interests (ROIs): first molars (M1), palatal alveolar bones of M1, palatine sutures, zygomatic sutures, miniscrews, and their surrounding bones. Methods A dry skull was scanned using CBCT and rendered into a three-dimensional (3D) model of craniomaxillary structures. The data analysis was done both visually and numerically. Result The stress distributions in RME group were located at the palatal side of M1, mesial side of palatal alveolar of M1, pulp chamber of M1, and inferior cortex of palatine sutures. The stress distributions in the MSE group were located at the distopalatal cusp of M1, palatal side of palatal alveolar of M1, and inferior and superior cortex of palatine sutures. The stress distributions in zygomatic sutures on both groups were located at the zygomaticotemporal sutures, whereas in the miniscrews, the stress were located at the anterior miniscrews and palatal side of surrounding bones. Conclusions There were significant differences of stress distribution of maxillary expansion measured in the ROIs in the craniomaxillary 3D model using RME and MSE.
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Affiliation(s)
- Nathania Hartono
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia
| | - Benny M Soegiharto
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia.
| | - Retno Widayati
- Department of Orthodontics, Faculty of Dentistry, University of Indonesia, Jl, Salemba Raya no. 4, Jakarta Pusat, 10430, Indonesia
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Cantarella D, Dominguez-Mompell R, Moschik C, Mallya SM, Pan HC, Alkahtani MR, Elkenawy I, Moon W. Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images. Am J Orthod Dentofacial Orthop 2018; 154:337-345. [PMID: 30173836 DOI: 10.1016/j.ajodo.2017.11.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our objectives were to evaluate midfacial skeletal changes in the coronal plane and the implications of circummaxillary sutures and to localize the center of rotation for the zygomaticomaxillary complex after therapy with a bone-anchored maxillary expander, using high-resolution cone-beam computed tomography. METHODS Fifteen subjects with a mean age of 17.2 ± 4.2 years were treated with a bone-anchored maxillary expander. Pretreatment and posttreatment cone-beam computed tomography images were superimposed and examined for comparison. RESULTS Upper interzygomatic distance increased by 0.5 mm, lower interzygomatic distance increased by 4.6 mm, frontozygomatic angles increased by 2.5° and 2.9° (right and left sides), maxillary inclinations increased by 2.0° and 2.5° (right and left sides), and intermolar distance increased by 8.3 mm (P <0.05). Changes in frontoethmoidal, zygomaticomaxillary, and molar basal bone angles were negligible (P >0.05). CONCLUSIONS A significant lateral displacement of the zygomaticomaxillary complex occurred in late adolescent patients treated with a bone-anchored maxillary expander. The zygomatic bone tended to rotate outward along with the maxilla with a common center of rotation located near the superior aspect of the frontozygomatic suture. Dental tipping of the molars was negligible during treatment.
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Affiliation(s)
- Daniele Cantarella
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif.
| | - Ramon Dominguez-Mompell
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Christoph Moschik
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Sanjay M Mallya
- Section of Oral and Maxillofacial Radiology, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Hsin Chuan Pan
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Mohammed R Alkahtani
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Islam Elkenawy
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif
| | - Won Moon
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California at Los Angeles, Los Angeles, Calif.
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Mohammed MA, Mohamed KM. Three-dimensional stress analysis with two molar protraction techniques using Finite Element Modeling. J World Fed Orthod 2018. [DOI: 10.1016/j.ejwf.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ulusoy Ç, Dogan M. A new method for the treatment of unilateral posterior cross-bite: a three-dimensional finite element stress analysis study. Prog Orthod 2018; 19:31. [PMID: 30146655 PMCID: PMC6110308 DOI: 10.1186/s40510-018-0227-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stress relieving corticoto mies during the treatment of maxillary expansion are needed in adult patients. METHODS Three-dimensional (3D) finite element model was prepared, and finite element analysis was processed to evaluate the stress distributions within the skull and maxillary teeth during surgically assisted rapid maxillary expansion (SARME) treatment. RESULTS Expansion forces generated more stress on the corticotomy-applied part of the maxilla. The stress levels decreased dramatically above the corticotomy line. CONCLUSION Asymmetric transveral maxillary expansion might be achieved from a symmetric force generating screw during SARME treatment. SARME osteotomies may concentrate the stress in the expanding maxilla and reduce the pain in other parts of the cranium.
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Affiliation(s)
- Çağrı Ulusoy
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Emek, Ankara, Turkey
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Eom J, Bayome M, Park JH, Lim HJ, Kook YA, Han SH. Displacement and stress distribution of the maxillofacial complex during maxillary protraction using palatal plates: A three-dimensional finite element analysis. Korean J Orthod 2018; 48:304-315. [PMID: 30206529 PMCID: PMC6123076 DOI: 10.4041/kjod.2018.48.5.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to analyze initial displacement and stress distribution of the maxillofacial complex during dentoskeletal maxillary protraction with various appliance designs placed on the palatal region by using three-dimensional finite element analysis. Methods Six models of maxillary protraction were developed: conventional facemask (Type A), facemask with dentoskeletal hybrid anchorage (Type B), facemask with a palatal plate (Type C), intraoral traction using a Class III palatal plate (Type D), facemask with a palatal plate combined with rapid maxillary expansion (RME; Type E), and Class III palatal plate intraoral traction with RME (Type F). In Types A, B, C, and D, maxillary protraction alone was performed, whereas in Types E and F, transverse expansion was performed simultaneously with maxillary protraction. Results Type C displayed the greatest amount of anterior dentoskeletal displacement in the sagittal plane. Types A and B resulted in similar amounts of anterior displacement of all the maxillofacial landmarks. Type D showed little movement, but Type E with expansion and the palatal plate displayed a larger range of movement of the maxillofacial landmarks in all directions. Conclusions The palatal plate served as an effective skeletal anchor for use with the facemask in maxillary protraction. In contrast, the intraoral use of Class III palatal plates showed minimal skeletal and dental effects in maxillary protraction. In addition, palatal expansion with the protraction force showed minimal effect on the forward movement of the maxillary complex.
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Affiliation(s)
| | - Mohamed Bayome
- Department of Dentistry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Postgraduate Studies, the Universidad Autonóma del Paraguay, Asunción, Paraguay
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hee Jin Lim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Ho Han
- Division of Orthodontics, Department of Dentistry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Pereira JDS, Jacob HB, Locks A, Brunetto M, Ribeiro GLU. Evaluation of the rapid and slow maxillary expansion using cone-beam computed tomography: a randomized clinical trial. Dental Press J Orthod 2018; 22:61-68. [PMID: 28658357 PMCID: PMC5484271 DOI: 10.1590/2177-6709.22.2.061-068.oar] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/09/2016] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE: The aim of this randomized clinical trial was to evaluate the dental, dentoalveolar, and skeletal changes occurring right after the rapid maxillary expansion (RME) and slow maxillary expansion (SME) treatment using Haas-type expander. METHODS: All subjects performed cone-beam computed tomography (CBCT) before installation of expanders (T1) and right after screw stabilization (T2). Patients who did not follow the research parameters were excluded. The final sample resulted in 21 patients in RME group (mean age of 8.43 years) and 16 patients in SME group (mean age of 8.70 years). Based on the skewness and kurtosis statistics, the variables were judged to be normally distributed and paired t-test and student t-test were performed at significance level of 5%. RESULTS: Intermolar angle changed significantly due to treatment and RME showed greater buccal tipping than SME. RME showed significant changes in other four measurements due to treatment: maxilla moved forward and mandible showed backward rotation and, at transversal level both skeletal and dentoalveolar showed significant changes due to maxillary expansion. SME showed significant dentoalveolar changes due to maxillary expansion. CONCLUSIONS: Only intermolar angle showed significant difference between the two modalities of maxillary expansion with greater buccal tipping for RME. Also, RME produced skeletal maxillary expansion and SME did not. Both maxillary expansion modalities were efficient to promote transversal gain at dentoalveolar level. Sagittal and vertical measurements did not show differences between groups, but RME promoted a forward movement of the maxilla and backward rotation of the mandible.
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Affiliation(s)
| | - Helder B Jacob
- Assistant Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston-TX, USA
| | - Arno Locks
- Federal University of Santa Catarina, Department of Orthodontics, Florianópolis, SC, Brazil
| | | | - Gerson L U Ribeiro
- Federal University of Santa Catarina, Department of Orthodontics, Florianópolis, SC, Brazil
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Ghoussoub MS, Rifai K, Garcia R, Sleilaty G. Effect of Rapid Maxillary Expansion on Glenoid Fossa and Condyle-Fossa Relationship in Growing Patients (MEGP): Study Protocol for a Controlled Clinical Trial. J Int Soc Prev Community Dent 2018; 8:130-136. [PMID: 29780738 PMCID: PMC5946521 DOI: 10.4103/jispcd.jispcd_458_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/15/2018] [Indexed: 01/29/2023] Open
Abstract
Aims and Objectives: Rapid maxillary expansion (RME) is an orthodontic nonsurgical procedure aiming at increasing the width of the maxilla by opening mainly the intermaxillary suture in patients presenting a transverse maxillary skeletal deficiency. The objectives of the current prospective controlled clinical and radiographic study are to evaluate the hypothesis that RME in growing patients will result in radiographic changes at the level of interglenoid fossa distance, condyle-fossa relationship, and nasal cavity widths compared to the group who received no treatment initially and served as untreated control. Materials and Methods: In this prospective controlled clinical and radiographic study, forty healthy growing patients selected from a school-based population following a large screening campaign, ranging in age between 8 and 13 years, presenting a maxillary constriction with bilateral crossbite, and candidates for RME are being recruited. The first group will include participants willing to undergo treatment (n = 25) and the other group will include those inclined to postpone (n = 15). Results: The primary outcome is to compare radiologically the interglenoid fossa distance and the condyle-fossa relationship; nasal cavity width will be a secondary outcome. A multivariable analysis of Covariance model will be used, with the assessment of the time by group interaction, using age as covariate. The project protocol was reviewed and approved by the Ethics Committee of the Lebanese University, National Institute in Lebanon (CUEMB process number 31/04/2015). The study is funded by the Lebanese University and Centre National de Recherche Scientifique, Lebanon (Number: 652 on 14/04/2016). Conclusion: This prospective controlled clinical trial will give information about the effect of RME on the glenoid fossa and condyle-fossa relationship and its impact on the nasal cavity width. Trial Registration: Retrospectively registered in BioMed Central (DOI10.1186/ISRCTN77788053).
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Affiliation(s)
- Mona Sayegh Ghoussoub
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, Lebanese University, Hadath, Lebanon
| | - Khaldoun Rifai
- Department of Prosthodontics, School of Dentistry, Lebanese University, Hadath, Lebanon
| | - Robert Garcia
- Department of Orthodontics School of Dentistry, Paris Diderot University, Paris, France
| | - Ghassan Sleilaty
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Evaluation of stress by finite element analysis of the midface and skull base at the time of midpalatal osteotomy in models with or without pterygomaxillary dysjunction. Br J Oral Maxillofac Surg 2018; 56:177-181. [DOI: 10.1016/j.bjoms.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/03/2018] [Indexed: 11/20/2022]
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Lee RJ, Moon W, Hong C. Effects of monocortical and bicortical mini-implant anchorage on bone-borne palatal expansion using finite element analysis. Am J Orthod Dentofacial Orthop 2017; 151:887-897. [PMID: 28457266 DOI: 10.1016/j.ajodo.2016.10.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bone-borne palatal expansion relies on mini-implant stability for successful orthopedic expansion. The large magnitude of applied force experienced by mini-implants during bone-borne expansion may lead to high failure rates. Use of bicortical mini-implant anchorage rather than monocortical anchorage may improve mini-implant stability. The aims of this study were to analyze and compare the effects of bicortical and monocortical anchorages on stress distribution and displacement during bone-borne palatal expansion using finite element analysis. METHODS Two skull models were constructed to represent expansion before and after midpalatal suture opening. Three clinical situations with varying mini-implant insertion depths were studied in each skull model: monocortical, 1-mm bicortical, and 2.5-mm bicortical. Finite element analysis simulations were performed for each clinical situation in both skull models. Von Mises stress distribution and transverse displacement were evaluated for all models. RESULTS Peri-implant stress was greater in the monocortical anchorage model compared with both bicortical anchorage models. In addition, transverse displacement was greater and more parallel in the coronal plane for both bicortical models compared with the monocortical model. Minimal differences were observed between the 1-mm and the 2.5-mm bicortical models for both peri-implant stress and transverse displacement. CONCLUSIONS Bicortical mini-implant anchorage results in improved mini-implant stability, decreased mini-implant deformation and fracture, more parallel expansion in the coronal plane, and increased expansion during bone-borne palatal expansion. However, the depth of bicortical mini-implant anchorage was not significant.
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Affiliation(s)
- Robert J Lee
- Division of Orthodontics, University of California at San Francisco, San Francisco, Calif
| | - Won Moon
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif
| | - Christine Hong
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif.
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Priyadarshini J, Mahesh CM, Chandrashekar BS, Sundara A, Arun AV, Reddy VP. Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion-a finite element method study. Prog Orthod 2017; 18:17. [PMID: 28603805 PMCID: PMC5502214 DOI: 10.1186/s40510-017-0172-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022] Open
Abstract
Background Rapid maxillary expansion (RME), indicated in the treatment of maxillary deficiency directs high forces to maxillary basal bone and to other adjacent skeletal bones. The aim of this study is to (i) evaluate stress distribution along craniofacial sutures and (ii) study the displacement of various craniofacial structures with rapid maxillary expansion therapy by using a Finite Element model. Methods An analytical model was developed from a dried human skull of a 12 year old male. CT scan images of the skull were taken in axial direction parallel to the F-H plane at 1 mm interval, processed using Mimics software, required portion of the skull was exported into stereo-lithography model. ANSYS software was used to solve the mathematical equation. Contour plots of the displacement and stresses were obtained from the results of the analysis performed. Results At Node 47005, maximum X-displacement was 5.073 mm corresponding to the incisal edge of the upper central incisor. At Node 3971, maximum negative Y-displacement was -0.86 mm which corresponds to the anterior zygomatic arch, indicating posterior movement of craniofacial complex. At Node 32324, maximum negative Z-displacement was -0.92 mm representing the anterior and deepest convex portion of the nasal septum; indicating downward displacement of structures medial to the area of force application. Conclusions Pyramidal displacement of maxilla was evident. Apex of pyramid faced the nasal bone and base was located on the oral side. Posterosuperior part of nasal cavity moved minimally in lateral direction and width of nasal cavity at the floor of the nose increased, there was downward and forward movement of maxilla with a tendency toward posterior rotation. Maximum von Mises stresses were found along midpalatal, pterygomaxillary, nasomaxillary and frontomaxillary sutures.
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Affiliation(s)
| | - C M Mahesh
- Department of Orthodontics and Dentofacial Orthopaedics, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, New Airport Road, Bangalore, 562157, Karnataka, India
| | - B S Chandrashekar
- Department of Orthodontics and Dentofacial Orthopaedics, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, New Airport Road, Bangalore, 562157, Karnataka, India
| | - Abhishek Sundara
- Department of Orthodontics and Dentofacial Orthopaedics, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, New Airport Road, Bangalore, 562157, Karnataka, India.
| | - A V Arun
- Department of Orthodontics and Dentofacial Orthopaedics, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, New Airport Road, Bangalore, 562157, Karnataka, India
| | - Vinay P Reddy
- Department of Orthodontics and Dentofacial Orthopaedics, Krishnadevaraya College of Dental Sciences, Hunasamaranahalli, New Airport Road, Bangalore, 562157, Karnataka, India
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Extensiometric analysis of strain in craniofacial bones during implant-supported palatal expansion. J Mech Behav Biomed Mater 2017; 76:104-109. [PMID: 28576607 DOI: 10.1016/j.jmbbm.2017.05.028] [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: 01/17/2017] [Revised: 04/24/2017] [Accepted: 05/20/2017] [Indexed: 11/21/2022]
Abstract
Palatal expansion has several orthodontic and orthopedic applications, such as increasing maxillary transverse dimensions and correcting maxillary atresia, oral breathing, and skeletal cross-bites. Little is known about the strain to which craniofacial bones are submitted when a palatal expander is loaded. The objectives of the present work were to propose a new palatal bone-borne titanium device (expansion screw), to determine patterns of strain distribution in craniofacial bones during palatal expansion and to show the clinical results of a new palatal expander supported by implants. For in vitro testing, the palatal expander supported by two commercially pure titanium (cp Ti) implants was inserted parallel to the median palatine suture of four dry adult human skulls. Uniaxial and triaxial strain gauges were attached to craniofacial bones and connected to a signal acquisition system. An expansion screw was turned and strain data were collected during palatal expansion. The results showed that the bone strain distribution in craniofacial bones loaded by the palatal bone-borne titanium device was complex: the strain was tensile in the palatine cortical bone and compressive in pterygopalatine processes, nasal bones, and orbital floor. The maximum compressive strain occurs in the upper portion of the pterygopalatine processes and the strain changes from compressive to tensile in the zygomatic process. The experimental results suggest that the bone strain due to the palatal expander is distributed over all craniofacial bones and that the upper portions of pterygopalatine processes are the main sites of resistance to palatal expansion. The new palatal expander supported by two cp Ti implants proposed was employed on adult patient as an illustrative report, where adequate palatal expansion was achieved. The new protocol proposed was less invasive, risky, painful and costless for the correction of moderate maxillary transverse deficiency.
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Canan S, Şenışık NE. Comparison of the treatment effects of different rapid maxillary expansion devices on the maxilla and the mandible. Part 1: Evaluation of dentoalveolar changes. Am J Orthod Dentofacial Orthop 2017; 151:1125-1138. [DOI: 10.1016/j.ajodo.2016.11.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
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Park JH, Bayome M, Zahrowski JJ, Kook YA. Displacement and stress distribution by different bone-borne palatal expanders with facemask: A 3-dimensional finite element analysis. Am J Orthod Dentofacial Orthop 2017; 151:105-117. [PMID: 28024761 DOI: 10.1016/j.ajodo.2016.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze displacement and stress distribution in the maxilla during maxillary expansion followed by protraction using bone-borne and conventional tooth-borne palatal expanders and a facemask via 3-dimensional finite element analysis. METHODS A finite element model of an adolescent skull was created, and 4 different types of appliances were integrated into it: facemask (type A); facemask with paramedian bone-borne expander (type B), facemask with palatal-slope bone-borne expander (type C), and facemask with conventional expander (type D). Expansion of 0.25 mm followed by 500 g of force per side was applied. RESULTS Type A showed anterior displacement of the dentition combined with downward displacement of posterior teeth and upward displacement of anterior teeth. The combination of protraction and expansion in type D showed the greatest anterior displacement. In types B and C, the expansion forces resulted in posterior displacement decreasing the net displacement of the combination. Stresses concentrated around the miniscrews in types B and C. In types A and D, stresses concentrated at the first premolar and first molar. Type B had the highest stresses followed by type C and then D. CONCLUSIONS The conventional tooth-borne expander (type D) enhanced the effect of maxillary protraction. Facemask alone (type A) resulted in more anterior displacement of the maxilla than the combination of facemask and bone-borne expanders (types B and C). The clinician should be aware of the initial stresses and movements from different expanders with facemask found in this study and confirm the movements in future clinical Class III studies.
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Affiliation(s)
- Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea.
| | - Mohamed Bayome
- Graduate School, Catholic University of Korea, Seoul, Korea; Department of Postgraduate Studies, Universidad Autonoma del Paraguay, Asuncion, Paraguay
| | | | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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