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Süküt Y, Yurdakurban E, Duran GS. ACCURACY OF DEEP LEARNING-BASED UPPER AIRWAY SEGMENTATION. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102048. [PMID: 39244033 DOI: 10.1016/j.jormas.2024.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION In orthodontic treatments, accurately assessing the upper airway volume and morphology is essential for proper diagnosis and planning. Cone beam computed tomography (CBCT) is used for assessing upper airway volume through manual, semi-automatic, and automatic airway segmentation methods. This study evaluates upper airway segmentation accuracy by comparing the results of an automatic model and a semi-automatic method against the gold standard manual method. MATERIALS AND METHODS An automatic segmentation model was trained using the MONAI Label framework to segment the upper airway from CBCT images. An open-source program, ITK-SNAP, was used for semi-automatic segmentation. The accuracy of both methods was evaluated against manual segmentations. Evaluation metrics included Dice Similarity Coefficient (DSC), Precision, Recall, 95% Hausdorff Distance (HD), and volumetric differences. RESULTS The automatic segmentation group averaged a DSC score of 0.915±0.041, while the semi-automatic group scored 0.940±0.021, indicating clinically acceptable accuracy for both methods. Analysis of the 95% HD revealed that semi-automatic segmentation (0.997±0.585) was more accurate and closer to manual segmentation than automatic segmentation (1.447±0.674). Volumetric comparisons revealed no statistically significant differences between automatic and manual segmentation for total, oropharyngeal, and velopharyngeal airway volumes. Similarly, no significant differences were noted between the semi-automatic and manual methods across these regions. CONCLUSION It has been observed that both automatic and semi-automatic methods, which utilise open-source software, align effectively with manual segmentation. Implementing these methods can aid in decision-making by allowing faster and easier upper airway segmentation with comparable accuracy in orthodontic practice.
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Affiliation(s)
- Yağızalp Süküt
- Department of Orthodontics, Gülhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey, 06010.
| | - Ebru Yurdakurban
- Department of Orthodontics, Faculty of Dentistry, Muğla Sıtkı Koçman University, Muğla, Turkey, 48000.
| | - Gökhan Serhat Duran
- Department of Orthodontics, Faculty of Dentistry, Çanakkale 18 March University, Çanakkale, Turkey, 17000.
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Ronsivalle V, Leonardi R, Lagravere M, Flores-Mir C, Grippaudo C, Alessandri Bonetti G, Lo Giudice A. Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study. J Dent 2024; 144:104934. [PMID: 38461886 DOI: 10.1016/j.jdent.2024.104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. METHODS This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. RESULTS All PAs' volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. CONCLUSIONS Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. CLINICAL SIGNIFICANCE From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.
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Affiliation(s)
- Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Manuel Lagravere
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Grippaudo
- Orthodontic Graduate Program, University of Roma Cattolica - Sacro Cuore
| | | | - Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Choi JY, Choo H, Kim MJ, Chung KR, Kim SH. Miniscrews position for a tissue bone borne palatal C-expander affects the displacement pattern of nasomaxillary complex: a finite element study. Sci Rep 2023; 13:17135. [PMID: 37816861 PMCID: PMC10564718 DOI: 10.1038/s41598-023-44432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/08/2023] [Indexed: 10/12/2023] Open
Abstract
This study aimed to evaluate the difference in expansion patterns based on the position of miniscrews for a tissue-bone-borne palatal C-expander using a finite element method. Ten expansion models were examined, each representing a different position of miniscrews on the palate. Models A and B had miniscrews symmetrically placed 7 mm and 15 mm below the cementoenamel junction (CEJ), respectively. Models C to J had miniscrews positioned in a triangular manner at 7 mm and 15 mm below CEJ. Stress, displacement, angular changes of the bone and teeth, and changes in the nasomaxillary complex were measured using elastoplastic behavior models through static-nonlinear simulation employing an implicit method. The anterior and posterior parts of paramidpalatal suture area were identified as ANT, TPS-M, and TPS-L, and their ratio was assessed. Model A, which featured three miniscrews located 7 mm below the CEJ, exhibited the least molar inclination and the smallest amount of skeletal expansion. Model I, with two miniscrews placed between the first and second molars, demonstrated the greatest lateral displacement at point N on the nasal cavity wall, along with the smallest ratio of ANT to TPS-M or TPS-L. This finding suggests that the posterior expansion of the palate in relation to the anterior expansion was maximized. The results of this study indicate that strategic positioning of miniscrews is effective in achieving various expansion patterns based on the targeted correction areas within the nasomaxillary complex.
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Affiliation(s)
- Jin-Young Choi
- Department of Orthodontics, Graduate School, Biocreative Orthodontic Strategy (BOS) Center, Kyung Hee University, Seoul, Korea
| | - HyeRan Choo
- Division of Plastic and Reconstruction Surgery, Neonatal and Pediatric Craniofacial and Airway Orthodontics, Department of Surgery, Stanford Orthodontic AIrway Plate Treatment Center, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Min-Jung Kim
- Department of Orthodontics, Graduate School, Biocreative Orthodontic Strategy (BOS) Center, Kyung Hee University, Seoul, Korea
| | - Kyu-Rhim Chung
- Department of Orthodontics, Graduate School, Biocreative Orthodontic Strategy (BOS) Center, Kyung Hee University, Seoul, Korea
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School, Biocreative Orthodontic Strategy (BOS) Center, Kyung Hee University, Seoul, Korea.
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Garrocho-Rangel A, Rosales-Berber MÁ, Ballesteros-Torres A, Hernández-Rubio Z, Flores-Velázquez J, Yáñez-González E, Ruiz-Rodríguez S, Pozos-Guillén A. Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: An umbrella review. Int J Pediatr Otorhinolaryngol 2023; 171:111633. [PMID: 37421834 DOI: 10.1016/j.ijporl.2023.111633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/03/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To identify, qualify, and summarize the evidence from different systematic reviews about the outcomes of Rapid Maxillary Expansion (RME) on upper airway dimensions and breathing function in young patients. METHODS A literature search (from 2000 to December 2022) was conducted through PubMed (MEDLINE), the Cochrane Library, EMBASE, and Dentistry & Oral Science Source. The authors conducted the following umbrella review phases: research question, study selection criteria (systematic reviews involving randomized clinical trials and longitudinal observational designs), data extraction, and critical appraisal (bias risk assessment) of selected articles through the ROBIS tool. RESULTS The initial search yielded 65 potential references. After screening titles and summaries, and the elimination of duplicated publications, 15 articles were eligible for the evaluation of the full-text document. Finally, 11 systematic reviews (5 combined with meta-analysis) were selected, reporting 132 single studies; 38 of them were unrepeatable. Risk-of-bias assessment showed an average global moderate/high quality among the included studies. There was high heterogeneity between the systematic reviews' (and meta-analyses') methodologies used. CONCLUSIONS The present umbrella review concludes that significant and stable increases in the nasal and oropharyngeal space volumes and a decrease in airway resistance of growing children and adolescents, occur immediately after RME and at 3, 6- and 12-months follow-up.
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Affiliation(s)
- Arturo Garrocho-Rangel
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | | | | | - Zaira Hernández-Rubio
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Joselin Flores-Velázquez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Esthela Yáñez-González
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Socorro Ruiz-Rodríguez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Amaury Pozos-Guillén
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico.
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Kinzinger GSM, Lisson JA, Buschhoff C, Hourfar J. Age-dependent effects on palate volume and morphology during orthodontic RME treatment. Clin Oral Investig 2023; 27:2641-2652. [PMID: 36602590 PMCID: PMC10264469 DOI: 10.1007/s00784-022-04831-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/18/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Rapid maxillary expansion (RME) shows different age-dependent effects. It has been shown that RME leads to a parallel expansion prior to the age of 10, while later and especially from the age of 12, a V-shaped expansion happens (transverse, anterior > posterior; horizontal, inferior > superior). However, it is not clear to what extent these effects influence palatal volume and morphology and eventually maxillary functional space. The aim of the present study was to examine possible age-related effects of treatment with a dental anchored RME appliance upon volume and width/height ratio of the anterior and posterior palate. MATERIALS AND METHODS Sixty children and adolescents with documented treatment histories after RME were divided into three equal groups according to age at treatment begin (PG 1, < 10 years, n=20; PG 2, 10 ≤ 12 years, n=20; PG 3, > 12 years, n=20). Maxillary dental casts before and after therapy were digitised. Changes in palatal volume were determined using 3D analyses. RESULTS In all patients, the palatal volume increases significantly after RME. Older patients experienced smaller increases in total and posterior volume in absolute and percentage terms. The anterior palate volume increases are almost equal in all patients. Since palatal width increases more markedly than palatal height, the width/height ratio always increases. Except for the posterior region in PG 3, its increase is significant in all groups, both anteriorly and posteriorly. After successful RME, the palatal morphology appears normal anteriorly in PG 1, PG 2 and PG 3 and rather steep posteriorly in PG 3. CONCLUSIONS RME treatment with identical force application causes different, age-dependent effects upon palate volume and morphology. Width changes have a greater influence on palate volume than height changes. CLINICAL RELEVANCE It is preferable to use an RME prior to the age of 10 if homogeneous changes of the anterior and posterior palate regarding maxillary symmetry and functional space are desired.
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Affiliation(s)
| | | | | | - Jan Hourfar
- Department of Orthodontics, Saarland University, Homburg, Saar, Germany
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Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020244. [PMID: 36832373 PMCID: PMC9954808 DOI: 10.3390/children10020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.
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Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective. J Clin Med 2022; 11:jcm11175243. [PMID: 36079172 PMCID: PMC9457357 DOI: 10.3390/jcm11175243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.
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Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022; 15:617-630. [PMID: 36865716 PMCID: PMC9973120 DOI: 10.5005/jp-journals-10005-2421] [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] [Indexed: 02/05/2023] Open
Abstract
Objective Rapid maxillary expansion (RME) has been extensively used in orthodontic practice for over a century, and it is claimed to benefit upper airway morphology. However, its effect in actually alleviating mouth breathing has remained unexplored. This systematic review was planned with an objective to provide a comprehensive synthesis of the effects of RME on upper airway volume and most importantly, its role in alleviating mouth breathing. Methods A literature search of electronic databases were done for the time period of 2000-2018. Randomized controlled trials (RCTs) and non-RCTs conducted on 8-15-year-old children who received bonded or banded RME and upper airway measured using three-dimensional (3D) imaging were included. Results Twelve studies (two RCTs, nine nonrandomized clinical trials, and one non-RCT) were included in this systematic review, and nine studies were included for meta-analysis. Among the evaluated parameters, nasal cavity volume showed a significant increase which was maintained even after the retention phase, whereas nasopharyngeal and oropharyngeal volume did not report a significant change. Conclusion Based on this systematic review, it can be concluded that RME causes a significant increase in nasal cavity volume, but its effect on nasopharyngeal and oropharyngeal volume is not statistically significant in majority of studies. This increase in volume may not be considered as an equivalent for enhancement of airway and function unless proven so. In order to establish its significance in the improvement of breathing, it is necessary to conduct more well-designed RCTs with samples actually comprising mouth breathers. How to cite this article Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022;15(5):617-630.
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Affiliation(s)
- Shruti Balasubramanian
- Department of Pediatric & Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Ritesh Kalaskar
- Department of Pediatric & Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Ashita Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
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Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion. J Maxillofac Oral Surg 2022; 21:765-771. [PMID: 36274864 PMCID: PMC9475003 DOI: 10.1007/s12663-021-01529-w] [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: 10/25/2020] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aim Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique. Patients and Methods This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate. Results A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05). Conclusion A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.
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Abd El-Ghafour M, Aboalnaga AA, Mostafa YA. Is maxillary expansion effective in treatment of obstructive sleep apnoea syndrome? A systematic review of systematic reviews. Evid Based Dent 2022:10.1038/s41432-022-0283-6. [PMID: 35986211 DOI: 10.1038/s41432-022-0283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Maxillary expansion (ME) might be beneficial in improving airway dimensions and obstructive sleep apnoea syndrome (OSAS) in patients with constricted maxillae. The aim of this overview is to present clinicians with a summary of the evidence. Data from systematic reviews and meta-analyses were evaluated to investigate the effect of ME on OSAS.Methods An electronic search was commenced in five databases, in addition to a manual search until July 2021. Screening of articles started with title and abstract followed by full-text assessment. Systematic reviews with/without meta-analyses were included. Critical appraisal was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Level of Research Design scoring and criteria of body of evidence scores. The search, study selection and critical appraisal were completed by three reviewers.Results In total, 14 systematic reviews with/without meta-analyses were included. The quality of available evidence ranged between low to high, based on the overall quality evaluation.Conclusions Based on the available evidence, maxillary expansion might be able to improve the nasal airway volume and OSAS in both growing and adult patients in the short term. ME can be considered as one of the treatment options in cases with OSAS.
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Affiliation(s)
- Mohamed Abd El-Ghafour
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Amira Ahmed Aboalnaga
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Yehya Ahmed Mostafa
- Professor, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt; Professor, Department of Orthodontics, Faculty of Dentistry, Future University, Egypt
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Tzironi G, Zubizarreta-Macho Á, Guinot-Barona C, Pérez-Barquero JA, Arias S, Vicente-Galindo P, Martínez AA. A reproducible and repeatable digital method for quantifying nasal and sinus airway changes following suture palatine expansion. Sleep Breath 2022; 27:1175-1183. [DOI: 10.1007/s11325-022-02691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose
The airway complex is modified by palatine expansion. Computer tomography has been used in the past to determine the change in volume, but there was a lack of a specific, reproducible method for this purpose. The present study sought to determine the accuracy, reproducibility, and repeatability of an innovative digital measurement technique for analyzing the volume of maxillary and nasal sinus airways following suture palatine expansion performed with the Hyrax disyuntor appliance.
Methods
Patients underwent preoperative and postoperative cone-beam computed tomography (CBCT) scans. The datasets were subsequently uploaded into a digital treatment planning software to record the volume of the right and left maxillary sinus, as well as the nasal and maxillary sinus airway complex. The Gage Repeatability & Reproducibility statistical analysis methodology was used to evaluate the repeatability and reproducibility of this measurement technique when measuring the volume of maxillary and nasal sinus airways following suture palatine expansion with the Hyrax disyuntor appliance. Additionally, comparative analysis between preoperative and postoperative measures was performed using Student’s t-test for statistical analysis.
Results
In 5 patients, paired t-tests found statistically significant differences before and after treatment in the volumes of the left maxillary sinus (p = 0.002), right maxillary sinus (p = 0.001), and nasal and maxillary sinus airway complex (p = 0.005) after suture palatine expansion with the Hyrax disyuntor appliance.
Conclusion
The proposed digital technique is an accurate, repeatable, and reproducible measurement technique for analyzing the volume of maxillary and nasal sinus airways following suture palatine expansion using the Hyrax disyuntor.
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13
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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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14
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Moin Anwer HM, Albagieh HN, Kalladka M, Chiang HK, Malik S, McLaren SW, Khan J. The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea. Saudi Dent J 2021; 33:424-433. [PMID: 34803282 PMCID: PMC8589585 DOI: 10.1016/j.sdentj.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. Material and methods A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. Results Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.
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Affiliation(s)
- Hafiz M Moin Anwer
- Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Hamad N Albagieh
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mythili Kalladka
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Harmeet K Chiang
- Virginia Commonwealth University, 521 N. 11th Street, Richmond, VA 23298, USA
| | - Shaima Malik
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Sean W McLaren
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
| | - Junad Khan
- Eastman Institute for Oral Health, 625 Elmwood Ave, Rochester, NY 14620, USA
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Abate A, Cavagnetto D, Fama A, Matarese M, Lucarelli D, Assandri F. Short term effects of rapid maxillary expansion on breathing function assessed with spirometry: A case-control study. Saudi Dent J 2021; 33:538-545. [PMID: 34803298 PMCID: PMC8589571 DOI: 10.1016/j.sdentj.2020.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this work is to evaluate changes following rapid maxillary expansion (RME) on breathing function in two groups of patients: mouth breathers and nasal breathers. MATERIALS AND METHODS Twenty-five oral breather patients (12 male, 13 female, mean age 15.2 ± 1.3), and 25 nasal breather patients (14 male, 11 female, mean age 15.3 ± 1.6) were treated with RME. Breathing function was evaluated by computerized spirometry. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), Tiffenau index (FEV1/ FVC ratio, IT%), forced expiratory flow at 25-75% of vital capacity (FEF 25-75%), and Tidal volume (TV) were assessed. Breathing function analysis was performed before RME and 6 and 12 months after RME during follow-up appointments. The Shapiro-Wilk test was used to assess whether data were normally distributed. As data were not normally distributed, Mann-Whitney U and Friedman tests were used to perform comparisons between treatment groups and within group comparisons, respectively. RESULTS Oral breathers and nasal breathers showed statistically significant differences in FVC, FEF 25-75%, and TV at T0. They did not present any statistically significant difference in FEV1 and IT% at the same time point.Statistically significant differences were noticed for all indices in the oral breather group after maxillary expansion, while the nasal breather group showed statistically significant differences only in FCV, FEF 25-75%, and TV after treatment.There were no statistically significant differences in all indices 12 months after maxillary expansion between the oral breather and nasal breather groups. CONCLUSIONS RME appeared to improve breathing function in both groups. Forced vital capacity (FVC), forced expiratory flow at 25-75% of vital capacity (FEF 25-75), and Tidal volume (TV) reached similar values in both groups after treatment with RME.
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Affiliation(s)
- Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Andrea Fama
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Marco Matarese
- Department of Biomedical, Odontostomatological Sciences and Morphological and Functional Images, School of Dentistry, Via Consolare Valeria 1, University of Messina, 98125 Messina, Italy
| | - Danilo Lucarelli
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Fausto Assandri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
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Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children. Sleep Med 2021; 86:81-89. [PMID: 34479051 DOI: 10.1016/j.sleep.2021.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). METHODS 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). RESULTS In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. CONCLUSION RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.
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17
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Çoban Büyükbayraktar Z, Doruk C, Doğan M, Ertaş G. Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial. J Orofac Orthop 2021; 83:395-402. [PMID: 34191034 DOI: 10.1007/s00056-021-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients. METHODS This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ 2 test and independent samples t‑test were used to evaluate the data. RESULTS The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05). CONCLUSION This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.
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Affiliation(s)
| | - Cenk Doruk
- Department of Orthodontics, Sivas Cumhuriyet University School of Dentistry, Sivas, Turkey
| | - Mansur Doğan
- Department of Otorhinolaryngology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| | - Gökcan Ertaş
- Department of Orthodontics, Sivas Cumhuriyet University School of Dentistry, Sivas, Turkey
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Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. Eur J Orthod 2021; 43:283-292. [PMID: 33564835 DOI: 10.1093/ejo/cjab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six growing subjects (10-16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. RESULTS Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: -45.8%, HH: -75.5%, K: -63.2%) and velocity (H: -30%, HH: -58.5%, K: -35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. CONCLUSIONS RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. LIMITATION Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. HARMS Replacement of blocked Keles expanders for finalizing treatment. PROTOCOL The protocol was not published before the trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
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Cheung GC, Dalci O, Mustac S, Papageorgiou SN, Hammond S, Darendeliler MA, Papadopoulou AK. The upper airway volume effects produced by Hyrax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial. Eur J Orthod 2021; 43:254-264. [PMID: 32377675 DOI: 10.1093/ejo/cjaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six patients, 10-16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. RESULTS Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1-3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). CONCLUSIONS RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. LIMITATIONS Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. HARMS Keles expanders blocked during activations and required substitution for completion of treatment. PROTOCOL The protocol was not published before trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).
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Affiliation(s)
- Gordon C Cheung
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Simone Mustac
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shanya Hammond
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
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20
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Tepedino M, Montaruli G, Scapato F, Laurenziello M, Suriano C, Chimenti C, Ciavarella D. Long-term effect on adenoid dimensions and craniocervical angulation after maxillary expansion with fixed or functional appliances. J Clin Exp Dent 2021; 13:e594-e600. [PMID: 34188766 PMCID: PMC8223156 DOI: 10.4317/jced.58171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background Maxillary expansion is a common orthodontic procedure that could have a positive effect also on airway patency. The aim of the present study was to evaluate the long-term effects of rapid maxillary expansion (RME) on nasopharyngeal area and cranio-cervical angulation in growing patients, compared to controls treated with a function-generating bite appliance (FGB).
Material and Methods Sixty patients aged 6-14 consecutively treated with RME or FGB were selected retrospectively and divided into two groups. Lateral cephalograms taken before and after treatment were retrieved, and the nasopharyngeal area, delimited superiorly by a sella-posterior nasal spine (PNS) line and inferiorly by a basion-PNS line, and the cranio-cervical angulation were measured.
Results The mean observation time was 17.6 ± 8 months. No differences were present between the two groups regarding age and gender. The nasopharyngeal area increased significantly in both groups after treatment, but with no statistically significant difference between them. The cranio-cervical angulation showed no differences within or between groups.
Conclusions Maxillary deficiency treatment with either RME or FGB was followed by a comparable increase in nasopharyngeal area. Key words:Rapid maxillary expansion, Airway, Nasopharyngeal area, Adenoid.
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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
| | - Francesco Scapato
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carmela Suriano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
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Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Gianoni-Capenakas S, Flores-Mir C, Vich ML, Pacheco-Pereira C. Oropharyngeal 3-dimensional changes after maxillary expansion with 2 different orthodontic approaches. Am J Orthod Dentofacial Orthop 2021; 159:352-359. [PMID: 33641816 DOI: 10.1016/j.ajodo.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective of this research was to compare the oropharyngeal volume and minimal cross-sectional area (MCA) changes after maxillary expansion using either the Damon system or Hyrax appliances as assessed through cone-beam computed tomography (CBCT) imaging. METHODS Patients aged between 11 and 17 years with skeletal maxillary transverse discrepancy in need of maxillary expansion were included and allocated randomly into 1 of the 2 treatment groups, Damon or Hyrax. Patients underwent CBCT imaging at 2 time points: T1, after initial clinical evaluation before treatment, and T2, after completion of full orthodontic treatment. The CBCT data were assessed using Dolphin software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). In addition, a qualitative assessment of breathing function was done using the modified Nasal Obstruction and Septoplasty Effectiveness Scale questionnaire. RESULTS A statistically significant increase in the oropharyngeal volume (2.23 mL; P = 0.005) and MCA (29.72 mm2; P = 0.007) after the completion of treatment (T2 - T1) for the Hyrax group was suggested. No statistically significant difference was found in the Damon group for volume (1 mL; P = 0.311) and for MCA (7.32 mm2; P = 0.643). In addition, no statistically significant difference was found in the breathing function in both treatment groups (P >0.05). CONCLUSIONS Hyrax expansion followed by fixed appliances produced more dimensional upper airway changes at the oropharyngeal level than the Damon system approach. No breathing functional changes were noted in either samples.
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Affiliation(s)
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Alberta, Canada
| | - Manuel Lagravère Vich
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Alberta, Canada
| | - Camila Pacheco-Pereira
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Alberta, Canada, University of Texas Health Science at San Antonio, San Antonio, Tex
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23
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Does Mini Screw Assisted Rapid Palatal Expansion (MARPE) have an influence on airway and breathing in middle-aged children and adolescents? A systematic review. Int Orthod 2021; 19:37-50. [DOI: 10.1016/j.ortho.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 12/20/2022]
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Santana DMC, Nogueira VS, Lima SAM, Fernandes LPA, Weber SAT. The effect of rapid maxillary expansion in children: a meta-analysis. Braz J Otorhinolaryngol 2021; 88:907-916. [PMID: 33674227 PMCID: PMC9615535 DOI: 10.1016/j.bjorl.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Craniofacial growth is modified by chronic mouth breathing. Rapid maxillary expansion leads to separation of the mid-palatal suture, improving the occlusion and the upper airway size. AIM Systematically evaluate scientific articles on the effects of rapid maxillary expansion on airway dimensions and classify the quality of the evidence of the information. METHODS Searches on PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE, as well as in the grey literature were performed. The articles found were selected and evaluated both for the risk of bias (ROBINS-I) and for the quality of evidence (GRADE). RESULTS Of the 309 works found, 26 papers were selected for full reading, of which 22 were excluded. Data compilation and analysis were performed in four papers, two being controlled non-randomized clinical trials and two non-randomized and uncontrolled clinical trials. No randomized clinical trial was found. CONCLUSIONS The meta-analysis found an increase in the internasal and inter-zygomatic distances and oropharyngeal volume after rapid maxillary expansion, which, together with clinical findings, makes the recommendation favorable to the intervention. The quality of the evidence for each outcome was considered very low.
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Affiliation(s)
- Denise M C Santana
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Programa de Cirurgia e Medicina Translacional, Botucatu, SP, Brazil.
| | - Vania S Nogueira
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Silvana A M Lima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Enfermagem, Botucatu, SP, Brazil
| | - Luciana P A Fernandes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Dermatologia e Radioterapia, Botucatu, SP Brazil
| | - Silke A T Weber
- Hospital Estadual de Botucatu, Laboratório do Sono do Hospital das Clínicas, Botucatu, SP Brazil; Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil
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25
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Truong CT, Jeon HH, Sripinun P, Tierney A, Boucher NS. Short-term and long-term effects of rapid maxillary expansion on the nasal soft and hard tissue. Angle Orthod 2021; 91:46-53. [PMID: 33289784 DOI: 10.2319/022320-120.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/01/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To evaluate nasal soft and hard tissue changes immediately post-rapid maxillary expansion (RME) and to assess the stability of these changes using cone beam computed tomography (CBCT). MATERIALS AND METHODS A total of 35 treatment group (TG) patients (18 girls, 17 boys; 9.39 ± 1.4) had a pre-RME CBCT and a post-RME CBCT approximately 66 days after expansion, and 25 patients had a follow-up CBCT 2.84 years later. A total of 28 control group (CG; no RME) patients (16 girls, 12 boys; 8.81 ± 1.6) had an initial CBCT and a CBCT an average of 2.25 years later. Soft and hard tissue nasal landmarks were measured in transverse, sagittal, and coronal planes of space on CBCT scans. Differences within the same group were evaluated by paired t-tests or Wilcoxon signed-rank tests. Long-term comparisons between TG and CG were evaluated by independent-sample t-tests or Wilcoxon rank-sum tests. RESULTS Immediately post-RME, there were statistically significant mean increases of 1.6 mm of alar base width, 1.77 mm of pyriform height, and 3.57 mm of pyriform width (P < .05). CG showed the significant increases over 2.25 years (P < .001). Compared with CG, the long-term evaluation of TG demonstrated only pyriform height and pyriform width showed a statistically significant difference (P < .01). CONCLUSIONS Although RME produced some significant increase on the nasal soft tissue immediately after expansion, it regressed to the mean of normal growth and development over time. However, long-term evaluation of TG compared with CG showed only pyriform height and pyriform width to be affected by RME.
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Kim SJ, Ahn HW, Kim SW. Advanced interdisciplinary treatment protocol for pediatric obstructive sleep apnea including medical, surgical, and orthodontic care: a narrative review. Cranio 2020; 41:274-286. [PMID: 33092497 DOI: 10.1080/08869634.2020.1839722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To suggest an updated interdisciplinary treatment protocol for pediatric obstructive sleep apnea (POSA) based on the integration of craniofacial growth modification into medical and surgical sleep practice. METHODS PubMed, Scopus, and Cochrane library were searched up to February 2020 using keywords. Among 184 articles, 80 studies were finally included. An integrated treatment protocol for POSA encompassing craniofacial skeletal management as well as medical and surgical care was attempted. RESULTS A differential diagnostic workflow for identifying the phenotype of POSA was suggested, and a phenotype-based treatment protocol for POSA was proposed. Despite the lack of high level of evidence, timely skeletal growth modification in three dimensions using craniofacial growth potential could be valuable treatment for upper airway development in POSA patients with craniofacial phenotypic cause. CONCLUSION A novel precision treatment protocol will advance clinicians to determine the primary option or to apply the combined strategy for POSA patients.
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Affiliation(s)
- Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Hyo-Won Ahn
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Sung-Wan Kim
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Rachmiel A, Turgeman S, Shilo D, Emodi O, Aizenbud D. Surgically Assisted Rapid Palatal Expansion to Correct Maxillary Transverse Deficiency. Ann Maxillofac Surg 2020; 10:136-141. [PMID: 32855930 PMCID: PMC7433940 DOI: 10.4103/ams.ams_163_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
Background Transverse maxillomandibular discrepancies are widespread. Treatment is comprised of orthodontic expansion in patients younger than 15 years or by surgically assisted rapid palatal expansion (SARPE) in skeletally mature patients where the possibility of successful orthodontic maxillary expansion decreases as sutures close and resistance to mechanical forces increases. Aim To present our experience of treating transverse maxillary deficiency using a unique L-shaped osteotomy and to demonstrate stable results. Patients and Methods 32 patients aged between 19 and 54 years exhibiting transverse maxillary deficiency. L-shaped osteotomy was performed laterally from the pterygoid plate posteriorly to above the roots of the second incisive anteriorly continuing with a vertical osteotomy between the lateral incisive and canine teeth toward the horizontal osteotomy. In 18 patients with dysgnathia, bimaxillary surgery was performed one year following the SARPE procedure. Results Mean transverse maxillary expansion of 6.2mm at the canine incisal and 6.4mm at the first molar occlusal regions were obtained. One year postoperatively results were relatively stable, 5.8mm and 6.2mm respectively. The SARPE procedure resulted in overcoming the maxillary buttress resistance, expansion of the anterior dental arch and bilateral distraction creating bone on both sides of the premaxilla contributing to better alignment of the anterior teeth and superior stability. Conclusions We conclude that SARPE is an effective and stable method for addressing severe maxillary transverse discrepancy in adults while the unique osteotomy performed allowed for maintaining proper position of the premaxilla and maxillary midline and allowing for division of the newly created bone bilaterally thus resulting in a more stable outcome.
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Affiliation(s)
- Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,Academic Institution, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shahar Turgeman
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Dekel Shilo
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,Academic Institution, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Omri Emodi
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Dror Aizenbud
- Department of Orthodontics and Craniofacial Anomalies, Rambam Health Care Campus, Haifa, Israel
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Caldas LD, Takeshita WM, Machado AW, Bittencourt MAV. Effect of rapid maxillary expansion on nasal cavity assessed with cone-beam computed tomography. Dental Press J Orthod 2020; 25:39-45. [PMID: 32844972 PMCID: PMC7437151 DOI: 10.1590/2177-6709.25.3.039-045.oar] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. Objective: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. Methods: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student’s t-test, with a significance level of 5%. Results: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). Conclusions: RME was able to significantly modify the internal dimensions of the nasal cavity.
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Affiliation(s)
| | - Wilton M Takeshita
- Departamento de Radiologia Oral, Faculdade de Odontologia, Universidade Federal do Sergipe, Aracaju, SE, Brazil
| | - André Wilson Machado
- Departamento de Ortodontia, Faculdade de Odontologia, Universidade Federal da Bahia, Salvador, BA, Brazil
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Niu X, Di Carlo G, Cornelis MA, Cattaneo PM. Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res 2020; 23:250-276. [PMID: 32248642 DOI: 10.1111/ocr.12378] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The purpose of this systematic review was to evaluate the three-dimensional (3D) changes occurring at short- and long-term follow-up after rapid maxillary expansion (RME) in nasal cavity (NC) and upper airway (UA) in growing patients. METHODS A literature search up to 1 July 2019 was performed. Randomized and non-randomized clinical trials and cohort studies comparing the effects of RME in a paediatric population using 3D analyses based on computed tomography (CT), cone-beam CT and MRI were included. The risks of bias of the included studies were assessed using the Cochrane Collaboration's risk of bias tool, the GRADE approach and a customized tool. The random-effects meta-analyses of the mean differences and 95% confidence intervals of NC and UA volume changes were carried out, followed by subgroup analyses. RESULTS Twenty-seven studies were included, with 18 selected for quantitative synthesis. Immediately after expansion, the nasopharynx and oropharynx increased significantly. After 3 months of retention, only the NC and nasopharynx showed a significant volume increase. Two studies mentioned the use of a sleep-disordered breathing questionnaire, and one study reported the difference before and after RME. None of the 27 articles included assessed the correlation between the skeletal widening and NC or UA volume changes after RME. CONCLUSIONS The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.
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Affiliation(s)
- Xiaowen Niu
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Gabriele Di Carlo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Department of Oral and Maxillofacial Sciences, Unit of Pediatric Dentistry, Sapienza University of Rome, Rome, Italy
| | - Marie A Cornelis
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Paolo M Cattaneo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
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30
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Gokce G, Veli I, Yuce YK, Isler Y. Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105260. [PMID: 31862681 DOI: 10.1016/j.cmpb.2019.105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aims to assess the effect of Rapid Maxillary Expansion (RME) on Nasal Septal Deviation (NSD) changes from three-dimensional (3D) images. METHODS In this study, cone-beam computed tomography (CBCT) images from 15 patients with maxillary constriction (mean age 12 ± 1.6 years) were included. RME treatment with Hyrax appliance was performed in all patients. CBCT scans were taken at three different times; before appliance insertion (T0), after active expansion (T1) and 3 months after appliance insertion (T2). We developed a novel Matlab-based application to quantify NSD based on the tortuosity ratio by dividing the actual length of the septum by the ideal length in the mid-sagittal plane by using this application. RESULTS Tortuosity ratio (TR) values were found as 1.03 ± 0.03 (T0), 1.02 ± 0.02 (T1), and 1.02 ± 0.02 (T2). Differences of TR values among these groups were evaluated using the statistical method of ANOVA (ANalysis Of VAriance) for repeated measures with the significance level of p ≤ .05. Results showed significant reductions in TR values between T0-T1 (p ≤ .05) and between T0-T2 (p ≤ .05). Nonetheless, a significant difference between T1-T2 was not determined (p > .05). CONCLUSIONS As a result, we can conclude that the NSD degree is affected by the RME treatment. The developed application can be used for both educational and research purposes.
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Affiliation(s)
- Gokcenur Gokce
- Faculty of Dentistry, Department of Orthodontics, Izmir Katip Celebi University, Cigli, Izmir, Turkey
| | - Ilknur Veli
- Faculty of Dentistry, Department of Orthodontics, Izmir Katip Celebi University, Cigli, Izmir, Turkey
| | - Yilmaz Kemal Yuce
- Rafet Kayis Faculty of Engineering, Department of Computer Engineering, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey
| | - Yalcin Isler
- Faculty of Engineering and Architecture, Department of Biomedical Engineering, Izmir Katip Celebi University, Cigli, Izmir, Turkey.
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Garrec P, Legris S, Soyer Y, Vi-Fane B, Jordan L. [Orthodontic management of obstructive sleep-disordered respiratory disorders]. Orthod Fr 2019; 90:321-335. [PMID: 34643519 DOI: 10.1051/orthodfr/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.
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Affiliation(s)
- Pascal Garrec
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Sylvie Legris
- AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Yves Soyer
- Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Brigitte Vi-Fane
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Laurence Jordan
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, PSL Research University, Institut de Recherche de Chimie Paris, UMR 8247-Chimie ParisTech, 75005 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
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Vásquez-Cárdenas J, Zapata-Noreña Ó, Carvajal-Flórez Á, Barbosa-Liz DM, Giannakopoulos NN, Faggion CM. Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting. Am J Orthod Dentofacial Orthop 2019; 156:442-452.e12. [PMID: 31582116 DOI: 10.1016/j.ajodo.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A). METHODS Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores. RESULTS Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting. CONCLUSIONS The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.
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Affiliation(s)
- Jenny Vásquez-Cárdenas
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Óscar Zapata-Noreña
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Álvaro Carvajal-Flórez
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana María Barbosa-Liz
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia.
| | | | - Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University of Münster, Münster, Germany
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Krishnaswamy NR. Expansion in the absence of crossbite – rationale and protocol. APOS TRENDS IN ORTHODONTICS 2019. [DOI: 10.25259/apos_115_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transverse maxillomandibular discrepancies are a major component of several malocclusions. Clinically, posterior crossbite is a common and valid indicator of maxillary transverse problems and orthopedic and orthodontic forces are routinely used to correct maxillary transverse deficiency. However, crossbite and transverse discrepancies are not a homologous group but must be viewed as a continuum with varying degree of abnormality. The etiology, diagnostic protocol, rationale, and procedures employed for correcting maxillary transverse discrepancy in the absence of crossbite are discussed in the article.
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Bucci R, Montanaro D, Rongo R, Valletta R, Michelotti A, D'Antò V. Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta-analyses. J Oral Rehabil 2019; 46:377-387. [PMID: 30664799 DOI: 10.1111/joor.12766] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/13/2018] [Accepted: 01/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue. OBJECTIVES This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs. METHODS Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). RESULTS Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function. CONCLUSION Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.
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Affiliation(s)
- Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
| | - Danilo Montanaro
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
| | - Rosa Valletta
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics and Temporomandibular Disorders, University of Naples "Federico II", Naples, Italy
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Alyessary AS, Othman SA, Yap AUJ, Radzi Z, Rahman MT. Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review. Int Orthod 2019; 17:12-19. [PMID: 30732977 DOI: 10.1016/j.ortho.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. MATERIALS AND METHODS An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. RESULTS The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. CONCLUSIONS Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.
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Affiliation(s)
- Akram S Alyessary
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia; Karbala University, College of dentistry, Department of Orthodontics, Karbala, Iraq.
| | - Siti A Othman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Adrian U J Yap
- National University Health System, Ng Teng Fong General Hospital, Department of Dentistry, Singapore, Singapore; University of Malaya, Faculty of Dentistry, Department of Restorative Dentistry, Kuala Lumpur, Malaysia
| | - Zamri Radzi
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Mohammad T Rahman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
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Pirelli P, Fanucci E, Giancotti A, Di Girolamo M, Guilleminault C. Skeletal changes after rapid maxillary expansion in children with obstructive sleep apnea evaluated by low-dose multi-slice computed tomography. Sleep Med 2018; 60:75-80. [PMID: 30630675 DOI: 10.1016/j.sleep.2018.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the skeletal effects of rapid maxillary expansion (RME) therapy performed using teeth as anchors, in obstructive sleep apnea (OSA) children, by low-dose computed tomography (CT) of the midpalatal suture opening, maxillary base width, nasal cavities width, first molar angulation and, unlike most studies in the literature, on the pterygoid processes distance. METHODS Fourteen children (mean age 8.68 years) with OSA presenting a malocclusion characterized by upper-jaw contraction had 16-Multislice CT (MSCT) scans taken before (T0) and after (T1) RME. All exams were performed using a rigid protocol to ensure reproducibility of image collection over time, with a 16-row MSCT scanner equipped with a Dentascan reconstruction program. Scanning parameters were as follows: scout view in the anteroposterior (AP) and laterolateral (LL); 1.25-mm slice thickness with 0.6-mm collimation from the dentoalveolar and basal areas of the maxilla up to the nasal cavity, parallel to the palatal plane; 80 kV, 100 mA with an 11.25-mm table speed/rotation, rotation time 0.6 s. Matrix size was 512 × 512. RESULTS Opening of the midpalatal suture was demonstrated in all cases. The results showed statistically significant T0 to T1 increments in all treated cases and clear imaging findings. CONCLUSION Use of three-dimensional (3D)-CT for follow-up studies requires a very rigid protocol to maintain reproducible positions in the scanner over time. The images confirm the real remodeling of craniofacial structure. However, to be valid such an imaging approach needs great attention to reproducibility of anatomic images over time. The changes in volume of the UA, even with a rigid protocol, cannot be affirmed with 3D-CT. There is a need to improve the definition of markers using this imaging approach when performing longitudinal studies; currently this issue is unresolved.
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Affiliation(s)
- Paola Pirelli
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy.
| | - Ezio Fanucci
- Department of Diagnostic Imaging, University Tor Vergata, Rome, Italy
| | - Aldo Giancotti
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - Michele Di Girolamo
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
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Buck LM, Dalci O, Darendeliler MA, Papageorgiou SN, Papadopoulou AK. Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis. Eur J Orthod 2018; 39:463-473. [PMID: 27440774 DOI: 10.1093/ejo/cjw048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Although Rapid Maxillary Expansion (RME) has been used for over a century, its effect on upper airways has not yet adequately been assessed in an evidence-based manner. Objective To investigate the volumetric changes in the upper airway spaces following RME in growing subjects by means of acoustic rhinometry, three-dimensional radiography and digital photogrammetry. Search methods Literature search of electronic databases and additional manual searches up to February 2016. Selection criteria Randomized clinical trials, prospective or retrospective controlled clinical trials and cohort clinical studies of at least eight patients, where the RME appliance was left in place for retention, and a maximum follow-up of 8 months post-expansion. Data collection and analysis After duplicate data extraction and assessment of the risk of bias, the mean differences and 95 per cent confidence intervals (CIs) of upper airway volume changes were calculated with random-effects meta-analyses, followed by subgroup analyses, meta-regressions, and sensitivity analyses. Results Twenty studies were eligible for qualitative synthesis, of which 17 (3 controlled clinical studies and 14 cohort studies) were used in quantitative analysis. As far as total airway volume is concerned patients treated with RME showed a significant increase post-expansion (5 studies; increase from baseline: 1218.3mm3; 95 per cent CI: 702.0 to 1734.6mm3), which did not seem to considerably diminish after the retention period (11 studies; increase from baseline: 1143.9mm3; 95 per cent CI: 696.9 to 1590.9mm3). Limitations However, the overall quality of evidence was judged as very low, due to methodological limitations of the included studies, absence of untreated control groups, and inconsistency among studies. Conclusions RME seems to be associated with an increase in the nasal cavity volume in the short and in the long term. However, additional well-conducted prospective controlled clinical studies are needed to confirm the present findings. Registration None. Funding Australian Society of Orthodontics Foundation for Research and Education Inc.
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Affiliation(s)
- Lloyd M Buck
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Australia
| | - Oyku Dalci
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Australia
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Australia
| | - Spyridon N Papageorgiou
- Departments of Orthodontics.,Oral Technology, School of Dentistry, University of Bonn, Germany
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Australia.,Department of Oral Surgery, Implantology and Dental Radiology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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Mitteilungen DGKFO. J Orofac Orthop 2018. [DOI: 10.1007/s00056-018-0152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Safari S, Mahdian A, Motamedian SR. Applications of stem cells in orthodontics and dentofacial orthopedics: Current trends and future perspectives. World J Stem Cells 2018; 10:66-77. [PMID: 29988866 PMCID: PMC6033713 DOI: 10.4252/wjsc.v10.i6.66] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
A simple overview of daily orthodontic practice involves use of brackets, wires and elastomeric modules. However, investigating the underlying effect of orthodontic forces shows various molecular and cellular changes. Also, orthodontics is in close relation with dentofacial orthopedics which involves bone regeneration. In this review current and future applications of stem cells (SCs) in orthodontics and dentofacial orthopedics have been discussed. For craniofacial anomalies, SCs have been applied to regenerate hard tissue (such as treatment of alveolar cleft) and soft tissue (such as treatment of hemifacial macrosomia). Several attempts have been done to reconstruct impaired temporomandibular joint. Also, SCs with or without bone scaffolds and growth factors have been used to regenerate bone following distraction osteogenesis of mandibular bone or maxillary expansion. Current evidence shows that SCs also have potential to be used to regenerate infrabony alveolar defects and move the teeth into regenerated areas. Future application of SCs in orthodontics could involve accelerating tooth movement, regenerating resorbed roots and expanding tooth movement limitations. However, evidence supporting these roles is weak and further studies are required to evaluate the possibility of these ideas.
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Affiliation(s)
- Shiva Safari
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 13819, Iran
| | - Arezoo Mahdian
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 13819, Iran
| | - Saeed Reza Motamedian
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 13819, Iran
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Rădescu OD, Colosi HA, Albu S. Effects of rapid palatal expansion (RPE) and twin block mandibular advancement device (MAD) on pharyngeal structures in Class II pediatric patients from Cluj-Napoca, Romania. Cranio 2018; 38:22-29. [PMID: 29790429 DOI: 10.1080/08869634.2018.1475940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: To compare cephalometric changes of pharyngeal structures after rapid palatal expansion (RPE) with those induced by a twin block mandibular advancement device (MAD) with palatal expansion capability. Methods: This retrospective study investigated 55 Class II pediatric patients, divided into two groups: 29 patients treated with RPE and 26 patients treated with MAD. Lateral cephalometric measurements were compared before and after treatment. Results: Changes in pharyngeal airway space were statistically significant in both groups (p < 0.001) from a pre-treatment mean distance measured between the lower posterior pharyngeal wall and the hyoid bone (LPF-H) of 25.42 mm in the MAD group and 28.62 mm in the RPE group, to a post-treatment mean LPF-H of 27.96 mm in the MAD group and 31.52 mm in the RPE group. Conclusion: Significant changes in pharyngeal space may be obtained in Class II patients through both rapid palatal expansion and mandibular advancement devices with palatal expansion capability.
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Affiliation(s)
- Ovidiu Dănuţ Rădescu
- Department of Orthodontics and Dentofacial Orthopaedics, Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Horațiu Alexandru Colosi
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Silviu Albu
- Department of Oto-Rhino-Laryngology, Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
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Ghoussoub MS, Rifai K, Garcia R, Sleilaty G. Effect of Rapid Maxillary Expansion on Glenoid Fossa and Condyle-Fossa Relationship in Growing Patients (MEGP): Study Protocol for a Controlled Clinical Trial. J Int Soc Prev Community Dent 2018; 8:130-136. [PMID: 29780738 PMCID: PMC5946521 DOI: 10.4103/jispcd.jispcd_458_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/15/2018] [Indexed: 01/29/2023] Open
Abstract
Aims and Objectives: Rapid maxillary expansion (RME) is an orthodontic nonsurgical procedure aiming at increasing the width of the maxilla by opening mainly the intermaxillary suture in patients presenting a transverse maxillary skeletal deficiency. The objectives of the current prospective controlled clinical and radiographic study are to evaluate the hypothesis that RME in growing patients will result in radiographic changes at the level of interglenoid fossa distance, condyle-fossa relationship, and nasal cavity widths compared to the group who received no treatment initially and served as untreated control. Materials and Methods: In this prospective controlled clinical and radiographic study, forty healthy growing patients selected from a school-based population following a large screening campaign, ranging in age between 8 and 13 years, presenting a maxillary constriction with bilateral crossbite, and candidates for RME are being recruited. The first group will include participants willing to undergo treatment (n = 25) and the other group will include those inclined to postpone (n = 15). Results: The primary outcome is to compare radiologically the interglenoid fossa distance and the condyle-fossa relationship; nasal cavity width will be a secondary outcome. A multivariable analysis of Covariance model will be used, with the assessment of the time by group interaction, using age as covariate. The project protocol was reviewed and approved by the Ethics Committee of the Lebanese University, National Institute in Lebanon (CUEMB process number 31/04/2015). The study is funded by the Lebanese University and Centre National de Recherche Scientifique, Lebanon (Number: 652 on 14/04/2016). Conclusion: This prospective controlled clinical trial will give information about the effect of RME on the glenoid fossa and condyle-fossa relationship and its impact on the nasal cavity width. Trial Registration: Retrospectively registered in BioMed Central (DOI10.1186/ISRCTN77788053).
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Affiliation(s)
- Mona Sayegh Ghoussoub
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, Lebanese University, Hadath, Lebanon
| | - Khaldoun Rifai
- Department of Prosthodontics, School of Dentistry, Lebanese University, Hadath, Lebanon
| | - Robert Garcia
- Department of Orthodontics School of Dentistry, Paris Diderot University, Paris, France
| | - Ghassan Sleilaty
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study. Sleep Breath 2018; 22:1053-1061. [PMID: 29453640 DOI: 10.1007/s11325-018-1636-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/11/2017] [Accepted: 01/28/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency. METHODS Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5 months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured. RESULTS Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed. CONCLUSIONS SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.
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Zhu S, Jayaraman J, Khambay B. Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review. Cleft Palate Craniofac J 2018; 53:187-96. [DOI: 10.1597/14-177] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images. Design Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol. Result Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP. Conclusions It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.
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Affiliation(s)
- Shiwen Zhu
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Jayakumar Jayaraman
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Balvinder Khambay
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Abstract
Maintaining teeth in their corrected positions following orthodontic treatment can be extremely challenging. Teeth have a tendency to move back towards the original malocclusion as a result of periodontal, gingival, occlusal and growth related factors. However, tooth movement can also occur as a result of normal age changes. Because orthodontics is unable to predict which patients are at risk of relapse, those which will remain stable and the extent of relapse that will occur in the long-term, clinicians need to treat all patients as if they have a high potential to relapse. To reduce this risk, long term retention is advocated. This can be a significant commitment for patients, and so retention and the potential for relapse must form a key part of the informed consent process prior to orthodontic treatment. It is vital that patients are made fully aware of their responsibilities in committing to wear retainers as prescribed in order to reduce the chance of relapse. If patients are unable or unwilling to comply as prescribed, they must be prepared to accept that there will be tooth positional changes following treatment. There is currently insufficient high quality evidence regarding the best type of retention or retention regimen, and so each clinician's approach will be affected by their personal, clinical experience and expertise, and guided by their patients' expectations and circumstances.
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Affiliation(s)
- S J Littlewood
- St Luke's Hospital, Little Horton Lane, Bradford, BD5 0NA, United Kingdom.,Leeds Dental Institute, University of Leeds, United Kingdom
| | - S Kandasamy
- School of Dentistry, The University of Western Australia.,Centre for Advanced Dental Education, Saint Louis University, MO, USA.,West Australian Orthodontics, Midland, WA, Australia
| | - G Huang
- University of Washington, Department of Orthodontics, Seattle, Washington, USA
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Aziz T, Wheatley FC, Ansari K, Lagravere M, Major M, Flores-Mir C. Nasal septum changes in adolescent patients treated with rapid maxillary expansion. Dental Press J Orthod 2017; 21:47-53. [PMID: 27007761 PMCID: PMC4816585 DOI: 10.1590/2177-6709.21.1.047-053.oar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/24/2015] [Indexed: 12/01/2022] Open
Abstract
Objective: To analyze cone-beam computed tomography (CBCT) scans to measure changes in nasal septal deviation (NSD) after rapid maxillary expansion (RME) treatment in adolescent patients. Methods: This retrospective study involved 33 patients presenting with moderate to severe nasal septum deviation as an incidental finding. Out of these 33 patients, 26 were treated for transverse maxillary constriction with RME and seven, who did not undergo RME treatment, were included in the study as control group. CBCT scans were taken before appliance insertion and after appliance removal. These images were analyzed to measure changes in nasal septum deviation (NSD). Analysis of variance for repeated measures (ANOVA) was used. Results: No significant changes were identified in NSD regardless of the application or not of RME treatment and irrespective of the baseline deviation degree. Conclusion: This study did not provide strong evidence to suggest that RME treatment has any effect on NSD in adolescent patients; however, the results should be interpreted with caution, due to the small sample size and large variation amongst individual patient characteristics.
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Affiliation(s)
| | | | - Kal Ansari
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel Lagravere
- Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Major
- Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Efficacy of Rapid Maxillary Expansion in the Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review With Meta-analysis. J Evid Based Dent Pract 2017; 17:159-168. [DOI: 10.1016/j.jebdp.2017.02.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/23/2022]
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Celebi F, Hologlu F, Akbulut S, Bicakci AA. Effects of Rapid Maxillary Expansion on Head Posture, Postural Stability, and Fall Risk. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_64_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective
The aim of this study was to investigate the effects of rapid maxillary expansion (RME) on head posture, postural stability, and fall risk.
Materials and Methods
A sample of 51 adolescent patients was randomly divided into two groups. In the first group, which consisted of 28 patients (15 females and 13 males), RME was performed as a part of routine orthodontic treatment. The remaining 23 individuals (12 females and 11 males) served as the control group. Lateral cephalometric radiographs taken in natural head position, postural stability, and fall risk scores were obtained during the first visit. They were repeated on average 3.8 months and 3.5 months later for the study and control groups, respectively. The changes were analyzed using the Wilcoxon signed-rank test, paired samples t-test, Mann–Whitney U-test, and independent samples t-test.
Results
As a result of RME, a statistically significant decrease was detected in the fall risk score (P < 0.05) in the study group, while the head position and postural stability remained unchanged. For the control group, no significant changes were observed in all measurements.
Conclusions
The result of the present study suggests that RME has a capacity of improving fall risk.
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Affiliation(s)
- Fatih Celebi
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
| | - Feyza Hologlu
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
| | - Sibel Akbulut
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
| | - Ali Altug Bicakci
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
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Rapid Maxillary Expansion and Upper Airway Morphology: A Systematic Review on the Role of Cone Beam Computed Tomography. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5460429. [PMID: 28791305 PMCID: PMC5534278 DOI: 10.1155/2017/5460429] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study aimed to investigate the quality of cone beam computed tomography (CBCT) studies evaluating the effects of rapid maxillary expansion on upper airway morphology. MATERIALS AND METHODS A database search was conducted using PubMed, Ovid, and Cochrane Library up to December 2016. Studies in which CBCT was adopted to visualize the upper airway before and after rapid maxillary expansion were included. The population target was growing patients. Methodological quality assessment was performed. RESULTS The screening process resulted in the exclusion of 1079 references, resulting in only 9 remaining papers that fulfilled the inclusion criteria. No randomized clinical trials were found. The quality scores ranged from 36% to 68% of the maximum achievable, and the mean quality score of the studies was 50%. No good quality studies were detected in our sample. CONCLUSIONS Inconsistencies in the CBCT protocols utilized were detected between studies. Head posture, tongue position, and segmentation protocols were not consistent. These discrepancies were reflected in the different results obtained in the studies. A valid and consistent protocol with regard to head and tongue positioning, as well as nasal cavity volume segmentation, is required.
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Tonello DL, Ladewig VDM, Guedes FP, Ferreira Conti ACDC, Almeida-Pedrin RR, Capelozza-Filho L. Midpalatal suture maturation in 11- to 15-year-olds: A cone-beam computed tomographic study. Am J Orthod Dentofacial Orthop 2017; 152:42-48. [DOI: 10.1016/j.ajodo.2016.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022]
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