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Sader LHB, Siécola G, Marin Ramirez CM, Otazu A, Torres DM, Cotrin P, Valarelli FP, Pinzan-Vercelino CRM, Freitas KMS. Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion. Orthod Craniofac Res 2024; 27:421-428. [PMID: 38124269 DOI: 10.1111/ocr.12745] [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] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE(S) This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. RESULTS The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. CONCLUSION Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.
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Affiliation(s)
| | - Gustavo Siécola
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | - Aldo Otazu
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Dino Marcelo Torres
- Department of Orthodontics, Institute of Advanced Dentistry, Asunción, Paraguay
| | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil
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Tepedino M, Montaruli G, Esposito R, Akhilanand C, Lorusso M, Laurenziello M, Ciavarella D. Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls. Orthod Craniofac Res 2024; 27:455-464. [PMID: 38180289 DOI: 10.1111/ocr.12754] [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] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chaurasia Akhilanand
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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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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Hsu LF, Moon W, Chen SC, Chang KWC. Digital workflow for mini-implant-assisted rapid palatal expander fabrication-a case report. BMC Oral Health 2023; 23:887. [PMID: 37985987 PMCID: PMC10659097 DOI: 10.1186/s12903-023-03589-5] [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: 03/12/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Non-surgical mini-implant assisted rapid palatal expansion, or midfacial skeletal expansion, is a paradigm-shifting concept that in recent years has expanded the envelope of orthopedic movement in the transverse direction for adult patients. Although adding mini-screws to a rapid palatal expander is not complicated, accurate and successful expansion strongly depends on the device's position and its relation to the resisting structures of the maxillofacial complex. CASE PRESENTATION This article presents a digital workflow to locate the optimal position of the Midfacial Skeletal Expander (MSE) device in a CBCT-combined intraoral scan file and describes how to transfer the MSE position intra-orally with properly sized bands during the device fabrication. The complete digital workflow of MSE fabrication and its application for a Class III orthognathic surgical case is presented in detail. CONCLUSIONS This report describes a completely digital process that can accurately position the MSE device according to the orientation and morphology of maxillary basal bone, which is crucial in adult cases demand maxillary expansion.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Won Moon
- The Forsyth Institute, Cambridge, MA, USA
- Ajou University School of Medicine, Suwon-si, Korea
| | - Shih-Chin Chen
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, CA, USA
| | - Kelvin Wen-Chung Chang
- Breeze Dental Center, No. 588, Xianzheng 2Nd Rd., Zhubei City, Hsinchu County, Taiwan (R.O.C.).
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Zeng W, Yan S, Yi Y, Chen H, Sun T, Zhang Y, Zhang J. Long-term efficacy and stability of miniscrew-assisted rapid palatal expansion in mid to late adolescents and adults: a systematic review and meta-analysis. BMC Oral Health 2023; 23:829. [PMID: 37924088 PMCID: PMC10623697 DOI: 10.1186/s12903-023-03574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The purpose of this study is to investigate the long-term efficacy and stability of Miniscrew-assisted Rapid Palatal Expansion (MARPE), including its primary outcomes, namely the nasomaxillary complex transverse skeletal and dental expansion, and related secondary outcomes. METHODS Electronic databases and manual literature searches, up to October 31, 2022, were performed. The eligibility criteria were the following: studies on patients with transverse maxillary deficiency treated with MARPE in adults and adolescents over 13.5 years of age. RESULTS Ultimately, twelve articles were included in the analysis, one prospective and eleven retrospective observational studies. Five studies showed a moderate risk of bias, while the remaining seven studies were at a serious risk of bias. The GRADE quality of evidence was very low. MARPE is an effective treatment modality for transverse maxillary deficiency (mean success rate: 93.87%). Patients showed increased mean in the skeletal and dental transverse expansion. The basal bone composition, mean alveolar bone and mean dental expansion accounted for 48.85, 7.52, and 43.63% of the total expansion, respectively. There was a certain degree of skeletal and dental relapse over time. MARPE could also cause dental, alveolar, and periodontal side effects, and have an impact on other craniofacial bones, upper airway, and facial soft tissue. CONCLUSIONS MARPE is an effective treatment for transverse maxillary deficiency, with a high success rate and a certain degree of skeletal and dental relapse over time.
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Affiliation(s)
- Weiqian Zeng
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China
| | - Shuyun Yan
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yating Yi
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China
| | - Hao Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China
| | - Tongke Sun
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China
| | - Yimeng Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China
| | - Jun Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, No.44-1 Wenhua Road West, 250012, Jinan, Shandong, China.
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Pan S, Gao X, Sun J, Yang Z, Hu B, Song J. Effects of novel microimplant-assisted rapid palatal expanders manufactured by 3-dimensional printing technology: A finite element study. Am J Orthod Dentofacial Orthop 2023; 164:700-711. [PMID: 37330728 DOI: 10.1016/j.ajodo.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The expansion effects of several new microimplant-assisted rapid palatal expanders (MARPEs) manufactured by 3-dimensional printing technology were evaluated by finite element analysis (FEA). The aim was to identify a novel MARPE suitable for treating maxillary transverse deficiency. METHODS The finite element model was established using MIMICS software (version 19.0; Materialise, Leuven, Belgium). First, the appropriate microimplant insertion characteristics were identified via FEA, and several MARPEs with the above insertion patterns were manufactured by 3-dimensional printing technology. Then, the stress distribution and displacement prediction of the 4 MARPEs and hyrax expander (model E) were evaluated via FEA: bone-borne (model A), bone-tooth-borne (model B), bone-mucous-borne (model C), bone-tooth-mucous-borne (model D). RESULTS Monocortical microimplants perpendicular to the cortical bone on the coronal plane resulted in better expansion effects. Compared with a conventional hyrax expander, the orthopedic expansion of each of the 4 MARPEs was far larger, the parallelism was greater, and the posterior teeth tipping rate was lower. Among them, the expansion effects of models C and D were the best; the von Mises peak values on the surfaces of the microimplants were smaller than those of models A and B. CONCLUSIONS This study may demonstrate that the 4 MARPEs obtained more advantageous orthopedic expansion effects than a hyrax expander. Models C and D obtained better biomechanical effects and had better primary stability. Overall, model D is the recommended expander for treating maxillary transverse deficiency because its structure acts like an implant guide and is beneficial for the accurate insertion of the microimplant.
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Affiliation(s)
- Shengyuan Pan
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiang Gao
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jicheng Sun
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Zun Yang
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Chen R. Effects of rapid maxillary expansion on anchorage alveolar bone meta-analysis. Acta Odontol Scand 2023; 81:499-507. [PMID: 37074788 DOI: 10.1080/00016357.2023.2199862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Rapid maxillary expansion (RME) is a routine method for correcting transverse maxillary deficiency. This paper investigated the effect of RME on anchorage alveolar bone and examined the differences between micro-implant-assisted RME and conventional RME. METHODS Relevant articles were selected from the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Review Manager software (v.5.3) was used for the pooled analysis and Cochran Q and I2 statistic tests were used to assess the heterogeneity. RESULTS Following conventional RME, the distal buccal alveolar bone thickness and the mesiobuccal alveolar thickness of the maxillary first molars were significantly reduced. Hyrax (standard mean difference [SMD]: -0.93, 95% confidence interval [CI]: -1.20-0.66) and Haas procedures (SMD: -0.88, 95% CI: -1.40-0.36) significantly reduced the buccal vertical alveolar height of the maxillary first molars. Similar results were obtained for the maxillary first premolars following RME. The thickness of the buccal alveolar bone decreased with conventional RME compared to when using the method assisted by micro-implants. CONCLUSIONS Conventional RME can reduce the thickness and vertical height of maxillary alveolar bone, and there is less loss of alveolar bone when using micro-implant-assisted RME. Further research is needed to validate the findings.
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Affiliation(s)
- Ruijun Chen
- Department of Orthodontic, Beijing Daxing Xingye Dental Hospital, Beijing, China
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Chen YC, Chen CYH, Chen MC, Ko EWC, Lin CH. Dental Occlusion Characteristics for Treatment Decision-Making Regarding Surgery-First Approach in Orthodontics. J Clin Med 2023; 12:6029. [PMID: 37762969 PMCID: PMC10531851 DOI: 10.3390/jcm12186029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/27/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The surgery-first approach (SFA) is conducted to decrease the difficulty and duration of orthodontic treatment by correcting the skeletal discrepancy at the initial stage of treatment. However, the indication of the SFA has not been well defined yet. This study explored the dental occlusion characteristics for treatment decision-making regarding the SFA. A total of 200 skeletal Class III patients were consecutively collected and divided into two groups: the orthodontic-first approach (OFA) group and the SFA group. The pretreatment digital dental models and lateral cephalograms were measured. Logistic regression was completed and receiver operating characteristic (ROC) curves were obtained to predict the probability of the SFA. Results showed that the ROC model with L1-MP, upper and lower arch length discrepancy, overbite, and asymmetric tooth number as influencing factors revealed that the sensitivity and specificity for determining SFA were 83.0% and 65.0%, respectively; the accuracy of prediction was 75.0%. In conclusion, our findings indicate that the six measurements from digital dental models and lateral cephalograms can be effectively applied in treatment decision-making for the SFA with satisfactory accuracy.
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Affiliation(s)
- Ying-Chen Chen
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Carol Yi-Hsuan Chen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkuo, Taoyuan 333, Taiwan;
| | - Cheng-Hui Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkuo, Taoyuan 333, Taiwan;
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Naveda R, Dos Santos AM, Miranda F, da Cunha Bastos JC, Garib D. Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults. Am J Orthod Dentofacial Orthop 2023; 164:416-422. [PMID: 37041098 DOI: 10.1016/j.ajodo.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.
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Affiliation(s)
- Rodrigo Naveda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | | | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | | | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil; Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Changes in Molar Tipping and Surrounding Alveolar Bone with Different Designs of Skeletal Maxillary Expanders. Biomedicines 2023; 11:2380. [PMID: 37760821 PMCID: PMC10525421 DOI: 10.3390/biomedicines11092380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This study compared the buccolingual angulation (BLA) of the upper and lower first permanent molars before and after using the different methods of microimplant-assisted expansion in adults and its influence on bone insertion loss. METHODS Cone-beam computed tomography scans taken before and after the expansion in 36 patients (29.9 ± 9.4 years) were used to assess dental and periodontal changes and compare changes between the groups. RESULTS This research shows a statistically significant increase in the BLA of the upper first molars. An increase of the BLA of the lower molars is also observed in MARPE. Regarding the comparison between cases treated with MARPE (4.42° ± 10.25°; 3.67° ± 9.56°) and BAME (-0.51° ± 4.61°; 2.34° ± 4.51°), it was observed that upper molar torque increased significantly less in cases treated with BAME. In cases with CWRU < 96° at T0, a slight bone insertion gain was observed at T1, whereas if CWRU ≥ 96°, a slight bone insertion loss was observed. Regarding the labial cortical bone loss, a slight gain of CBW was observed in all cases. This labial cortical enlargement (T0-T1) is greater in cases where the CWRU < 96° at T0. CONCLUSIONS Patients treated with MARPE show torque increase in the teeth selected to support the expansion appliance compared to cases treated with BAME. In cases where the BLA at T0 < 96°, an increase in thickness and cortical insertion is observed in the upper molars after treatment with disjunction appliances assisted with microscrews.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), 28922 Alcorcón, Spain;
| | | | | | - Martín Romero
- Department of Orthodontics, Rey Juan Carlos University, 28922 Alcorcón, Spain;
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Anéris FF, El Haje O, Rosário HD, de Menezes CC, Franzini CM, Custodio W. The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification. J World Fed Orthod 2023; 12:150-155. [PMID: 37344294 DOI: 10.1016/j.ejwf.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. METHODS This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n = 10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α = 0.05). RESULTS Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increase for all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P = 0.3356). CONCLUSIONS MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.
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Affiliation(s)
- Fábio Ferreira Anéris
- Graduate student, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Ossam El Haje
- Professor, Departament of Oral Biology, Univeristy Center UNIFACVEST, Lages, Santa Catarina, Brazil
| | - Henrique Damian Rosário
- Professor, Departament of Dentistry, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Carolina Carmo de Menezes
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Cristina Maria Franzini
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - William Custodio
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil.
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Chamberland S. Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update. J World Fed Orthod 2023; 12:173-183. [PMID: 37344295 DOI: 10.1016/j.ejwf.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/22/2023] [Indexed: 06/23/2023]
Abstract
Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.
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Castro ACRD, Kim H, Cho HJ, Nojima LI, Nojima MDCG, Kim HJ, Hu KS, Lee KJ. Three-dimensional micromorphology of human midpalatal suture and pterygomaxillary articular complex. J World Fed Orthod 2023; 12:141-149. [PMID: 37400305 DOI: 10.1016/j.ejwf.2023.05.007] [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: 04/27/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sutures exist in the craniofacial area, and the pattern of maturation and synostosis of facial sutures is largely unknown. METHODS For a comprehensive understanding of the three-dimensional circummaxillary suture micromorphology, human midpalatal suture (MPS) and pterygomaxillary articular complex from eight subjects' (five males, three females, 72-88 years old) autopsies were longitudinally scanned with microcomputed tomography. Additional histology was performed for hematoxylin and eosin staining. Sutural micromorphology was assessed by interdigitation index (II), obliteration index (OI) and obliteration number. Intergroup comparisons were performed with Kruskal-Wallis and Mann-Whitney U with Bonferroni correction (α = 0.005). Correlation with anteroposterior and craniocaudal gradients was assessed with Spearman's correlation test (α = 0.05). RESULTS Maxillary region of MPS presented a higher II 1.50 (0.61) and obliteration number per slice 8 (9) (P < 0.005). OI was increased in palatomaxillary 35% (47%) followed by pterygopalatine suture 25% (49%) (P < 0.005). The II and OI of the MPS exhibited only a weak anteroposterior gradient, with relatively low correlations. Obliteration areas were found sporadically along the entire MPS. CONCLUSIONS Based on these findings, it is conceivable that the success of nonsurgical maxillary expansion largely depends on individual variations in sutural morphology and maturation rather than appliance design.
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Affiliation(s)
- Amanda Cunha Regal de Castro
- Professor, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Doctoral Research Fellow, Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Harim Kim
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Hee Jin Cho
- Graduate school, Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Lincoln Issamu Nojima
- Professor, Division of Anatomy, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Matilde da Cunha Gonçalves Nojima
- Professor, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hee-Jin Kim
- Professor, Division of Anatomy, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyung-Seok Hu
- Professor, Division of Anatomy, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Kee-Joon Lee
- Professor, Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.
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14
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Inchingolo AM, Patano A, De Santis M, Del Vecchio G, Ferrante L, Morolla R, Pezzolla C, Sardano R, Dongiovanni L, Inchingolo F, Bordea IR, Palermo A, Inchingolo AD, Dipalma G. Comparison of Different Types of Palatal Expanders: Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1258. [PMID: 37508755 PMCID: PMC10378123 DOI: 10.3390/children10071258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Maxillary bone contraction is caused by genetics or ambiental factors and is often accompanied by dental crowding, with the possibility of canine inclusion, crossbite, class II and III malocclusion, temporomandibular joint disorder, and obstructive sleep apnea (OSAS). Transverse maxillary deficits, in which the maxillary growth is unusually modest, are frequently treated with maxillary expansion. The purpose of this study is to compare the dental and skeletal effects of different types of expanders, particularly the Leaf Expander, rapid and slow dental-anchored or skeletal-anchored maxillary expanders. METHODS We chose studies that compared effects determined by palatal expansion using a rapid palatal expander, expander on palatal screws, and leaf expander. RESULTS Reports assessed for eligibility are 26 and the reports excluded were 11. A final number of 15 studies were included in the review for qualitative analysis. CONCLUSIONS Clinically and radiographically, the outcomes are similar to those obtained with RME and SME appliances; Therefore, it might be a useful treatment choice as an alternative to RME/SME equipment in cases of poor patient compliance or specific situations. Finally, all of the devices studied produce meaningful skeletal growth of the palate. The use of skeletally anchored devices does, without a doubt, promote larger and more successful growth in adolescent patients.
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Affiliation(s)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Matteo De Santis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Sardano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | | | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
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15
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Lin JH, Wang S, Abdullah UA, Le AD, Chung CH, Li C. Sagittal and Vertical Changes of the Maxilla after Surgically Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103488. [PMID: 37240593 DOI: 10.3390/jcm12103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Surgically assisted rapid palatal expansion (SARPE) is often performed to correct the transverse deficiency in the maxilla for skeletally mature patients. However, there is little consensus on the sagittal and vertical displacement of the maxilla after SARPE. This systematic review aims to analyze the position changes of the maxilla in the sagittal and vertical dimensions after the completion of SARPE. Registered with PROSPERO (registration number: CRD42022312103), this study complied with the 2020 PRISMA guideline and was conducted on 21 January 2023. Original studies were screened from MEDLINE (PubMed), Elsevier (SCOPUS), and Cochrane, and supplemented by hand-searching. Cephalometric changes of skeletal vertical and sagittal measurements were the focus. A fixed-effects model was applied in R for meta-analysis. After applying inclusion and exclusion criteria, seven articles were included in the final review. Four studies had a high risk of bias, and the other three had a medium risk of bias. Meta-analysis revealed that the SNA angle increased by 0.50° ± 0.08° (95% confidence interval, 0.33° to 0.66°), and the SN-PP angle increased by 0.60° ± 0.09° (95% confidence interval, 0.41° to 0.79°) after SARPE. In summary, the maxilla displayed statistically significant forward and clockwise downward movement after SARPE. However, the amounts were small and might not be clinically significant. Due to the high risk of bias of included studies, our results must be taken cautiously. Future studies are needed to discern the effects of direction and angulation of the osteotomies of SARPE on the displacement of the maxilla.
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Affiliation(s)
- Jia-Hong Lin
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Steven Wang
- Department of Oral and Maxillofacial Surgery/Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Usama Al Abdullah
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anh D Le
- Department of Oral and Maxillofacial Surgery/Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chun-Hsi Chung
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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16
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Alves ACDM, de Carvalho NO, Cunha ÂCPDP, Rabelo SGF, Pereira HSG. Do the miniscrews of the prefabricated systems for the "appliance first" protocol of miniscrew-assisted rapid palatal expansion have lengths that meet the palatal thickness of patients? Am J Orthod Dentofacial Orthop 2023; 163:e152-e161. [PMID: 37125981 DOI: 10.1016/j.ajodo.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION In the "appliance first" protocol of miniscrew-assisted rapid palatal expansion, the prefabricated shape of the expanders limits the potential locations for miniscrew placement. Considering the influence of palatal thickness on the selection of the optimal length of miniscrews, this study aimed to evaluate the thickness of both bone and mucosa of the palate of patients aged 6-65 years and suggest optimal lengths of miniscrews for this approach. METHODS Two hundred and eighty-two cone-beam computed tomography of patients of both sexes were divided into 3 groups according to age. The thicknesses of bone and mucosa were measured in the anterior and posterior regions of the palate. RESULTS Males showed a greater thickness of palatal bone than females. The thickness of both bone and mucosa was greater in the anterior region of the palate. The young patients showed greater bone thickness than adults and mature adults. The mature adults showed thinner bone thickness in the posterior region of the palate and greater mucosal thickness along the palate than young patients and adults. Development of miniscrews with longer thread lengths is necessary. Miniscrews with a 3-mm thread length would prevent excessive extravasation in the posterior region of the palate. CONCLUSIONS The thickness of both bone and mucosa of the palate is variable and influenced by sex and age. Manufacturing additional miniscrews with different lengths of thread is suggested to achieve bicortical anchorage in patients undergoing the "appliance first" protocol of miniscrew-assisted rapid palatal expansion.
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Affiliation(s)
- Arthur César de Medeiros Alves
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Nathália Oliveira de Carvalho
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Sergei Godeiro Fernandes Rabelo
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Hallissa Simplício Gomes Pereira
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Kaya N, Seker ED, Yücesoy T. Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study. Prog Orthod 2023; 24:7. [PMID: 36872417 PMCID: PMC9986190 DOI: 10.1186/s40510-023-00459-2] [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: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 03/07/2023] Open
Abstract
AIM To compare the effects of three different maxillary expansion appliances with five different types of expansion modalities on stress distribution and displacement on the maxilla and its adjacent craniofacial structures using the finite element method (FEM). MATERIALS AND METHODS Cone-beam computed tomography data of a patient with maxillary transverse deficiency were rendered into a three-dimensional model of craniomaxillary structures. The expansion appliances included tooth-borne, hybrid, and bone-borne expanders. Five different expansion modalities were applied to each expander [conventional Rapid Maxillary Expansion (RME) (type 1), midpalatal suture cortico-puncture-assisted RME (type 2), LeFort l cortico-puncture-assisted RME (type 3), surgically assisted RME (SARME) without pterygomaxillary junction (PMJ) separation (type 4), and SARME with bilateral PMJ separation (type 5)]. The numerical and visual data were analyzed. RESULTS The highest amount of stress accumulation on teeth was found in the tooth-borne and hybrid groups. On the other hand, more stress concentration on the maxilla was observed in the bone-borne group. SARME cuts with PMJ separation increased total movement by reducing the stress on the midpalatal suture in all groups. While types 1, 2, and 3 were similar in terms of the amounts of displacement, types 4 and 5 increased the total amount of displacement in all groups. The total amounts of displacements from the highest value to the lowest value for the anterior and posterior maxilla were in the bone-borne, tooth-borne, and hybrid groups. CONCLUSIONS SARME cuts were effective in reducing stress on the teeth, but the cortico-puncture application affected neither the stress values on the teeth nor the transverse displacement in the tooth-borne expanders. Surgical procedures such as SARME and corticotomy should be used with bone-borne devices to improve the outcomes of maxillary expansion procedures.
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Affiliation(s)
- Nihal Kaya
- Department of Orthodontics, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
| | - Elif Dilara Seker
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Meirelles CM, Ferreira RM, Suzuki H, Oliveira CB, Souza de Jesus A, Garcez AS, Suzuki SS. Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00063-X. [PMID: 36868909 DOI: 10.1016/j.ajodo.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 10/01/2022] [Accepted: 10/01/2022] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects. METHODS Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM + CP technique (SMCP), failure MARPE (FM), and FM + CP (FMCP). RESULTS Successful groups presented more skeletal expansion and dental tipping than failure groups (P <0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P <0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P <0.05). CONCLUSIONS Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears to have a positive impact, increasing the chance of treatment success.
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Affiliation(s)
- Carolina Marques Meirelles
- Department of Post-graduation in Orthodontics, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil.
| | - Rafael Malagutti Ferreira
- Department of Post-graduation in Orthodontics, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Hideo Suzuki
- Department of Orthodontics, São Leopoldo Mandic School and Dental Institute, Campinas, São Paulo, Brazil
| | | | - Adriana Souza de Jesus
- Department of Orthodontics, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Aguinaldo Silva Garcez
- Department of Oral Microbiology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Department of Orthodontics, São Leopoldo Mandic School and Dental Institute, Campinas, São Paulo, Brazil
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Mandibular asymmetry retreatment with minimal presurgical orthodontic preparation and fully customized lingual orthodontics: A case report with new possibilities using blender open-source software. Int Orthod 2023; 21:100724. [PMID: 36657213 DOI: 10.1016/j.ortho.2023.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023]
Abstract
New possibilities such as Surgery-first and Minimal Presurgical Orthodontics have become extra alternatives for patients, orthodontists, and oral and maxillofacial surgeons, with immediate facial improvements, reduced preparation time, and shorter treatment time. The purpose of this case report was to demonstrate the retreatment of a female patient, dissatisfied with the instability of the compensatory orthodontic treatment, chin deviation, and forward inclination of the maxillary incisors, which was successfully treated with Minimal Presurgical Orthodontic approach associated with customized lingual brackets and virtual planning on the open-source Blender 3D software, where the post-surgical maxillary lingual brackets were also designed. Orthodontic preparation was performed in 5 months. After surgery, orthodontic treatment was finished with the aid of mini-implants and miniplates. The total treatment time was 18 months. Great facial and occlusal results were obtained and the patient was satisfied. Overall, all treatment steps were performed following a digital workflow and open-source software. It is possible to conclude that Minimal Presurgical Orthodontic Preparation was an excellent alternative for the retreatment of this patient with mandibular asymmetry and increased treatment expectations. Additionally, the surgical planning and design of lingual braces with open-source software can be considered useful and low-cost alternatives for orthodontists.
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20
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Wilmes B, Drescher D. CAD-CAM workflows for palatal TAD anchored appliances. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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21
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Xavier J, Sarika K, Ajith VV, Sapna Varma NK. Evaluation of Strain and Insertion Torque of Mini-implants at 90° and 45° Angulations on a Bone Model using Three-Dimensional Finite Element Analysis. Contemp Clin Dent 2023; 14:25-31. [PMID: 37249992 PMCID: PMC10209767 DOI: 10.4103/ccd.ccd_725_21] [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: 11/02/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Temporary anchorage devices or mini-implants have gained great attraction due to its capability to provide absolute anchorage, low cost, versatility, and can be loaded immediately after placement. Aims and Objectives The aim of this study is to use FEA analysis to assess the strain and insertion torque of mini-implants on a bone model at two distinct angulations of 45° and 90°. Materials and Methods A computer-aided three-dimensional (3-D) model representing alveolar bone and mini-implants were developed using ANSYS software. Computed tomography scan images of the implant and the alveolar bone were taken and exported in DICOM format for 3-D image processing. The thickness of the bone model is 1 mm. Ti6Al4V orthodontic single and double threaded mini-implants (L = 7 mm, D = 1.5 mm) were inclined at 45° and 90° on to the bone surface to measure the insertion torque and strain produced. Results Maximum insertion torque (MIT) for single-threaded mini implant at 45° and 90° angulations are 20.001 Nmm and 19.977 Nmm, respectively. MIT for double-threaded mini-implants obtained is 19.977 Nmm at 90° and 19.991 Nmm at 45° angulation. The strain of the bone at 90° angulation for single-threaded mini-implant is 0.00893 mm and for single-threaded mini implant at 45° angulation is 0.01257 mm. The strain in double-threaded mini-implant at 90° angulation is 0.0125 mm and that of 45° angulation is 0.01773 mm. Conclusion For maximum stability single-threaded mini-implant with perpendicular insertion, angle is preferred.
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Affiliation(s)
- Jes Xavier
- Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K Sarika
- Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - VV Ajith
- Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - NK Sapna Varma
- Department of Orthodontics and Dentofacial Orthopaedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Akyalcin S, Alev Y. Clinical advances in maxillary skeletal expansion and introduction of a new MARPE concept. J ESTHET RESTOR DENT 2023; 35:291-298. [PMID: 36478642 DOI: 10.1111/jerd.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transverse maxillary deficiency, typically characterized by the clinical manifestations of unilateral or bilateral crossbite, is a common orthodontic discrepancy. The primary goal of maxillary expansion should be to obtain a nearly maximum width increase in the basal bone of the constricted maxilla and to avoid the dental expansion of the anchor teeth. The introduction of miniscrew anchorage-supported rapid maxillary expansion (MARPE) devices has helped increase the feasibility of obtaining nonsurgical transverse correction in late adolescents and young adults with optimum orthopedic effects. However, the success rate of MARPE shows a negative correlation with age. Although MARPE offers an effective method for correcting a transverse skeletal deficiency, given the appliance cost and increased risk for complications, it could present challenges for adult patients and practitioners in daily practice. AIMS In this article, current advances in maxillary skeletal expansion are summarized, and a new MARPE concept is introduced. CONCLUSION The new MARPE design offers several advantages to other existing methods: (1) it can be installed directly to the patient in the clinical setting with no additional laboratory waiting times. (2) It is purely a bone-borne appliance. (3) The appliance is designed to be placed in the thickest part of the anterior palate to maximize the cortical and trabecular bone support. (4) Allows for bicortical placement of the miniscrews with no perforations in the nasal floor. Finally, (5) offers an esthetic and minimalistic approach to maxillary skeletal expansion in late adolescent and adult patients.
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Affiliation(s)
- Sercan Akyalcin
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Yi F, Liu OS, Lei L, Liu SL, Wang Y, Chu YH, Zhang LL, Li CR, Chen JJ, Lu YQ. Factors related to microimplant-assisted rapid palatal expansion in teenagers and young adults: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2022; 163:475-482. [PMID: 36564316 DOI: 10.1016/j.ajodo.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION For patients with maxillary transverse deficiency, selecting an appropriate therapeutic method is important for the treatment effect and prognosis. Our study aimed to explore factors related to microimplant-assisted rapid palatal expansion (MARPE) in teenagers and young adults using cone-beam computed tomography. METHODS Twenty-five patients who underwent MARPE were included in this retrospective study from February 2014 to June 2019. Midpalatal suture density (MPSD) ratio, midpalatal suture maturation (MPSM), bone effect, dentoalveolar effect, and dental effect in maxillary first molar were evaluated using cone-beam computed tomography. Spearman correlation analysis was used to analyze the correlation between the MPSD ratio, MPSM, age, and the expansion amount generated by MARPE. RESULTS Twenty-five patients (mean age, 19.84 ± 3.96 years; range, 15-29 years) with maxillary transverse deficiency were analyzed. Age was negatively correlated with bone expansion, alveolar expansion, and alveolar change (all P <0.05). There was a negative correlation between MPSM and nasal cavity variation, bone expansion, and alveolar change (all P <0.05). The bone expansion was negatively correlated with MPSD ratio 3 (r = -0.417; P <0.05) and MPSD ratio 4 (all P <0.05). CONCLUSIONS Age, MPSM, and MPSD ratio were significantly related to the MARPE effect. Age, MPSM, and MPSD ratio should be considered when choosing MARPE.
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Affiliation(s)
- Fang Yi
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Ou-Sheng Liu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Lei Lei
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Si-Ling Liu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yue Wang
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yan-Hao Chu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Ling-Ling Zhang
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Cheng-Ri Li
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Jun-Jie Chen
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yan-Qin Lu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China.
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Potnis SS, Patni VJ, Rengarajan K, Vaid NR. An Innovative Design for a Versatile Maxillary Expander: FAVEX. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2022. [DOI: 10.1177/03015742221132057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rapid palatal expansion has been associated with significant short and long term unwanted effects such as dentoalveolar tipping and detrimental periodontal effects when carried out in skeletally mature individuals. Mini implant assisted rapid palatal expansion (MARPE) has proven to reduce the undesirable effects seen in tooth supported expanders and allows expansion even in adults. A variety of designs have been suggested with their pros and cons. Biomechanically, it is important that the TADs attachment of the expansion appliance should be as close to the palatal vault as possible. This prevents bending of TADs and allows for a better split by keeping forces closer to the bone. According to the T zone concept given by Benedict Wilmes, the bone in the canine-premolar region is much superior for TAD insertion and stability as compared to the bone in the molar region. Considering all the above features a new MARPE appliance was designed which is versatile, anatomically compatible and easy to use. FAVEX is a treatment-centric appliance so that the treatment need not be appliance centric.
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Affiliation(s)
- Sheetal S. Potnis
- Department of Orthodontics & Dentofacial Orthopedics, Sinhgad Dental College & Hospital, Pune, Maharashtra, India
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Shayani A, Sandoval Vidal P, Garay Carrasco I, Merino Gerlach M. Midpalatal Suture Maturation Method for the Assessment of Maturation before Maxillary Expansion: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12112774. [PMID: 36428834 PMCID: PMC9689184 DOI: 10.3390/diagnostics12112774] [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: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Assessment of midpalatal suture maturation is crucial before deciding which type of maxillary expansion technique will be performed to treat transverse discrepancies. In 2013, Angelieri et al. proposed a new method to evaluate midpalatal maturation using cone-beam computed tomography. The aim of this study was to systematically identify, evaluate, and provide a synthesis of the existing literature about this new method and to rigorously assess the methodological quality of these articles. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluation, assessment, and assess. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Hence, 56 articles were obtained, of which only 10 met the selection criteria. We could not include any of the data into an analysis because of the large variation of the data collected and high methodological heterogeneity found among studies. Of all the studies included, 10% had poor quality, 70% fair, and 20% good quality, respectively. Even though age and sex play a role in midpalatal suture obliteration, there is a poor correlation between these variables. Thus, every patient should be assessed individually before choosing the best protocol for maxillary expansion. The midpalatal suture maturation method has the potential to be used for diagnostic purposes, but clinicians should be cautious of routinely using it because an extensive training and calibration program should be performed prior.
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Affiliation(s)
- Anis Shayani
- Master Program in Dental Science, Faculty of Dentistry, Universidad de la Frontera, Temuco 4780000, Chile
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Paulo Sandoval Vidal
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
- Correspondence:
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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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Naveda R, dos Santos AM, Seminario MP, Miranda F, Janson G, Garib D. Midpalatal suture bone repair after miniscrew-assisted rapid palatal expansion in adults. Prog Orthod 2022; 23:35. [PMID: 36244995 PMCID: PMC9573844 DOI: 10.1186/s40510-022-00431-6] [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: 05/15/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Midpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients.
Materials and methods The study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1–45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient.
Results The objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients.
Conclusions A decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.
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Kushwah A, Kumar M, Premsagar S, Sharma S, Kumar S, Sailesh T. Analysis of initial stress distribution in palatal bone around the implant in lingual orthodontics for single and double palatal implant systems: a FEM study. Dental Press J Orthod 2022; 27:e2120492. [PMID: 36169494 PMCID: PMC9507026 DOI: 10.1590/2177-6709.27.4.e2120492.oar] [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: 10/07/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To analyze and compare the Von Mises stress and principal stress distribution in palatal bone around the palatal implant in lingual orthodontics (LiO) for single and double palatal implant systems with varying lengths of lever arm. Methods: Two groups were assessed: single (Group 1) and double (Group 2) palatal implant systems, which were further divided into two subgroups, based on lever arm length, for analyzing stress in the palatal bone around the implant. Hence, two 3D finite element models of bilateral maxillary first premolar extraction cases were constructed in each system. Lingual brackets (0.018-in slot) were positioned at the center of the clinical crown. In both systems, 150g of retraction force was applied, and ANSYS v. 12.1 software was used to analyze and compare stress in the palatal bone around the palatal implant. Results: In this study, higher stress was observed at the inner threaded interface of cortical bone. Magnitude of Von Mises stress was higher in Group 2 (0.63 MPa and 0.65 MPa) in comparison to Group 1 (0.29 MPa and 0.29 MPa). Similarly, magnitude of principal stress was higher in Group 2, in comparison to Group 1. Higher stress was observed in the apical region of the implant-bone interface of cancellous bone. Conclusion: This study concluded that the Von Misses stress as well as principal stress in the palatal bone were within the optimal limit in both groups. Finally, it can be concluded that both systems (single and double palatal implant) were safe for the patients in clinical use of 150g of retraction force.
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Affiliation(s)
- Ashish Kushwah
- Institute of Dental Education & Advance Studies, Department of Orthodontics and Dentofacial Orthopaedics, (Gwalior/MP, India)
| | - Mukesh Kumar
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics, (Moradabad/UP, India)
| | - Shruti Premsagar
- ITS Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Greater Noida, UP, India)
| | | | - Sumit Kumar
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics, (Moradabad/UP, India)
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Early Class III Treatment Using a Hybrid Rapid Palatal Expander and Facemask in a Patient with Partially Edentulous Maxilla Post MNTI Removal: A Case Report. Healthcare (Basel) 2022; 10:healthcare10091746. [PMID: 36141358 PMCID: PMC9498524 DOI: 10.3390/healthcare10091746] [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: 08/30/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
This case report describes the orthodontic treatment of a 9-year-old girl who presented with multiple agenesis, maxillary contraction, and skeletal Class III malocclusion after the surgical removal of a melanocytic neuroectodermal tumour of infancy (MNTI) or the so-called melanocytic progonoma at 40 days of age. The lack of dental anchorage in the posterior segment of the second quadrant and the search for maximum control during suture expansion to reduce dental effects led to the use of a hybrid rapid palatal expander (RPE) with dental anchorage in the first quadrant and skeletal anchorage on the two miniscrews placed in the second quadrant, to allow a more even distribution of expansion forces. The expansion procedures performed with the hybrid anchorage device and extraoral traction demonstrate the possibility of solving the contraction in the posterior segments and anterior crossbite in a few months with maximum control of the applied forces, despite the objective difficulties related to the specificity of the case.
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Correlation between cervical vertebrae maturation and midpalatal suture fusion in patients aged between 10 and 20 years: A cross-sectional and 3D study. Int Orthod 2022; 20:100659. [DOI: 10.1016/j.ortho.2022.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/15/2022]
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Tavares A, Braga E, Neves FS. Influence of the palatal plane cant and skeletal patterns in the hard palate thickness? Orthod Craniofac Res 2022; 26:224-230. [PMID: 36047667 DOI: 10.1111/ocr.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of the present study was to evaluate the thickness of the hard palate at the different angles formed by the palatal plane and the Frankfort horizontal line using computed tomography in patients with different facial patterns for planning the installation of MARPE. MATERIALS AND METHODS The measurements were analysed in the hard palate of 106 patients. Four regions were selected passing through the mesial face, tangent at the level of the cemento-enamel junction of the premolars and molars. The bone thickness was measured from the floor of the nasal cavity to the cortical bone of the hard palate, 02 measurements with a distance of 05 mm between them (2.5 mm on each side starting from the midsagittal line) and 2 more with a distance of 7 mm between measurements (3.5 mm on each side starting from the midsagittal line). The palatal plane cant was determined based on the palatal plane and the Frankfort horizontal plane. The sagittal skeletal pattern was determined based on the ANB angle and the vertical skeletal pattern based on the SN.Go.Gn angle. RESULTS Palatal bone thickness was greater in males than in females. Regarding the sagittal skeletal pattern, patients with Class II were found to have a thinner hard palate than Class I and Class III patients. No difference in the vertical skeletal pattern was observed between groups. Regarding the palatal plane cant, bone thickness was greater in patients with clockwise rotation. CONCLUSIONS Careful planning should be considered in the case of female patients; patients with greater angles of the palatal plane cant and Class II patients have a smaller bone thickness.
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Affiliation(s)
- Alana Tavares
- Program in Dentistry and Health School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
- Avenida Alphaville, 635, apt 1103, Alphaville Salvador 1 Salvador /Bahia Brazil
| | - Emanuel Braga
- Department of Orthodontics School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
| | - Frederico Sampaio Neves
- Division of Dentomaxillofacial Radiology School of Dentistry, Federal University of Bahia, Ufba Salvador Brazil
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Pozzan L, Migliorati M, Dinelli L, Riatti R, Torelli L, Di Lenarda R, Contardo L. Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis. Prog Orthod 2022; 23:27. [PMID: 35965264 PMCID: PMC9376185 DOI: 10.1186/s40510-022-00423-6] [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: 04/14/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background The introduction in the orthodontic field of the digital workflow for guided insertion of palatal TADs and the development of the 1-visit protocol led to the reduction of chair time and the possibility of complete customization of designs and materials. Conversely, the reduction of operative steps implicates a lower tolerance of deviations between the planned and the actual position of the miniscrews, particularly when the orthodontic device is fixed on 4 palatal TADs or has a rigid structure. This study aims to analyze the influence of each step of the digital workflow on the deviation of the miniscrews’ axis of insertion in a bicortical sample. The null hypothesis is that there are no significant differences in the deviations among the operative steps.
Methods 33 subjects were selected for insertion of bicortical palatal miniscrews with a 1-visit protocol. Digital files were collected at the three stages of the workflow (i.e., digital planning, laboratory prototype, post-insertion impression). A 3D software analysis was performed on a total of 64 miniscrews. After automatic shape recognition of the guiding holes of the digital plan and the scanbodies of the laboratory prototype and post-insertion impression as geometric cylinders, their three-dimensional longitudinal axis was traced and the deviation among them was calculated. Friedman test with Bonferroni correction was performed to assess the significance of the deviations among the three steps, with significance set at p < 0.05.
Results The laboratory step has a significantly lower degree of deviations (2.12° ± 1.62) than both the clinical step (6.23° ± 3.75) and the total deviations (5.70° ± 3.42). No significant differences were found between miniscrews inserted on the left or the right side. Conclusions This study suggests that laboratory procedures such as surgical guide production or rapid prototyping don’t play a significant role in the degree of deviations between the planned and the positioned palatal TADs. Conversely, the clinical steps have a bigger influence and need to be carefully evaluated. Despite this difference, there is a cumulative effect of deviations that can lead to the failure of the 1-visit protocol.
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Solano Mendoza P, Aceytuno Poch P, Solano Reina E, Solano Mendoza B. Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography. J Clin Med 2022; 11:jcm11164652. [PMID: 36012886 PMCID: PMC9410327 DOI: 10.3390/jcm11164652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.
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Management of Class III Malocclusion and Maxillary Transverse Deficiency with Microimplant-Assisted Rapid Palatal Expansion (MARPE): A Case Report. Medicina (B Aires) 2022; 58:medicina58081052. [PMID: 36013519 PMCID: PMC9415682 DOI: 10.3390/medicina58081052] [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: 06/11/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Microimplant-assisted rapid palatal expansion (MARPE) has been demonstrated successfully in maxillary expansion in late adolescence and adulthood. The maxillary advancement accompanied by expansion is frequently anticipated, which is beneficial for the treatment of class III malocclusion. Airway volume increase can also be noted in some cases from the measurement of cone beam computerized tomography (CBCT) after expansion. The objective of this case report is to demonstrate the feasibility of applying MARPE on late adolescence patients with maxillary transverse deficiency and to present the changes in transverse and anteroposterior dimensions as well as the volume increase in velopharyngeal airway after MARPE. A 15-year-old female presented class III skeletal pattern. She had maxillary transverse deficiency with moderate crowding and posterior/anterior crossbites. Maxillary Skeletal Expander (MSE; Biomaterials Korea Inc.) type-2 was used as a MARPE device in this case. After four weeks of maxillary expansion, a significant amount of expansion was achieved and the anterior crossbite was spontaneously corrected. Fixed appliance treatment was commenced four weeks after MARPE with 0.022-slot preadjusted brackets (MBT prescription). Temporary anchorage devices (TADs) were placed over the mandibular buccal shelves for posterior teeth distalization and crowding relief. After 25 months of treatment, the facial profile was improved with maxillary advancement (SNA: 83° to 83.5°) and mandibular backward rotation (SNB: 83° to 82°; SN-MP: 34.5° to 35°). In this case, MARPE not only engenders significant transverse correction but also aids in anteroposterior change. The treatment effects of maxillary advancement and mandibular backward rotation can lead to a more esthetic profile in skeletal class III cases.
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Roy T, Steinbacher DM. Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery. Semin Plast Surg 2022; 36:169-182. [PMID: 36532897 PMCID: PMC9750797 DOI: 10.1055/s-0042-1760209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Orthognathic surgery is a powerful tool to improve facial balance, form, and function. Virtual planning and three-dimensional printing has improved our ability to visualize complex anatomy, consider various iterations and execute complex movements, and create accurate splints, plates, and cutting guides. This article will outline the distinct advantages of the use of virtual surgical planning over traditional planning, and it will explore the utility of computer-aided design and technology within contemporary orthognathic surgery, including its expanded applications and limitations.
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Affiliation(s)
- Tulsi Roy
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Derek M. Steinbacher
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
- Address for correspondence Derek M. Steinbacher, DMD, MD Section of Plastic and Reconstructive Surgery, Yale University School of Medicine330 Cedar St, New Haven, CT 06519
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Skeletal expansion using a miniscrew-assisted rapid palatal expansion in a 50-year-old patient. Am J Orthod Dentofacial Orthop 2022; 162:568-579. [PMID: 35811187 DOI: 10.1016/j.ajodo.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
This case report illustrates a nonsurgical treatment plan using a miniscrew-assisted rapid palatal expander (MARPE) in a 50-year-old patient with maxillary transverse deficiency. The MARPE appliance consisted of a conventional Hyrax expander anchored to 4 orthodontic miniscrews. The exact locations of the miniscrews were determined with virtual planning software. Cone-beam computed tomography (CBCT) scans were superimposed on the maxillary digital model, and 3-dimensional-printed surgical guides were used to accurately position the mini-implants. A slow expansion protocol was used, and the appliance was held in place during the entire treatment (almost 20 months). Pretreatment, postexpansion, and posttreatment CBCT scans show the parallel expansion obtained without dental torque compensation or bite opening. The posttreatment scan showed that a long period is required to complete the midpalatal suture mineralization. MARPE has proven effective in correcting transverse discrepancies, even in adults. However, posttreatment CBCT imaging showed incomplete ossification of the midpalatal suture, demonstrating that the retention period should be extended in some adult patients.
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Malmvind D, Golež A, Magnuson A, Ovsenik M, Bazargani F. Three-dimensional assessment of palatal area changes after posterior crossbite correction with tooth-borne and tooth bone-borne rapid maxillary expansion. Angle Orthod 2022; 92:483352. [PMID: 35793528 PMCID: PMC9374361 DOI: 10.2319/012822-85.1] [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: 01/01/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess and compare the three-dimensional treatment changes in palatal surface area and volume using either tooth-borne (TB) or tooth bone-borne (TBB) rapid maxillary expanders and to evaluate the long-term effects of the two devices and the incidence of the relapse between the groups. MATERIALS AND METHODS A total of 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (standard deviation [SD], 1.3), or the TBB group, mean age 9.5 years (SD, 1.2). Study casts were taken before, directly after, 1 year after, and 5 years after expansion. Study casts were digitized, superimposed, and evaluated. Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. RESULTS Changes in palatal volume, palatal surface area, and palatal projection area within and between the groups up to 5 years after expansion followed the same pattern and did not show any statistically significant differences between the groups. Relapse was seen in 15% of the patients. It seemed that open-bite and a Class III growth pattern could be assumed as prognosis-deteriorating factors in regard to stability of the treatment. CONCLUSIONS There were no significant differences between the TB and TBB groups in palatal volume, palatal shell area, or palatal projection area directly after expansion or at 1 year and 5 years after expansion, which implies that the two devices gave rise to the same immediate and long-term outcomes.
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Alsayegh E, Balut N, Ferguson DJ, Makki L, Wilcko T, Hansa I, Vaid NR. Maxillary Expansion: A Comparison of Damon Self-Ligating Bracket Therapy with MARPE and PAOO. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1974467. [PMID: 35586819 PMCID: PMC9110185 DOI: 10.1155/2022/1974467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area. Conclusions All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.
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Affiliation(s)
- Eman Alsayegh
- Department of Orthodontics, European University College, Dubai, UAE
| | - Nasib Balut
- Universidad Autónoma de Baja California, Mexicali, Mexico
- Universidad Del Valle, Cali, Colombia
| | | | - Laith Makki
- Department of Orthodontics, European University College, Dubai, UAE
| | - Thomas Wilcko
- Department of Periodontology, Case Western Reserve University, Cleveland, USA
| | - Ismaeel Hansa
- Department of Orthodontics, European University College, Dubai, UAE
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Maxillary Skeletal Expansion with Monocortical and Bicortical Miniscrew Anchorage: A 3D Finite Element Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of the present study is to use a 3D finite element analysis to investigate and compare the transverse displacement and stress distribution between stainless steel miniscrews and titanium alloy miniscrews used for monocortical and bicortical anchorage during miniscrew-assisted rapid maxillary expansions. Skull models were constructed to depict expansion after and before midpalatal suture opening at varying miniscrew insertion depths in four clinical scenarios: monocortical, monocortical deepening, bicortical, and bicortical deepening. Finite element analyses of miniscrew properties, including transverse displacement and von Mises stress distribution, were performed for each clinical scenario. Peri-implant stress was lesser in both bicortical anchorage models compared to both monocortical models. Transverse displacement in the coronal and axial planes was also greater and more parallel in both bicortical models compared to both monocortical models. Transverse displacement and peri-implant stress did not significantly differ between monocortical and monocortical deepening models or between bicortical and bicortical deepening models. From a biomechanical perspective, the bicortical deepening miniscrew anchorage is preferable to monocortical and monocortical deepening anchorage, because bicortical anchorage induces less stress on the peri-implant bone. Consequently, bicortical deepening anchorage should be considered the preferred option in challenging clinical scenarios in which strong anchorage is required for maxillary skeletal expansion.
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Wilmes B. “Appliance First” or “Bone First” for miniscrew assisted rapid palatal expansion? APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_57_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chun JH, de Castro ACR, Oh S, Kim KH, Choi SH, Nojima LI, Nojima MDCG, Lee KJ. Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): a prospective randomized clinical trial using low-dose CBCT. BMC Oral Health 2022; 22:114. [PMID: 35395801 PMCID: PMC8994336 DOI: 10.1186/s12903-022-02138-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients. Methods This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point. Results The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05). Conclusions Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).
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Affiliation(s)
- Joo-Hee Chun
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Amanda Cunha Regal de Castro
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.,Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro, Av. Pedro Calmon, 550, 21941-901, Rio de Janeiro, Brazil
| | - Sunmee Oh
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Lincoln Issamu Nojima
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro, Av. Pedro Calmon, 550, 21941-901, Rio de Janeiro, Brazil
| | - Matilde da Cunha Gonçalves Nojima
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro, Av. Pedro Calmon, 550, 21941-901, Rio de Janeiro, Brazil
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Kinzinger GSM, Lisson JA, Buschhoff C, Hourfar J, Korbmacher-Steiner H. Impact of rapid maxillary expansion on palatal morphology at different dentition stages. Clin Oral Investig 2022; 26:4715-4725. [PMID: 35267098 PMCID: PMC9276570 DOI: 10.1007/s00784-022-04434-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
Objective Rapid maxillary expansion (RME) is an established and frequently used procedure to overcome maxillary constriction. In-depth studies about morphological changes of the alveolar process and its immediate surroundings are missing. Therefore, the aim of the present study was to examine the treatment effects of a dentally anchored, rapid maxillary expander at different dentition stages upon palatal width, height and shape. Material and methods The dental casts of 114 patients—taken immediately before and after RME—were three-dimensionally analysed. Depending on the dentition stage, the patients were divided into two groups (each n = 57, group 1, early mixed dentition; group 2, late mixed or permanent dentition). Results The width increases were highly significant, both in the overall and in the individual groups (p < 0.001). While the width increase was greater in the posterior area than anteriorly in the early group, the widening in the late group happened significantly greater anteriorly than posteriorly. Palatal height increased anteriorly and posteriorly in both groups to a significant extent (p < 0.001). The height increase was more pronounced in the anterior region than in the posterior region in the late group. The palatine index according to Kim revealed a change in palatal morphology both anteriorly and posteriorly in the early group but only anteriorly in the late group. Conclusions Maxillary expansion occurs more parallel in early treatment compared to V-shaped opening in the later treatment approach. Clinical relevance RME is more advantageous in an early dentition.
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Affiliation(s)
| | | | | | - Jan Hourfar
- Department of Orthodontics, Saarland University, Homburg, Saar, Germany
| | - Heike Korbmacher-Steiner
- Department of Orthodontics, Philipps-University Medical Center Marburg, Philipps-University, Georg-Voigt-Str. 3, 35039, Marburg, Germany.
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Mehta S, Wang D, Upadhyay M, Vich ML, Yadav S. Long-term effects on alveolar bone with bone-anchored and tooth-anchored rapid palatal expansion. Am J Orthod Dentofacial Orthop 2022; 161:519-528. [PMID: 35272886 DOI: 10.1016/j.ajodo.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the long-term effects of bone-anchored and tooth-anchored expansion appliances on alveolar bone in vertical and horizontal dimensions, compared with controls, using cone-beam computed tomography. METHODS We evaluated 180 cone-beam computed tomography scans for 60 patients at 3-time points: T1 (pretreatment), T2 (postexpansion), and T3 (posttreatment), for 3 groups: bone-anchored expansion appliance (BA), tooth-anchored expansion appliance (TA), and controls (T1-T3: BA, 2 years 8 months; TA, 2 years 9 months; control: 2 years 7 months). The intermolar width, molar angulation, palatal width, vertical buccal bone height, buccal bone thickness at the alveolar crest, and root apex were measured in the 3 groups at different time points. RESULTS In the short term, both BA and TA led to a statistically significant increase in the intermolar width and vertical buccal bone loss after expansion compared with controls. Vertical buccal bone loss was significantly greater in TA than in BA. In addition, TA led to significantly increased molar angulation (buccal tipping) compared with controls at T2. There were no significant differences in the 3 groups in the long term except vertical buccal bone loss, which was significantly greater in TA than controls. A substantial correlation was found between molar angulation and vertical buccal bone loss, and a moderate negative correlation was found between intermolar width and buccal bone thickness at the alveolar crest at T3. CONCLUSIONS There was no difference in the treatment outcomes between the 3 groups in the long term except vertical buccal bone loss, which was significantly increased in the TA group compared with controls.
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Affiliation(s)
- Shivam Mehta
- Department of Developmental Sciences/Orthodontics, Marquette University School of Dentistry, Milwaukee, Wis
| | - Dennis Wang
- Division of Orthodontics, University of Connecticut Health, Farmington, Conn
| | - Madhur Upadhyay
- Division of Orthodontics, University of Connecticut Health, Farmington, Conn
| | | | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, Conn.
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Ventura V, Botelho J, Machado V, Mascarenhas P, Pereira FD, Mendes JJ, Delgado AS, Pereira PM. Miniscrew-Assisted Rapid Palatal Expansion (MARPE): An Umbrella Review. J Clin Med 2022; 11:jcm11051287. [PMID: 35268377 PMCID: PMC8911209 DOI: 10.3390/jcm11051287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
In postpubertal patients, maxillary transverse discrepancy is a common condition often requiring surgical approaches. To overcome the excess morbidity and discomfort, maxillary expansion through miniscrew-assisted rapid palatal expansion (MARPE) was proposed and studied in the last few years. This umbrella review aims to critically appraise the quality of evidence and the main clinical outcomes of available systematic reviews (SRs) on MARPE. An extensive search was carried out in five electronic databases (PubMed-Medline, Cochrane Database of SRs, Scielo, Web of Science, and LILACS) until December 2021. The methodological quality was appraised using the A Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality of SRs. Overall, four SRs were included and analyzed, one of high methodological quality, one of low and two of critically low. Despite the verified methodological constraints, MARPE seems to present significant clinical changes when compared to conventional RPE, SARPE or controls and less adverse clinical outcomes. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better clarify the clinical protocols and outcomes success of MARPE.
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Affiliation(s)
- Vanda Ventura
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Correspondence:
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Paulo Mascarenhas
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - François Durand Pereira
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Ana Sintra Delgado
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
| | - Pedro Mariano Pereira
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
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Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:4509-4523. [PMID: 35211817 DOI: 10.1007/s00784-022-04415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency. MATERIALS AND METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99). CONCLUSIONS MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination. REGISTRATION This study is registered with PROSPERO, CRD42021256750. CLINICAL RELEVANCE MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.
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Almaqrami BS, Ngan P, Alhammadi MS, Al-Somairi MAA, Xiong H, Hong H. Three-dimensional craniofacial changes with maxillary expansion in young adult patients with different craniofacial morphology. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_177_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives:
Skeletally mature patients with transverse deficiency are best treated with surgically assisted rapid palatal expansion (RPE) procedure. Recent studies have shown that microimplant-assisted RPE (MARPE) appliances can be effective in achieving skeletal expansion in young adults. This retrospective study aimed to evaluate the skeletal and dental alveolar changes in response to treatment with MARPE appliances in three types of anteroposterior skeletal malocclusions using cone-beam computed tomography (CBCT) scans.
Material and Methods:
Seventy-eight subjects diagnosed with maxillary transverse deficiency and treated with the MARPE appliance (mean age of 22.9 ± 4.2 years) were divided into skeletal Class I, II, and III malocclusions with 26 subjects in each group. Pre- and post-treatment CBCT scans were used for superimposition to examine the skeletal and dentoalveolar changes following maxillary expansion treatment.
Results:
Significant lateral separation of the maxilla was found at the levels of the nasal floor, interzygomatic bones, and the inferior palatine margin of the alveolar process (P < 0.05) in the whole sample. Most of the sagittal and vertical variables change significantly in the whole sample and each studied group separately. Intergroup comparisons revealed no significant differences among the three skeletal classes except for the left frontozygomatic angle, left maxillary inclination angle, and torque in the first and second premolars. In Class III patients, the maxilla moved forward significantly in most of the cases (eight of 26 cases) (0.88°, P < 0.05) and the mandible moved downward and backward improving the anteroposterior skeletal relationship. Significant differences were also found in the vertical measurements (N-Me, MMP, and MP/SN, P < 0.05) in all three types of anteroposterior malocclusions.
Conclusion:
Maxillary expansion with the MARPE appliance in young adult patients induced different skeletal and dentoalveolar changes in the anteroposterior and vertical dimensions in each skeletal malocclusion with no significant difference among the three skeletal classes.
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Affiliation(s)
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Maged Sultan Alhammadi
- Department of Preventive Dental Sciences, Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia,
| | - Majedh Abdo Ali Al-Somairi
- Department of Orthodontic, Lanzhou University, School of Stomatology Lanzhou University, Lanzhou, China,
| | - Hui Xiong
- Department of Orthodontics, Wuhan University, Wuhan, Hubei, China,
| | - H. Hong
- Department of Orthodontics, Wuhan University, Wuhan, Hubei, China,
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Assessment of the bone thickness of the palate on cone-beam computed tomography for placement of miniscrew-assisted rapid palatal expansion appliances. Am J Orthod Dentofacial Orthop 2022; 161:849-857. [DOI: 10.1016/j.ajodo.2021.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/20/2022]
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Parekh H, Trivedi R, Mehta F, Patel R, Joshi N. Modified Hyrax for Microimplant-Assisted Rapid Palatal Expansion. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2022. [DOI: 10.1177/03015742211056245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Temporary anchorage device-assisted rapid maxillary expansion has widened the horizon to treat adults having maxillary transverse deficiency without any surgical procedure. Three-dimensional custom modifications have also been developed, but they can be expensive. A modification of Hyrax screw with the use of lingual sheaths is suggested for microimplant-assisted rapid palatal expansion, which can be an easy to fabricate in-office and economical option.
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Affiliation(s)
- Harshikkumar Parekh
- Department of Orthodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Rahul Trivedi
- Department of Orthodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Falguni Mehta
- Department of Orthodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Renuka Patel
- Department of Orthodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Palone M, Casella S, De Sbrocchi A, Siciliani G, Lombardo L. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular fixed appliance: A case report. Int Orthod 2022; 20:100602. [PMID: 35012896 DOI: 10.1016/j.ortho.2021.100602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
This case report demonstrates how the use of skeletal anchorage and appropriate orthodontic biomechanics can be used to resolve even complex cases, reducing unwanted dental movements and allowing the use of a partial vestibular appliance. It describes the complete mesialization of the left upper third molar and space closure following extraction of tooth UR7, due to vertical fracture one year after previous endodontic therapy for caries. This therapeutic choice was conditioned by the need not to alter the good pre-existing interarch relationships, and above all by the patient's request to be treated conservatively, and therefore not to undergo prosthetic implant rehabilitation. The use of orthodontic miniscrews and the careful application of orthodontic biomechanics, based on both direct and indirect anchorage, enabled the treatment objectives to be achieved in a reasonable period of time with reduced treatment costs.
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Affiliation(s)
- Mario Palone
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi-Borsari, 46, 44121 Ferrara, Italy
| | - Sofia Casella
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi-Borsari, 46, 44121 Ferrara, Italy.
| | | | - Giuseppe Siciliani
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi-Borsari, 46, 44121 Ferrara, Italy
| | - Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi-Borsari, 46, 44121 Ferrara, Italy
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MARPE as an adjunct to orthodontic treatment. Dental Press J Orthod 2022; 27:e22bbo6. [PMID: 36995846 PMCID: PMC10042462 DOI: 10.1590/2177-6709.27.6.e22bbo6] [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: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction: Miniscrew or microimplant-assisted rapid palatal expansion (MARPE) devices are used to achieve a skeletal expansion of the palate and to increase the arch perimeter. Objective: To describe the treatment of a 23-year-old woman with an Angle Class II, division 1 malocclusion with constricted maxillary and mandibular arches. Case report: The patient’s main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with maxillary expansion, using a MARPE appliance in combination with a full-fixed appliance to align and level the crowded mandibular teeth, along with miniscrews as anchorage for the maxillary teeth and for distalization of the molars and premolars. A successful non-extraction orthodontic treatment was accomplished after 28 months, and the occlusion and teeth alignment, as well as facial goals, were resolved in a clinically satisfactory manner. Conclusion: The treatment objectives were met, and the outcome of the expansion of the maxillary arch with a MARPE appliance as an adjunct to a fixed appliance was considered a success. An esthetic, functional, and stable result after a 1-year follow-up was achieved and was satisfactory to the patient.
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