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Cannatà D, Galdi M, Scelza C, Simeon V, Giordano F, Martina S. Impact of maxillary expansion on the sagittal skeletal and dental parameters of growing Class II patients: A systematic review with meta-analysis. Orthod Craniofac Res 2024. [PMID: 39244738 DOI: 10.1111/ocr.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024]
Abstract
A "spontaneous" correction of the Class II malocclusion has been described after maxillary expansion (ME) treatment. The aim of the present review was to systematically summarize changes in the sagittal dentoskeletal parameters of growing Class II patients after ME. The study protocol was developed according to the PRISMA statement and registered in PROSPERO before literature search, data extraction and analysis. The PICO model was followed in the definition of the research question, search strategies and study selection criteria. Randomized and non-randomized studies on the sagittal effects of ME published in English language without date restrictions were electronically searched across the Cochrane Library, Scopus and MEDLINE/PubMed databases. Changes in sagittal dentoskeletal cephalometric parameters were analysed. The risk of bias in randomized and nonrandomized studies was assessed using the Rob2 and ROBINS-I tools, respectively. A narrative synthesis was performed, focusing on the investigated population, intervention, comparison, and main outcomes. Pairwise meta-analyses were used to compare the outcomes assessed in subjects who underwent ME versus untreated subjects. Ten studies met the inclusion criteria, four were included in the pairwise meta-analyses due to the presence of a control group. Slight but significant improvements in OVJ (MD: -0.36; 95%; CI [-0.69 to -0.01]; p = .04) and 6/6 molar relation (MD: 1.5; 95%; CI [0.69 to 1.61]; p < .0001) were found in patients who underwent ME compared with untreated subjects, whereas no improvement in skeletal parameters was observed. However, the limitations of a small body of moderate-quality evidence and possible confounding factors should be considered. Evidence on the sagittal skeletal and dental effects of ME in Class II patients is still ambiguous, suggesting the need for more clinical trials, including appropriate control subjects, randomization and blinding during outcome assessment.
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Affiliation(s)
- Davide Cannatà
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Marzio Galdi
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Carmine Scelza
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Mental Health and Public Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Abate A, Ugolini A, Bruni A, Quinzi V, Lanteri V. Three-dimensional assessment on digital cast of spontaneous upper first molar distorotation after Ni-ti leaf springs expander and rapid maxillary expander: A two-centre randomized controlled trial. Orthod Craniofac Res 2024. [PMID: 39244736 DOI: 10.1111/ocr.12849] [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: 07/16/2024] [Revised: 08/01/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE The aim of this randomized controlled trial (RCT) was to evaluate the spontaneous distorotation of upper first permanent molars and the transverse dentoalveolar changes on digital casts in growing patients following maxillary expansion treatment using either the Leaf Expander® or the rapid maxillary expander (RME), both anchored to the deciduous second molar. TRIAL DESIGN AND SETTING This study was a two-arm, parallel-assignment, RCT with a dual-centre design conducted at two teaching hospitals in Italy. PARTICIPANTS Inclusion criteria included maxillary transverse deficiency, prepubertal development stage (cervical vertebra maturation stage [CVMS] 1-2) and early mixed dentition with fully erupted upper first permanent molars. Exclusion criteria were systemic diseases or syndromes, CVMS 3-6, agenesis of upper second premolars, unavailability of the second deciduous molar for anchorage and Class III malocclusion. RANDOMIZATION Patients were randomly assigned to the Leaf Expander® or RME group using a computer-generated randomization list created by a central randomization centre. Randomization was conducted immediately before the start of treatment. INTERVENTION The intervention involved treatment with either the Leaf Expander® or the RME. Both devices were anchored to the second deciduous molars. Following randomization, patients were further categorized based on the presence of no crossbite, unilateral crossbite or bilateral crossbite. MAIN OUTCOME MEASURE The primary outcome measure was the distorotation of the upper first molar (U6). Secondary outcomes included measurements of interdental linear dimensions, specifically upper inter-canine width (53-63), upper inter-molar width (MV16-MV26) and upper inter-deciduous second molar width (55-65). BLINDING The examiner analysing the digital casts was blinded to the treatment groups to prevent detection bias and ensure objective assessment. However, due to the nature of the intervention, blinding was not feasible for the patients and clinicians involved in administering the treatment. RESULTS A total of 150 patients were enrolled and randomly assigned to two groups: 75 to the Leaf Expander® group and 75 to the RME group. Recruitment started in November 2021 and was completed in November 2022. At the time of analysis, the trial was complete with no ongoing follow-ups. ANOVA tests revealed no significant differences between the three subgroups (no-cross, unilateral-cross and bilateral-cross) within both the Leaf Expander® and RME groups at T0. The Leaf Expander® demonstrated significantly greater distorotation in the unilateral crossbite subgroup compared to the RME (p = .014). In terms of total molar distorotation, the Leaf Expander® appliance showed a significantly greater effect (12.66°) compared with conventional RME (7.83°). Linear regression analysis demonstrated a significant correlation between the extent of expansion and the degree of molar rotation. CONCLUSIONS Maxillary expansion resulted in significant spontaneous molar distorotation when the appliance was bonded to the second deciduous molars. The Leaf Expander® exhibited significantly greater molar distorotation compared with conventional RME. The degree of molar distorotation was correlated with the extent of expansion obtained on the second deciduous molar. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (ID: NCT05135962).
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Affiliation(s)
- Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, Genoa, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, Genoa, Italy
| | - Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Quinzi
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, L'Aquila, Italy
| | - Valentina Lanteri
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, Modena, Italy
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Hansson S, Josefsson E, Lund H, Miranda-Bazargani S, Magnuson A, Lindsten R, Bazargani F. Skeletal effects of posterior crossbite treatment with either quad helix or rapid maxillary expansion: a randomized controlled trial with 1-year follow-up. Angle Orthod 2024; 94:512-521. [PMID: 39230018 PMCID: PMC11363985 DOI: 10.2319/010424-9.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/01/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To assess skeletal and dental effects and evaluate possible side effects of maxillary expansion with two different appliances, directly after expansion and 1 year postexpansion. MATERIALS AND METHODS Forty-two patients with unilateral posterior crossbite (mean 9.5 ± 0.9 years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous second molars and bonded to the primary canines or slow expansion with quad helix (QH) on the permanent first molars. Cone-beam computed tomography records were taken at baseline, directly after correction of the posterior crossbite and at follow-up 1 year after expansion. RESULTS All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly (mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture could be shown in the QH group after expansion, P < .001. Buccal bone width had significantly decreased (P < .001) in the QH group compared with the RME group. Buccal fenestrations and root resorption on the left first molar had a higher prevalence directly after expansion finished in the QH group (P = .0086, P = .013) but were not significant at 1-year follow-up (P = .11, P = .22). CONCLUSIONS Opening of the suture with RME was more anterior and inferior, and the QH did not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the permanent first molar in patients treated with conventional QH than RME anchored to deciduous teeth.
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Affiliation(s)
| | | | | | | | | | | | - Farhan Bazargani
- Corresponding author: Dr Farhan Bazargani, Department of Orthodontics, Sahlgrenska Academy, Gothenburg University, PO Box 450, SE-405 30 Gothenburg, Sweden. (e-mail: )
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Ciavarella D, Lorusso M, Fanelli C, Ferrara D, Esposito R, Laurenziello M, Esperouz F, Lo Russo L, Tepedino M. The Efficacy of the RME II System Compared with a Herbst Appliance in the Treatment of Class II Skeletal Malocclusion in Growing Patients: A Retrospective Study. Dent J (Basel) 2024; 12:254. [PMID: 39195098 DOI: 10.3390/dj12080254] [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: 07/06/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
(1) Background: The objective of this study was to evaluate the efficacy of the Rapid Maxillary Expander (RME) II System compared to a Herbst appliance and a control group in the treatment of class II skeletal malocclusions in growing patients. (2) Methods: A total of 30 class II patients treated using the RME II System (group R) were compared with 30 patients treated with a Herbst appliance (group H) and 30 untreated class II children (group C). Cephalograms were compared at the start (T0) and after 24 months (T1). Nine cephalometric parameters were analyzed: SN-MP, SN-PO, ANB, AR-GO-ME, AR-GO-N, N-GO-ME, SN-PP, LFH, CO-GN, 1+SN, IMPA, OVERJET, and OVERBITE. Since the variables failed the normality test, a Wilcoxon test was performed for a pairwise comparison of the cephalometric measurements taken at T0 (pre-treatment) and at T1 (post-treatment). ANOVA with Tukey post hoc correction was used to evaluate the differences among the groups. (3) Results: ANOVA showed a statistically significant difference for all analyzed variables except for AR-GO-ME, AR-GO-N, and N-GO-ME. Post hoc Tukey's HSD test showed the following difference: the SN-PO angle in group H was 3.59° greater than in group R; the LFH in group H was 4.13 mm greater than in group R. The mandibular length (CO-GN) in group H was 3.94 mm greater than in group R; IMPA in group H was 6.4° greater than in group R; and the ANB angle in group H was 1.47° greater than in group R. (4) Conclusions: The RME II System is an effective therapeutic device for class II skeletal malocclusion treatment in growing patients.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Carlotta Fanelli
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Donatella Ferrara
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, 67100 L'Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Fariba Esperouz
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, 67100 L'Aquila, Italy
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Silva I, Miranda F, Bastos JCDC, Garib D. Comparison of alveolar bone morphology after expansion with hybrid and conventional Hyrax expanders. Angle Orthod 2024; 94:414-420. [PMID: 39229946 PMCID: PMC11210521 DOI: 10.2319/092623-650.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To compare the buccal and palatal bone changes of maxillary posterior teeth produced by hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients. MATERIAL AND METHODS A sample of 32 patients with posterior crossbites in the late mixed dentition was recruited and randomly allocated into two groups. Group HH was composed of 18 individuals with a mean age of 10.7 years (six female, 12 male) treated with a hybrid expander with two anterior parasagittal miniscrews. Group CH was composed of 14 individuals with a mean age of 11.4 years (six female, eight male) treated with a conventional Hyrax expander. Cone-beam computed tomography (CBCT) exams were obtained before expansion (T1) and after 11 months when the expander was removed (T2). Buccal and palatal bone plate thickness and height of maxillary posterior teeth were measured. Intergroup comparisons were performed using t or Mann-Whitney tests (P < .05). RESULTS The CH group showed greater decreases of the buccal bone plate height (mean change: 1.27 mm) at the maxillary first premolars compared to the HH group (mean change: 0.11 mm, P = .001). No intergroup difference was found for changes in the buccal and palatal bone thickness. CONCLUSIONS Hybrid expanders showed a tendency to cause less negative impact on the buccal bone plate height of first premolars compared to conventional Hyrax expanders. However, the difference was not clinically significant. Both hybrid and conventional Hyrax expanders are safe for the alveolar bone morphology in the late mixed dentition.
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Affiliation(s)
- Ivan Silva
- Corresponding author: Dr Ivan Silva, Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru 17012-901, Brazil (e-mail: )
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Sader LHB, Siécola G, Marin Ramirez CM, Otazu A, Torres DM, Cotrin P, Valarelli FP, Pinzan-Vercelino CRM, Freitas KMS. Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion. Orthod Craniofac Res 2024; 27:421-428. [PMID: 38124269 DOI: 10.1111/ocr.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE(S) This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. RESULTS The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. CONCLUSION Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.
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Affiliation(s)
| | - Gustavo Siécola
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | - Aldo Otazu
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Dino Marcelo Torres
- Department of Orthodontics, Institute of Advanced Dentistry, Asunción, Paraguay
| | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil
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Ahmed AS, Al-Nimri KS, Ahmed WS. Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial. Clin Oral Investig 2024; 28:338. [PMID: 38797781 DOI: 10.1007/s00784-024-05724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. MATERIALS AND METHODS Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. RESULTS Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. CONCLUSIONS Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. CLINICAL RELEVANCE Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.
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Affiliation(s)
- Amgad S Ahmed
- Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Kazem S Al-Nimri
- Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Wesam S Ahmed
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
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Chen R. Effects of rapid maxillary expansion on anchorage alveolar bone meta-analysis. Acta Odontol Scand 2023; 81:499-507. [PMID: 37074788 DOI: 10.1080/00016357.2023.2199862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Rapid maxillary expansion (RME) is a routine method for correcting transverse maxillary deficiency. This paper investigated the effect of RME on anchorage alveolar bone and examined the differences between micro-implant-assisted RME and conventional RME. METHODS Relevant articles were selected from the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Review Manager software (v.5.3) was used for the pooled analysis and Cochran Q and I2 statistic tests were used to assess the heterogeneity. RESULTS Following conventional RME, the distal buccal alveolar bone thickness and the mesiobuccal alveolar thickness of the maxillary first molars were significantly reduced. Hyrax (standard mean difference [SMD]: -0.93, 95% confidence interval [CI]: -1.20-0.66) and Haas procedures (SMD: -0.88, 95% CI: -1.40-0.36) significantly reduced the buccal vertical alveolar height of the maxillary first molars. Similar results were obtained for the maxillary first premolars following RME. The thickness of the buccal alveolar bone decreased with conventional RME compared to when using the method assisted by micro-implants. CONCLUSIONS Conventional RME can reduce the thickness and vertical height of maxillary alveolar bone, and there is less loss of alveolar bone when using micro-implant-assisted RME. Further research is needed to validate the findings.
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Affiliation(s)
- Ruijun Chen
- Department of Orthodontic, Beijing Daxing Xingye Dental Hospital, Beijing, China
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Savoldi F, Fung KKF, Mak WS, Kan EYL, Yang Y, Kwok KL, Gu M. Are the severity of obstruction and the apnea-hypopnea index related to orofacial anatomy in children with obstructive sleep apnea? a kinetic MRI study. Dentomaxillofac Radiol 2023; 52:20220422. [PMID: 37192022 PMCID: PMC10304841 DOI: 10.1259/dmfr.20220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction. METHODS MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). RESULTS As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = -0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = -0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). CONCLUSIONS In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Kevin KF Fung
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Elaine YL Kan
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR, PRC
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong, Hong Kong SAR, PRC
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Alkadhi OH, Alotaibi LH, Alrashoud RR, Almutairi MH, Al Matar HA, Mallineni SK. Effect of Maxillary Expansion on the Maxillary Arch Width in Patients with Bilateral Cleft Palate: A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:762. [PMID: 37238310 PMCID: PMC10217325 DOI: 10.3390/children10050762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/01/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To perform a comprehensive review of the literature to compare the effects of slow maxillary expansion (SME) and rapid maxillary expansion (RME) on maxillary arch width in patients with bilateral cleft palate. METHODS The databases include Medline, PubMed, Cochrane (CENTRAL) and (CDSR), OpenGrey, and ClinicalTrials.gov were searched for relevant studies that met the eligibility criteria published before or on 31 October 2022. The search was confined to the English language. The selection of eligible studies and collection of data were performed independently. Risk of bias assessment was conducted using the Cochrane Risk of Bias tool 2.0. RESULTS Two randomized controlled trials were available based on the search in the published literature. Both studies compared arch width between SME and RME in cleft palate patients and digitals casts and three-dimensional images used for the evaluation. A moderate risk of bias was evident in the available studies. CONCLUSIONS Both SME and RME can achieve similar amounts of maxillary expansion in patients with bilateral cleft palate.
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Affiliation(s)
- Omar H Alkadhi
- Preventive Dentistry Department, College of Dentistry, Riyadh Elm University (REU), Riyadh 13244, Saudi Arabia
| | - Lamis Hejab Alotaibi
- Department of Preventive Dental Science, College of Dentistry, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Rowaida R Alrashoud
- College of Dentistry, Riyadh Elm University (REU), Riyadh 13244, Saudi Arabia
| | - Mohammed Hamad Almutairi
- General Dentist, College of Dentistry, Prince Sattam bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | | | - Sreekanth Kumar Mallineni
- Pediatric Dentistry, Dr. Sulaiman Al Habib Hospital, Ar Rayyan, Riyadh 14212, Saudi Arabia
- Center for Transdisciplinary Research (CFTR), Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
- Division for Globalization Initiative, Liaison Center for Innovative Dentistry Graduate School of Dentistry, Tohoku University, Sendai 980-8575, Japan
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Bistaffa AGI, Belomo-Yamaguchi L, Almeida MRD, Conti ACDCF, Oltramari PVP, Fernandes TMF. Immediate skeletal effects of rapid maxillary expansion at midpalatal suture opening with Differential, Hyrax and Haas expanders. Dental Press J Orthod 2023; 27:e2220525. [PMID: 36790245 DOI: 10.1590/2177-6709.27.6.e2220525.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/24/2021] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to test the null hypothesis that there is no difference at the midpalatal suture opening after rapid maxillary expansion (RME) using Expander with Differential Opening (EDO), Hyrax-type and Haas-type expanders. METHODS Occlusal radiographs of 52 patients (19 males and 33 females; average age= 9.46?1.20 years) treated with RME were divided into three groups, according to the expander used: EDO (n=17), Hyrax-type (n=21) and Haas-type (n=14). The evaluated variables were: A) Distance between the maxillary central incisors at the incisal edge; B) Distance between the alveolar ridges at the midpalatal suture; C) Suture opening at 10-mm distance from the crest to posterior, at the midpalatal suture; D) Suture opening at 20-mm distance from the crest to posterior, at the midpalatal suture; and E) Suture opening at 30-mm distance from the crest to posterior, at the midpalatal suture. To assess the normality of variables, the Shapiro-Wilk test was performed. For intergroup comparison, ANOVA with a significance level of 5% was used. RESULTS At the region A, Hyrax-type (4.66 mm) and EDO (4.87 mm) groups presented larger openings than the Haas-type group (3.43 mm). In regions B and C, EDO showed a statistically significant greater opening than the Haas-type group. In region D, a smaller opening of the midpalatal suture was observed in the Haas-type group, compared to the Hyrax-type and EDO groups. CONCLUSIONS EDO and Hyrax-type produced greater immediate skeletal effects, compared with Haas-type, but these differences were about 1 mm and might not be clinically significant.
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Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod 2022; 23:47. [PMID: 36503984 PMCID: PMC9742070 DOI: 10.1186/s40510-022-00440-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients. OBJECTIVE The objective of this systematic review was to compare PROMs in RME versus SME in growing patients. MATERIALS AND METHODS Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied. RESULTS Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I2 = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction. CONCLUSIONS Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.
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Affiliation(s)
- Valentina Rutili
- grid.8404.80000 0004 1757 2304Postgraduate Program in Orthodontics, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Michele Nieri
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Debora Franceschi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Felicita Pierleoni
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Veronica Giuntini
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Lorenzo Franchi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy ,grid.214458.e0000000086837370Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA
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13
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Shayani A, Sandoval Vidal P, Garay Carrasco I, Merino Gerlach M. Midpalatal Suture Maturation Method for the Assessment of Maturation before Maxillary Expansion: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12112774. [PMID: 36428834 PMCID: PMC9689184 DOI: 10.3390/diagnostics12112774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Assessment of midpalatal suture maturation is crucial before deciding which type of maxillary expansion technique will be performed to treat transverse discrepancies. In 2013, Angelieri et al. proposed a new method to evaluate midpalatal maturation using cone-beam computed tomography. The aim of this study was to systematically identify, evaluate, and provide a synthesis of the existing literature about this new method and to rigorously assess the methodological quality of these articles. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluation, assessment, and assess. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Hence, 56 articles were obtained, of which only 10 met the selection criteria. We could not include any of the data into an analysis because of the large variation of the data collected and high methodological heterogeneity found among studies. Of all the studies included, 10% had poor quality, 70% fair, and 20% good quality, respectively. Even though age and sex play a role in midpalatal suture obliteration, there is a poor correlation between these variables. Thus, every patient should be assessed individually before choosing the best protocol for maxillary expansion. The midpalatal suture maturation method has the potential to be used for diagnostic purposes, but clinicians should be cautious of routinely using it because an extensive training and calibration program should be performed prior.
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Affiliation(s)
- Anis Shayani
- Master Program in Dental Science, Faculty of Dentistry, Universidad de la Frontera, Temuco 4780000, Chile
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Paulo Sandoval Vidal
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
- Correspondence:
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14
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Serafin M, Fastuca R, Caprioglio A. CBCT Analysis of Dento-Skeletal Changes after Rapid versus Slow Maxillary Expansion on Deciduous Teeth: A Randomized Clinical Trial. J Clin Med 2022; 11:jcm11164887. [PMID: 36013125 PMCID: PMC9409744 DOI: 10.3390/jcm11164887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022] Open
Abstract
The aim of the present study was to compare skeletal and dental changes after rapid maxillary expansion (RME) and slow maxillary expansion (SME) performed by a Leaf Expander (LE) with upper deciduous teeth as anchorage and using 3D CBCT (Cone Beam Computed Tomography) analysis. Mixed dentition patients were randomly divided in two groups, according to the different expansion used anchored on maxillary primary second molars: the RME group (n = 16) was treated with a Hyrax type expander, whereas the SME group (n = 16) was treated with an LE expander. CBCT scans were performed before (T1) and after treatment (T2) and analyzed with a custom landmarks system. A paired t-test was used for intragroup analysis between T1 and T2, and a Student t-test was used for intergroup analysis; statistical significance was set at 0.05. Both RME and SME groups showed a statistically significant increase in dental and skeletal diameters. Group comparisons between T1 and T2 showed a significant expansion rate in the RME group for upper permanent molars (p = 0.025) but not for deciduous molars (p = 0.790). Moreover, RME showed higher increases for skeletal expansion evaluated at nasal walls (p = 0.041), whereas at pterygoid plates did not show any significant differences compared with the SME group (p = 0.849). A significant transverse expansion could be achieved with the expander anchored on deciduous teeth. RME and SME produced effective both skeletal and dentoalveolar transverse expansion; RME produced more anterior expansion than SME but less control regarding the permanent molar decompensation. SME by LE therefore could be an efficient and helpful alternative in the treatment of transverse maxillary deficiency in growing patients.
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Affiliation(s)
- Marco Serafin
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-348-833-5831
| | | | - Alberto Caprioglio
- Department of Biomedical, Surgical and Dental Sciences, Section of Orthodontics, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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15
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A Modified Hyrax-Type Expander Is Effective for Distal Bodily Movement of the Maxillary First Molar. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impaction and eruption disturbance of permanent teeth are frequently encountered in orthodontic practice. The canine teeth play an important role both functionally and esthetically. Eruption disturbance of a maxillary canine, if left untreated, can cause not only disturbed jaw movement and esthetic problems, but also root resorption of adjacent permanent teeth, and thus should be diagnosed and treated appropriately. In this report, we present a case of a patient with eruption disturbance of the maxillary left canine in which the maxillary left second molar was extracted and the maxillary left first molar was distally moved with a Hyrax-type expander (Veltri Monolateral Screw®; Leone, Firenze, Italy) designed to enable the distal movement of a unilateral first molar in order to create eruption space for the maxillary left canine, resulting in smooth distal molar movement and alignment of the left maxillary canine in the dental arch. Furthermore, the maxillary third molar was also aligned to achieve a good occlusal relationship without reducing the number of teeth.
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16
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Ayub PV, Garib DG, Ebrahim H, Polido J, Blasca W, Yen S. Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate. Dental Press J Orthod 2022; 27:e2220233. [PMID: 35792786 PMCID: PMC9255986 DOI: 10.1590/2177-6709.27.3.e2220233.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to compare the occlusal changes of rapid maxillary expansion (RME) and slow maxillary expansion (SME) in patients with unilateral complete cleft lip and palate (UCLP), by means of digital dental models. Methods: Group RME was composed by 22 patients (13 males and 9 females), with mean age of 9.9 years, treated with rapid maxillary expansion with Hyrax appliance in Center 1. Group SME was composed by 29 patients (14 females and 15 males), with mean age of 10.7 years, treated with slow maxillary expansion with quad-helix appliance in Center 2. Digital dental models of the maxillary dental arch were obtained immediately pre-expansion (T1) and 6-month post-expansion (T2). Transversal distances, arch perimeter, arch length, palatal depth, palatal volume and posterior tooth inclination were digitally measured. Interphase and intergroup comparisons were performed with paired t-test and independent t-test, respectively. Results: Intercanine expansion was 4 to 5mm in both groups, and increase in the intercanine distance was similar for both groups. RME group showed a greater increase in arch distances at the region of permanent premolar and molars, compared to SME group. Arch perimeter increase was greater for RME group, compared to SME. No differences were found for arch length, palatal depth, palatal volume and posterior tooth buccal tipping. Conclusion: RME and SME produced similar dentoalveolar outcomes, with greater amount of expansion on RME group.
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Affiliation(s)
- Priscila Vaz Ayub
- Universidade Estadual Paulista, Faculdade de Odontologia, Departamento de Ortodontia (Araraquara/SP, Brazil)
| | - Daniela Gamba Garib
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia, Hospital de Reabilitação de Anomalias Craniofaciais (Bauru/SP, Brazil)
| | | | - José Polido
- University of Southern California, Ostrow School of Dentistry (Los Angeles/CA, USA).,Children's Hospital Los Angeles, Division of Dentistry (Los Angeles/CA, USA)
| | - Wanderléia Blasca
- Universidade de São Paulo. Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia e Audiologia (Bauru/SP, Brazil)
| | - Stephen Yen
- University of Southern California, Center for Craniofacial Molecular Biology (Los Angeles/CA, USA).,Children's Hospital Los Angeles, Craniofacial and Special Care Orthodontics (Los Angeles/CA, USA)
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17
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El-Beialy AR, El-Ashmawi NA, Abd El-Ghafour M. Canine root/cortical bone relation (CRCR) and the orthodontic tooth movement. Sci Rep 2022; 12:10714. [PMID: 35739156 PMCID: PMC9226186 DOI: 10.1038/s41598-022-14663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
This observational study evaluates three-dimensionally the relation between the root of maxillary canine and overlying labial cortical plate of bone during orthodontic canine retraction. Eighty-four bilateral maxillary canines in 42 patients were retracted in the extraction space of first premolars, using conventional orthodontic NiTi retraction spring delivering 150gm. Three-dimensional evaluation at the cusp tip, root apex, and the overlying cortical bone was done based on Classification of Root/Cortical bone relation (CRCR) before and after canine retraction. 168 observations of the canines pre- and post-retraction showed a mean distal movement of the canine cusp tip of 3.78(± 2.05) mm, while the canine root apex was almost stationary. Scarcely, 5.4% of the canine roots and root apices persisted in the medullary bone during retraction, while 16.1% contacted the overlying cortical bone. Fenestration of the overlying cortical bone by the canine roots or root apices occurred in 78.6% of the sample. The unembellished intimacy between the canine root and apex to the overlying thick dense cortical bone might have the decelerating effect on the maxillary canine retraction. The natural bone plate labial to the maxillary canine root did not yield infront nor enlarge due to canine retraction, but else defeated the current orthodontic biomechanical implementation.
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Affiliation(s)
- Amr R El-Beialy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt.
| | - Noha A El-Ashmawi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt
| | - Mohamed Abd El-Ghafour
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, 11553, Egypt
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18
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Success and complication rate of miniscrew assisted non-surgical palatal expansion in adults - a consecutive study using a novel force-controlled polycyclic activation protocol. Head Face Med 2021; 17:50. [PMID: 34895287 PMCID: PMC8665552 DOI: 10.1186/s13005-021-00301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Bone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents. Adult patients usually present a challenge, as they often require additional surgical assisted maxillary expansion (SARPE). There is still no clear statement about non-surgical expansion in adult patients using this technique. The aim of this study was to evaluate the success and complication rate of non-surgical palatal expansion in adults utilizing MAPE with a novel force-controlled polycyclic expansion protocol (FCPC). Methods This consecutive study consisted of 33 adult patients with an average age of 29.1 ± 10.2 years (min. 18 years, max. 58 years), including one dropout patient. First, four miniscrews were inserted and after 12-weeks latency, the expander was placed and the FCPC protocol was applied (MAPE group). In case of missing expansion, a SARPE was performed (SARPE group). After maximum expansion, a cone beam CT was made and widening of the midpalatal suture was measured. The outcome variables were successful non-surgical expansion and, with sample size power above 80%, the odds of failed non-surgical expansion and associated complications were evaluated. The primary predictor variable was age. Statistical analysis was performed using R (Version 3.1) to calculate power, to construct various models for measuring the odds of requiring surgical intervention/complications, and others. Results Successful non-surgical expansion was achieved in 27 patients (84.4%), ranging from 18 to 49 years. Mean age differed significantly between both groups (26.8 ± 8.2 years vs. 41.3 ± 9.9 years; p < 0.001). Mean expansion at the anterior and posterior palate for the MAPE group was 5.4 ± 1.5 mm and 2.5 ± 1.1 mm, respectively. Among these subjects’ complications were observed in 18.5%. Age significantly increased the odds of complications (p = 0.019). Conclusions 1. The success rate of MAPE among individuals aged 18 to 49 years was 84.4%. 2. A V-shaped expansion pattern in the antero-posterior dimension was mostly observed. 3. Complications were significantly associated with age. 4. A careful expansion protocol seems to be beneficial to prevent unfavorable results in adult patients. Trial registration Consecutive cohort study, Review Board No. EK-2-2014/0016.
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19
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Oliveira PLE, Soares KEM, Andrade RMD, Oliveira GCD, Pithon MM, Araújo MTDS, Sant'anna EF. Stress and displacement of mini-implants and appliance in Mini-implant Assisted Rapid Palatal Expansion: analysis by finite element method. Dental Press J Orthod 2021; 26:e21203. [PMID: 34468562 PMCID: PMC8405139 DOI: 10.1590/2177-6709.26.4.e21203.oar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: In this study, simulations were performed by the finite element method (FEM) to determine the tension and displacement in mini-implants and in expander appliance during rapid maxillary expansion, by varying the number and location of the mini-implants. Methods: For the computational simulation, a three-dimensional mesh was used for the maxilla, mini-implants and expander appliance. Comparisons were made on six different Mini-implant Assisted Rapid Palatal Expander (MARPE) configurations, by varying the amount and location of mini-implants. A closed suture was design and received two activations of 0.25 mm, and an open suture had a 0.5-mm aperture that received 20 activations, also of 0.25 mm. Results: For the closed suture, the maximum displacement values in the mini-implants were between 0.253 and 0.280 mm, and stress was between 1,348.9 and 2,948.2 MPa; in the expander appliance, the displacement values were between 0.256 and 0.281 mm, and stress was between 738.52 and 1,207.6 MPa. For the open suture, the maximum displacement values in the mini-implants were between 2.57 and 2.79 mm, and stress was between 5,765.3 and 10,366 MPa; in the appliance, the maximum displacements was between 2.53 and 2.89 mm, and stress was between 4,859.7 and 9,157.4 MPa. Conclusions: There were higher stress concentrations in the mini-implant than in the expander arm. In the simulations with a configuration of three mini-implants, stress overload was observed in the isolated mini-implant. Displacements of the mini-implants and arms of the appliance were similar in all simulations.
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Affiliation(s)
- Pedro Lima Emmerich Oliveira
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
| | | | | | | | - Matheus Melo Pithon
- Universidade Estadual do Sudoeste da Bahia, Departamento de Ortodontia e Odontologia Pediátrica (Vitória da Conquista/BA, Brazil)
| | - Mônica Tirre de Souza Araújo
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
| | - Eduardo Franzotti Sant'anna
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
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Colak C, Aras B, Cheng LL, Elekdag-Turk S, Turk T, Darendeliler MA. Effects of rapid and slow maxillary expansion on root resorption: a micro-computed tomography study. Eur J Orthod 2021; 43:682-689. [PMID: 34345908 DOI: 10.1093/ejo/cjab024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To compare root resorption (RR) after rapid maxillary expansion (RME) and slow maxillary expansion (SME) through micro-computed tomography (micro-CT). SUBJECTS AND METHODS Twenty-six subjects who required maxillary expansion and bilateral upper first premolar extraction were randomly assigned to RME (n = 13, mean age: 13.25 ± 0.88 years) or SME (n = 13, mean age: 13.53±1.28 years) group. A hyrax-type acrylic bonded expansion appliance was used. The Hyrax screw was activated ¼ turn twice a day for 20 days in the RME group and ¼ turn every second day for 80 days in the SME group. One randomly selected upper first premolar was extracted in each patient after active expansion. The appliance was left in situ for a 24-week retention period then the contralateral upper first premolar was extracted. Extracted teeth were scanned with micro-CT and the volume of the resorption craters was analysed with a specialized software. Transversal skeletal and dental widths were measured on posteroanterior radiographs taken before and after expansion and retention periods. RESULTS The resorption craters were concentrated mostly on the buccal surface and middle level in all samples. The total RR in the RME group was less post-expansion (P ≤ 0.05) and more post-retention (P > 0.05) than the SME group. During retention, there was a significant decrease in the total RR in the SME group (P > 0.05) and an increase in the RME group. Both RME and SME groups displayed a similar increase in skeletal transverse dimensions, but inter-molar width increased significantly more in the SME group during the whole experimental period. CONCLUSION RME does not have an advantage over SME in terms of skeletal expansion and the amount of RR when a retention period of six months is followed.
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Affiliation(s)
- Canan Colak
- Orthodontist, Private Practice, Esentepe Mah. FSM Bulvari Bahar Sitesi A Blok No: 96/5 Nilüfer/Bursa, Turkey
| | - Banu Aras
- Orthodontist, Former Senior Dental Registrar, Sydney Dental Hospital, Sydney, Australia
| | - Lam L Cheng
- Department of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
| | - Selma Elekdag-Turk
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Tamer Turk
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - M Ali Darendeliler
- Department of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
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21
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Bazargani F, Lund H, Magnuson A, Ludwig B. Skeletal and dentoalveolar effects using tooth-borne and tooth-bone-borne RME appliances: a randomized controlled trial with 1-year follow-up. Eur J Orthod 2021; 43:245-253. [PMID: 32761047 DOI: 10.1093/ejo/cjaa040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate and compare the skeletal and dentoalveolar effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion (RME). MATERIALS AND METHODS Fifty-two consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years [standard deviation (SD) 1.3], or the TBB group, mean age 9.5 years (SD 1.2). Cone-beam computed tomography (CBCT) records and plaster models were taken before (T0), directly after (T1), and 1 year after expansion (T2). Dentoalveolar and skeletal measurements were made on the CBCT images. The dental expansion was also measured on the plaster models. RANDOMIZATION Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. The randomization list was also stratified by sex to ensure homogeneity between groups. BLINDING Due to clinical limitations, only the outcomes assessors were blinded to the groups to which the patients were allocated. RESULTS Skeletal expansion in the midpalatal suture and at the level of the nasal cavity was significantly higher in the TBB group. However, the magnitude of the expansion in the midpalatal suture was around 1 mm [95 per cent confidence interval (CI) 0.5-1.7, P = 0.001] more and perhaps not clinically significant. The magnitude of the expansion at the level of the nasal cavity was almost two times higher in the TBB group (95 per cent CI 0.7-2.6, P = 0.001). The dental expansion, alveolar bending, tipping of the molars, and stability 1 year post-expansion did not show any statistically significant differences between the groups. The actual direct cost of the treatment for the TBB group was approximately €300 higher than TB group. LIMITATIONS Double blinding was not possible due to the clinical limitations. CONCLUSIONS In young preadolescents with constricted maxilla and no signs of upper airway obstruction, it seems that conventional TB RME achieves the same clinical results with good stability 1 year post-expansion at lower cost. TRIAL REGISTRATION The trial was not registered.
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Affiliation(s)
- Farhan Bazargani
- Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden
| | - Henrik Lund
- Institute of Odontology, Sahlgrenska Academy, Department of Oral and Maxillofacial Radiology, University of Gothenburg, Göteborg, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Björn Ludwig
- Private Orthodontic Office, Traben-Trarbach, Germany.,Department of Orthodontics, University of Saarland, Homburg/Saar, Germany
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22
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Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis. Eur J Orthod 2021; 43:301-312. [PMID: 33950178 DOI: 10.1093/ejo/cjaa086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND No systematic review and meta-analysis of dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols is available. OBJECTIVE To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients. SEARCH METHODS PubMed (MEDLINE), Cochrane Library, Scopus, Embase, and OpenGrey were searched with no language or publication date restrictions. SELECTION CRITERIA Only randomized controlled trials (RCTs) were selected and the following inclusion criteria were used: growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). For the aggregation of continuous data, the mean of the differences (MD) between treatments was used. A random effect model was applied. RESULTS From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias. Maxillary intermolar distance showed no significant differences between the two modalities of expansion [pooled MD = 0.99 mm favouring RME, with 95% confidence interval (CI) = -2.09 to 4.06, P = 0.53, I2 = 90%]. As for maxillary molar inclination measured as the angle formed by the axes passing through the disto-buccal cusps and the apexes of the palatine root of the first upper molars, it was significantly smaller in the SME group (MD = -11.51°, with 95% CI = -15.23 to -7.79, P < 0.0001). Posterior maxillary expansion was significantly greater in RME than SME (pooled MD = 0.75 mm, with 95% CI = 0.27-1.23, P = 0.002, I2 = 0%). CONCLUSIONS Both RME and SME produce an effective dento-skeletal expansion of the maxilla. RME is slightly more effective in increasing the posterior transverse skeletal width of the maxilla while SME induces smaller molar inclination. REGISTRATION PROSPERO CDR42018105530.
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Affiliation(s)
- Valentina Rutili
- Postgraduate Program in Orthodontics, Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | | | - Michele Nieri
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Debora Franceschi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Felicita Pierleoni
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA
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Sperl A, Gaalaas L, Beyer J, Grünheid T. Buccal alveolar bone changes following rapid maxillary expansion and fixed appliance therapy. Angle Orthod 2021; 91:171-177. [PMID: 33289805 DOI: 10.2319/060220-504.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess factors that may be associated with buccal bone changes adjacent to maxillary first molars after rapid maxillary expansion (RME) and fixed appliance therapy. MATERIALS AND METHODS Pretreatment (T1) and posttreatment (T2) cone-beam computed tomography scans were obtained from 45 patients treated with RME and preadjusted edgewise appliances. Buccal alveolar bone thickness was measured adjacent to the mesiobuccal root of the maxillary first molar 4 mm, 6 mm, and 8 mm apical to the cementoenamel junction, and anatomic defects were recorded. Paired and unpaired t-tests were used to compare alveolar bone thickness at T1 and T2 and to determine whether teeth with posttreatment anatomic defects had thinner initial bone. Correlation analyses were used to examine relationships between buccal alveolar bone thickness changes and amount of expansion, initial bone thickness, age at T1, postexpansion retention time, and treatment time. RESULTS There was a statistically significant reduction in buccal alveolar bone thickness from T1 to T2. Approximately half (47.7%) of the teeth developed anatomic defects from T1 to T2. These teeth had significantly thinner buccal bone at T1. Reduction in alveolar bone thickness was correlated with only one tested variable: initial bone thickness. CONCLUSIONS RME and fixed-appliance therapy can be associated with significant reduction in buccal alveolar bone thickness and an increase in anatomic defects adjacent to the expander anchor teeth. Anchor teeth with greater initial buccal bone thickness have less reduction in buccal bone thickness and are less likely to develop posttreatment anatomic defects of buccal bone.
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Lanteri V, Cavagnetto D, Abate A, Mainardi E, Gaffuri F, Ugolini A, Maspero C. Buccal Bone Changes Around First Permanent Molars and Second Primary Molars after Maxillary Expansion with a Low Compliance Ni-Ti Leaf Spring Expander. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9104. [PMID: 33291246 PMCID: PMC7730214 DOI: 10.3390/ijerph17239104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
Background: Vestibular bone thickness changes and dento-alveolar buccal tipping of second primary molars and of first molars after maxillary expansion performed with a slow maxillary expansion protocol was investigated. Methods: Twenty patients (mean age 7.3 ± 0.9 years old; 9 male and 11 female) were treated according to the Leaf Expander protocol. Buccal alveolar bone thickness (BT), buccal alveolar bone height (BH), inter-dental angle (TIP), and inter-molar width (IW) regarding first molars and second primary molars were calculated before and after expansion on cone beam computed tomography (CBCT) images. Descriptive statistics and paired t-tests were used to assess changes between the pre-treatment and post-treatment measurements. Results: Bone thickness vestibular to second primary molars and intermolar width of both teeth were the only variables that showed statistically significant changes. Conclusions: It appears that buccal bone thickness vestibular to first molars was not significantly reduced after maxillary expansion with the Leaf Expander. The clinical use of a slow maxillary expander with Ni-Ti springs appears efficient and safe in in the correction of maxillary hypoplasia during mixed dentition.
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Affiliation(s)
- Valentina Lanteri
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Davide Cavagnetto
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Andrea Abate
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Eleonora Mainardi
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Francesca Gaffuri
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16132 Genova, Italy;
| | - Cinzia Maspero
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (V.L.); (D.C.); (A.A.); (E.M.); (F.G.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
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Cozzani M, Antonini S, Lupini D, Decesari D, Anelli F, Doldo T. A New Proposal: a Digital Flow for the Construction of a Haas-Inspired Rapid Maxillary Expander (HIRME). MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2898. [PMID: 32605189 PMCID: PMC7372468 DOI: 10.3390/ma13132898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Abstract
Maxillary expansion is a common orthodontic treatment used for the correction of posterior crossbite resulting from reduced maxillary width. Transverse maxillomandibular discrepancies are a major cause of several malocclusions and may be corrected in different manners; in particular, the rapid maxillary expansion (RME) performed in the early mixed dentition has now become a routine procedure in orthodontic practice. The aim of this study is to propose a procedure that reduces the patient cooperation as well as the lab work required in preparing a customized Haas-inspired rapid maxillary expander (HIRME) that can be anchored to deciduous teeth and can be utilized in mixed dentition with tubes on the molars and hooks and brackets on the canines. This article thus presents an expander that is completely digitally developed, from the first moment of taking the impression with an optical scanner to the final solidification phase by the use of a 3D printer. This digital flow takes place in a CAD environment and it starts with the creation of the appliance on the optical impression; this design is then exported as an stl extension and is sent to the print service to obtain a solid model of the device through a laser sintering process. This "rough" device goes through a post-processing procedure; finally, a commercial expansion screw is laser-welded. This expander has all the advantages of a cast-metal Haas-type RME that rests on deciduous teeth; moreover, it has the characteristic of being developed with a completely digitized and individualized process, for the mouth of the young patient, as well as being made completely of cobalt-chrome, thus ensuring greater adaptability and stability in the patient's mouth.
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Affiliation(s)
| | | | - Daniela Lupini
- Department of Medical, Surgical and Health Sciences, School of Dentistry, Università di Trieste, 34100 Trieste, Italy;
| | | | - Fabrizio Anelli
- Teor laboratorio specializzato in ortodonzia, 80 47923 Rimini, Italy;
| | - Tiziana Doldo
- Dipartimento di Biotecnologie Mediche, Università di Siena, 53100 Siena, Italy;
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Authors' response. Am J Orthod Dentofacial Orthop 2020; 157:734-735. [PMID: 32487299 DOI: 10.1016/j.ajodo.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 11/21/2022]
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27
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Mandelaris GA, Huang I, Relle R, Vence BS, DeGroot BS. Surgically Facilitated Orthodontic Therapy (SFOT): Diagnosis and Indications in Interdisciplinary Dentofacial Therapy Involving Tooth Movement. Clin Adv Periodontics 2020; 10:204-212. [PMID: 32096352 DOI: 10.1002/cap.10102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/03/2020] [Indexed: 11/06/2022]
Abstract
FOCUSED CLINICAL QUESTION What are the key considerations for the interdisciplinary dentofacial therapy (IDT) team in the diagnostic process to evaluate a patient for surgically facilitated orthodontic therapy (SFOT)? SUMMARY SFOT creates a demineralized bone matrix and augments dentoalveolar deficiencies in the management of dentofacial disharmony malocclusion. Numerous indications and contraindications exist which are essential to the periodontal surgeon for proper case selection. A collaboratively focused workup by an IDT team is equally essential. Cone beam computed tomography (CBCT) and orthodontic simulation software which identifies changes in the dentoalveolar complex influenced by tooth movement are critical in providing transparency to the patient and IDT team during the treatment planning process. Such transparency can aid the team in assessing goals and outcomes that consider and respect foundational dentoalveolar parameters while contributing to sustainable outcomes. CONCLUSIONS The SFOT IDT decision making process is complex, yet full of opportunities. Embracing SFOT IDT with innovative and novel 3D technology can optimize conditions leading to long-term outcomes that align with periodontal stability as well as patient goals and preferences which permeate beyond the achievement of "straightening teeth". Transparency of complex IDT through 3D CBCT and orthodontic simulation software engenders "collaborative accountability" and can improve patient communication which is critical to developing meaningful and essential treatment plans.
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Affiliation(s)
- George A Mandelaris
- Private Practice, Periodontics and Dental Implant Surgery, Periodontal Medicine & Surgical Specialists, LLC, Oakbrook Terrace, IL.,Department of Graduate Periodontics, College of Dentistry, University of Illinois, Chicago, IL.,Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Iwei Huang
- Private Practice, Orthodontics and Dentofacial Orthopaedics, Chicago, IL
| | - Robert Relle
- Private Practice, Oral and Maxillofacial Surgery, Los Angeles, CA.,Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California-Los Angeles, Los Angeles, CA
| | - Brian S Vence
- Private practice, Restorative Dentistry, Oakbrook Terrace, IL
| | - Bradley S DeGroot
- Private Practice, Periodontics and Dental Implant Surgery, Periodontal Medicine & Surgical Specialists, LLC, Oakbrook Terrace, IL
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Ploder O, Winsauer H, Juengling K, Grill F, Bissinger O, Wolff KD, Kolk A. Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances? J Oral Maxillofac Surg 2020; 79:213-224. [PMID: 32422194 DOI: 10.1016/j.joms.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For surgically assisted rapid palatal expansion (SARPE), studies comparing different devices are missing. The aim was to evaluate expansion, relapse, and the complication rates for 3 different appliances. PATIENTS AND METHODS In this retrospective cohort study, tooth-borne (TB, n = 29), bone-borne (BB, n = 12), or orthodontic mini-implant (OMI)-borne (n = 13) appliances were used for SARPE in 2 clinical centers. Patients presenting with a maxillary width discrepancy greater than 5 mm were included. Measurements of cast models and radiographs were performed preoperatively, immediately after consolidation, and at 1 year postoperatively. All distances were measured between canines, premolars, and molars. Complications (tooth damage, infection, technical failure) were evaluated. The outcome variables were expansion, relapse, and complications. Type of appliance was selected as predictor variable. Within- and between-group differences regarding expansion, relapse, and complications for the 3 appliances were statistically analyzed. RESULTS In 54 patients (aged 28.8 ± 8.6 years), mean expansion (±standard deviation) for the TB, BB, and OMI appliances immediately after consolidation was 5.29 ± 1.39 mm, 5.22 ± 1.72 mm, and 3.81 ± 2.19 mm, respectively, at the dental level, and 5.51 ± 1.40 mm, 4.66 ± 2.03 mm, and 3.51 ± 1.66 mm, respectively, at the bone level. Mean (±standard deviation) relapse for the TB, BB, and OMI appliances at 1 year postoperatively measured 1.44 ± 1.01 mm, 0.76 ± 1.37 mm, and 0.27 ± 1.63 mm, respectively, at the tooth level and 1.19 ± 0.93 mm, 0.71 ± 0.96 mm, and 0.12 ± 1.56 mm, respectively, at the bone level. Analysis of variance and the Tukey test showed significant differences between the TB and OMI appliances for expansion and relapse (P = .034 and P = .024, respectively). The overall complication rate differed significantly (P < .001), with rates of 17.2%, 66.7%, and 15.4% for the TB, BB, and OMI appliances, respectively. CONCLUSIONS BB and OMI appliances resulted in less relapse. Owing to the high complication rate, the further use of BB appliances is questionable.
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Affiliation(s)
- Oliver Ploder
- Head of Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Katharina Juengling
- Postdoctoral Student, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Florian Grill
- Resident, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Oliver Bissinger
- Senior Physician, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Klaus-Dietrich Wolff
- Head of Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Kolk
- Head of Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria; Formerly, Executive Senior Physician, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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Luiz Ulema Ribeiro G, Jacob HB, Brunetto M, da Silva Pereira J, Motohiro Tanaka O, Buschang PH. A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial. Int J Paediatr Dent 2020; 30:349-359. [PMID: 31755620 DOI: 10.1111/ipd.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study compared the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME) using cone-beam computed tomography (CBCT). AIM To evaluate the skeletal and dentoalveolar effects produced by two different maxillary expansion protocols. DESIGN Eligibility criteria included maxillary transverse deficiencies in children (mean age, 8.18 years old), randomly assigned to either RME or SME. At the outcome analysis phase, a sample of 29 subjects were analysed (RME group, N = 16 and SME group, N = 13). CBCT scans taken before expansion and 6 months later were evaluated. Five posterior and 6 anterior transverse measurements were made at different vertical levels. Treatment changes were analysed using paired t tests; independent t tests were used to compare the two groups. RESULTS There were statistically significant (P<.05) increases in maxillary width at the skeletal, alveolar, and dental levels for both groups, with significantly smaller increases at the more superior than inferior levels. The RME group exhibited statistically larger width increases than the SME group for all measures except interorbital width, anterior alveolar process width, and intercanine width. The group differences were greater for anterior than posterior apical base widths. CONCLUSIONS Rapid maxillary expansion produced greater orthopaedic effects than slow maxillary expansion, with the greatest effects occurring in the anterior apical base.
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Affiliation(s)
- Gerson Luiz Ulema Ribeiro
- Departamento de Estomatologia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil
| | - Helder B Jacob
- Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
| | | | | | - Orlando Motohiro Tanaka
- Centro de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, Curitiba, PR, Brazil
| | - Peter H Buschang
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, TX, USA
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Alves ACDM, Janson G, Mcnamara JA, Lauris JRP, Garib DG. Maxillary expander with differential opening vs Hyrax expander: A randomized clinical trial. Am J Orthod Dentofacial Orthop 2020; 157:7-18. [PMID: 31901284 DOI: 10.1016/j.ajodo.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this 2-arm parallel trial was to compare the dentoskeletal effects of the expander with differential opening (EDO) and the Hyrax expander in the mixed dentition. METHODS Patients aged 7-11 years with maxillary dental arch constriction and Class I or Class II sagittal relationships were randomly allocated into 2 study groups. The experimental group comprised 22 patients (10 males, 12 females) with a mean age of 8.46 years treated with the EDO. The comparison group was composed of 24 patients (6 males, 18 females), mean age of 8.92 years treated with the conventional Hyrax expander. One complete turn per day for 6 days was performed for the posterior screw of the EDO and for the Hyrax expander. The anterior screw of the EDO was activated 1 complete turn per day for 10 days. The primary outcomes were the anterior opening of the midpalatal suture, changes on the interincisal diastema width, maxillary dental arch widths, arch perimeter, arch length, palatal depth, inclination of maxillary posterior teeth and on dental arch shape, and the amount of differential expansion in the anterior region compared with the posterior region of the maxillary dental arch. Computer-generated randomization was used. Allocation was concealed with sequentially, numbered, sealed, and opaque envelopes. Blinding was applicable for outcome assessment only. Occlusal radiographs of the maxilla were obtained at the end of the active expansion phase (T2). Intraoral photographs were obtained immediately pre-expansion (T1) and at T2. Digital dental models were obtained at T1 and 6 months after the active expansion period (T3). Intergroup comparisons of T1-T2 changes were performed using multiple linear regression analysis (P < 0.05). The independent variables were both treatment and the starting forms. Bonferroni correction for multiple tests was applied. RESULTS The experimental group showed a significantly greater opening of the anterior region of the midpalatal suture, a greater increase of the interincisal diastema width, and greater increases of the intercanine distance and inter-first deciduous molar distance than the Hyrax expander. The experimental group showed a significant differential expansion between the anterior and posterior regions, whereas the Hyrax group produced a similar expansion in the canine and molar regions. Serious harm was not observed. CONCLUSIONS The EDO was capable of promoting greater orthopedic and dental changes in the anterior region of the maxilla than the conventional Hyrax expander. Similarity between the 2 expanders was observed for changes in the posterior region width, arch perimeter, arch length, palatal depth, and posterior teeth inclination.
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Affiliation(s)
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - James A Mcnamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, School of Medicine, and Center for Human Growth and Development, University of Michigan, Ann Arbor, Mich; Private practice, Ann Arbor, Mich
| | | | - Daniela Gamba Garib
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Haffaf RA, Hasan AK, Tizini M. Mandibular Behavior after Rapid Maxillary Expansion: A Clinical Study. Open Dent J 2019. [DOI: 10.2174/1874210601913010537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Rapid Maxillary Expansion (RME) is a primary part of the contemporary orthodontic treatment plans. In addition to the maxilla, it is important to know its effect on the other dentofacial components. Some studies showed dentofacial changes after RME in the sagittal and vertical planes. The clinical importance of these changes is controversial.
Objective:
To investigate the mandibular changes after RME as the only treatment intervention in the sagittal and vertical planes.
Methods:
Twenty-eight growing patients aged 4-14 years were included in the current study. The bonded acrylic splint expander was used. Lateral cephalometric radiographs were taken at the beginning of the treatment (T1) and after a retention phase of six months (T2). The mandibular changes were assessed using vertical parameters (SN.MP, MMA, LAFH/TAFH, S.AR/AR.GO) and sagittal parameters (SNB, S.N.POG, N.A.POG). The changes between T1 and T2 were examined by paired samples T-test.
Results:
Two parameters showed a backward rotation in the vertical plane. The parameter S.AR/AR.GO showed a significant increase. The skeletal convexity increased with no clinical significance.
Conclusion:
There were statistically significant changes in the sagittal and vertical planes with no clinical importance. RME may affect the mandibular condyle position.
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Siécola G, Henriques JFC, Freitas KMS, Janson G. Dentoalveolar changes in adults promoted by the use of auxiliary expansion arch: A cbct study. J Clin Exp Dent 2019; 11:e898-e905. [PMID: 31636859 PMCID: PMC6797465 DOI: 10.4317/jced.56169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 11/12/2022] Open
Abstract
Background The objective of this study was to evaluate the dentoalveolar effects and the changes of buccal cortical bone in the posterior area after expansion obtained with TMA auxiliary expansion arch in adult patients. Material and Methods A retrospective analysis of CT scans of 13 patients (6 male, 7 female) treated at a private clinic, taken immediately before and after the use of an auxiliary expansion archwire, was performed. Mean age at installation of TMA auxiliary expansion arch was 29.23 years (s.d.=9.13) and the mean age when the auxiliary arch was removed was 29.52 years (s.d.=9.16). Mean time of the use of the TMA auxiliary expansion arch was 0.29 years (s.d.=0.09). The patients used fixed appliances and after leveling and alignment, a TMA auxiliary expansion arch was installed, combined with the primary 0.017x0.025-inch thermoactivated Ni-Ti archwire. CBCT scans were taken at T1 and T2. Linear and angular measurements regarding the positioning of maxillary molar, premolars and canines were performed. Intragroup comparison of the variables at T1 and T2 was performed with dependent t tests. Results There was statistically significant transverse increase and buccal inclination of all teeth. The cortical bone showed adaptability and displacement in the same direction of tooth movement, but in smaller amounts. Conclusions The auxiliary expansion arch proved to be effective to correct dentoalveolar constriction in adult patients, by increasing the buccal dental inclination with larger displacements than the bone crest adaptation and with significant transverse gains. Key words:Cone-Beam Computed Tomography, Maxillary Expansion, Adult treatment.
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Affiliation(s)
- Gustavo Siécola
- D.D.S., M.Sc., Ph.D. Orthodontic graduate student. Department of Orthodontics, Bauru Dental School, University of São Paulo. Bauru, SP, Brazil
| | | | | | - Guilherme Janson
- D.D.S., M.Sc., Ph.D., M.R.C.D.C. (Member of the Royal College of Dentists of Canada). Professor and Head. Department of Orthodontics. Bauru Dental School, University of São Paulo, Brazil
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Jacob HB, Ribeiro GLU, English JD, Pereira JDS, Brunetto M. A 3-D evaluation of transverse dentoalveolar changes and maxillary first molar root length after rapid or slow maxillary expansion in children. Dental Press J Orthod 2019; 24:79-87. [PMID: 31390454 PMCID: PMC6677328 DOI: 10.1590/2177-6709.24.3.079-087.oar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of the present study was to conduct a randomized clinical trial comparing the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME). Maxillary permanent first molar root length and tooth movement through the alveolus were studied using cone-beam computed tomography (CBCT). METHODS Subjects with maxillary transverse deficiencies between 7 and 10 years of age were included. Using Haas-type expanders, children were randomly assigned to two groups: RME (19 subjects, mean age of 8.60 years) and SME (13 subjects, mean age of 8.70 years). RESULTS Buccal cortical, buccal bone thicknesses and dentoalveolar width decreased in both groups. In the RME group the greatest decrease was related to distal bone thickness (1.26 mm), followed by mesial bone thickness (1.09 mm), alveolar width (0.57 mm), and the buccal cortical (0.19 mm). In the SME group the mesial bone thickness decreased the most (0.87 mm) and the buccal cortical decreased the least (0.22 mm). The lingual bone thickness increased in the RME and SME groups (0.56 mm and 0.42 mm, respectively). The mesial root significantly increased in the RME group (0.52 mm) and in the SME group (0.40 mm), possibly due to incomplete root apex formation at T1 (prior to installation of expanders). CONCLUSIONS Maxillary expansion (RME and SME) does not interrupt root formation neither shows first molar apical root resorption in juvenile patients. Although slightly larger in the RME group than SME group, both activation protocols showed similar buccal bone thickness and lingual bone thickness changes, without significant difference; and RME presented similar buccal cortical bone changes to SME.
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Affiliation(s)
- Helder Baldi Jacob
- The University of Texas Health Science Center at Houston School of Dentistry, Department of Orthodontics (Houston/ TX, USA)
| | | | - Jeryl D English
- The University of Texas Health Science Center at Houston School of Dentistry, Department of Orthodontics (Houston/ TX, USA)
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Alomari EB, Sultan K. Efficacy of injectable platelet-rich plasma in reducing alveolar bone resorption following rapid maxillary expansion: A cone-beam computed tomography assessment in a randomized split-mouth controlled trial. Angle Orthod 2019; 89:705-712. [PMID: 30920874 DOI: 10.2319/091018-661.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of platelet-rich plasma (PRP) with its growth factors in minimizing the side effects of rapid maxillary expansion (RME) on the periodontal tissue of anchoring teeth using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A randomized, split-mouth clinical trial was conducted on 18 patients aged 12-16 years (14 ± 1.65) with a skeletal maxillary constriction who underwent RME using a Hyrax appliance. The sample was randomly divided into two groups: intervention and control sides. PRP was prepared and injected on the buccal aspect of supporting teeth in the intervention group. High-resolution CBCT imaging (H-CBCT) was carried out preoperatively (T0) and after 3 months of retention (T1) to study the buccal bone plate thickness (BBPT) and buccal bone crest level (BBCL) of anchoring teeth. Changes induced by expansion were evaluated using paired sample t-test (P < .05). RESULTS Results showed that there was no significant difference in BBPT and BBCL between the two groups after RME (P > .05). The prevalence of dehiscence and fenestrations was increased at (T1) in both groups and the percentage was higher in the PRP group. CONCLUSIONS RME induced vertical and horizontal bone loss. PRP did not minimize alveolar defects after RME.
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Gregório L, de Medeiros Alves AC, de Almeida AM, Naveda R, Janson G, Garib D. Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial. Angle Orthod 2019; 89:583-589. [PMID: 30741579 DOI: 10.2319/081018-589.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To compare the dentoskeletal effects of rapid (RME) and slow (SME) maxillary expansion in patients with bilateral complete cleft lip and palate (BCLP). MATERIALS AND METHODS This was a secondary analysis of a previous randomized controlled trial (RCT). Forty-six patients (34 male, 12 female) with BCLP and posterior crossbite (mean age of 9.2 years) were randomly assigned to two study groups. Group RME comprised subjects treated with Haas/Hyrax expander. Group SME included patients treated with quad-helix appliance. Cone-beam computed tomography (CBCT) was performed before expansion (T1) and after appliance removal at the end of a 6-month retention period (T2) for a previous RCT that compared the transverse skeletal effects of RME and SME. CBCT-derived cephalometric images were generated and cephalometric analysis was performed using Dolphin Imaging Software (Chatsworth, Calif). Intergroup comparisons were performed using t tests (P < .05). RESULTS Baseline forms were similar between groups. No significant differences between RME and SME groups were found. CONCLUSIONS Rapid and slow maxillary expansion produced similar sagittal and vertical changes in patients with BCLP. Both Haas/Hyrax and quad-helix appliances can be used in patients with vertical facial pattern. Clinical relevance: RME and SME can be equally indicated in the treatment of maxillary arch constriction in patients with BCLP.
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Bastos RTDRM, Blagitz MN, Aragón MLSDC, Maia LC, Normando D. Periodontal side effects of rapid and slow maxillary expansion: A systematic review. Angle Orthod 2019; 89:651-660. [PMID: 30741576 DOI: 10.2319/060218-419.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To identify the scientific evidence that demonstrates which of the transverse maxillary treatments has the least effect on periodontal tissues. MATERIALS AND METHODS PubMed (MEDLINE), Cochrane Library, Scopus, Web of Science, Virtual Health Library, Google Scholar, and OpenGrey were searched without restrictions. A hand search was also carried out in the reference lists of the articles selected. The related articles tool in the PubMed database was checked for each article included. Risk of bias assessment was performed using Cochrane Collaboration's Risk of Bias tool for randomized clinical trials and the ROBINS-I tool for nonrandomized studies of interventions. The GRADE tool was used to assess the quality of the evidence. RESULTS After examination of the full texts, three studies were finally included. Two studies used a Haas expander with different protocols, and one study used a Haas expander compared with a quad-helix appliance. These studies evaluated periodontal parameters and periodontal indices by clinical examination with a millimeter probe, and one study examined computed tomography images. After quality assessment, two studies were considered as having a "low" risk of bias. One study was scored as having a moderate risk of bias. The evidence was graded as moderate quality for alveolar bone level, tooth displacement, and inclination and very low for all other outcomes. CONCLUSIONS There were no significant differences to enable a sound conclusion about which type of maxillary expansion has the least periodontal side effects.
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Lemos Rinaldi MR, Azeredo F, Martinelli de Lima E, Deon Rizzatto SM, Sameshima G, Macedo de Menezes L. Cone-beam computed tomography evaluation of bone plate and root length after maxillary expansion using tooth-borne and tooth-tissue-borne banded expanders. Am J Orthod Dentofacial Orthop 2018; 154:504-516. [PMID: 30268261 DOI: 10.1016/j.ajodo.2017.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The objective of this research was to evaluate the buccal bone plate and root length of maxillary permanent first molars using cone-beam computed tomography after maxillary expansion with different activation protocols. METHODS Cone-beam computed tomography images of growing patients were obtained from the orthodontic department of Pontifical Catholic University of Rio Grande do Sul in Brazil. The groups were Haas-type 2/4 turns, Haas-type 4/4 turns, hyrax-type 2/4 turns, and hyrax-type with alternate rapid maxillary expansions and constrictions (alt-RAMEC) 4/4 turns a day. Tooth length, periodontal insertion, alveolar bone thickness, and intermolar distances were evaluated. The data at the start of treatment and 6 months later were compared using generalized linear models. The intergroup differences were determined by univariate analysis of variance with the Bonferroni adjustment. RESULTS Tooth length was significantly shortened after expansion in all groups (-0.28 to -0.51 mm), except for the alt-RAMEC group. Bone level variables (bone level and bone level at the tooth tip) changed statistically in all groups, except for the Haas 4/4 turns group. There was significant periodontal attachment loss after rapid maxillary expansion with the hyrax/alt-RAMEC (5.09 mm). The hyrax/alt-RAMEC and hyrax groups had more dehiscences, fenestrations, and exposures of the root. CONCLUSIONS The consequence of rapid maxillary expansion using the hyrax was alveolar bone resorption, especially in the hyrax/alt-RAMEC group, whereas the Haas expander caused mild root resorption.
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Affiliation(s)
- Mariana Roennau Lemos Rinaldi
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fabiane Azeredo
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Martinelli de Lima
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Susana Maria Deon Rizzatto
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Glenn Sameshima
- Advanced Dental Education Program in Orthodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Luciane Macedo de Menezes
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
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Celenk-Koca T, Erdinc AE, Hazar S, Harris L, English JD, Akyalcin S. Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: A prospective randomized clinical trial. Angle Orthod 2018; 88:702-709. [PMID: 30102085 DOI: 10.2319/011518-42.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES: To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents. MATERIALS AND METHODS: Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods. RESULTS: Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups. CONCLUSION: Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.
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Le MHT, Lau SF, Ibrahim N, Noor Hayaty AK, Radzi ZB. Adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model. Korean J Orthod 2018; 48:98-106. [PMID: 29564219 PMCID: PMC5854887 DOI: 10.4041/kjod.2018.48.2.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to explore the usefulness of adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model using cone-beam computed tomography (CBCT). Methods Twelve adult sheep were randomly divided into two groups (each n = 6): a control group, where no treatment was administered, and a treatment group, where buccal and palatal corticotomy-assisted maxillary expansion was performed. CBCT scans were taken before (T1) and after (T2) treatment. Differences in all transverse dental and alveolar dimensions, alveolar width at crest level, hard palate level, horizontal bone loss, interdental cusp width and inter-root apex were assessed using Wilcoxon signed-rank and Mann-Whitney U-tests. Kruskal-Wallis tests and pairwise comparisons were used to detect the significance of differences among the inter-premolar and inter-molar widths. Results CBCT data revealed significant changes in all transverse dental and alveolar dimensions. The mean interpremolar alveolar width showed an increase of 2.29 to 3.62 mm at the hard palate level, 3.89 to 4.38 mm at the alveolar crest level, and 9.17 to 10.42 mm at the buccal cusp level. Dental changes in the vertical dimension were not significant. Conclusions Our findings based on an adult animal model suggest that adjunctive buccal and palatal corticotomy can allow for both skeletal and dental expansion, with the amount of dental expansion exceeding that of skeletal expansion at alveolar crest and hard palate levels by two and three folds, respectively. Therefore, this treatment modality is potential to enhance the outcomes of maxillary expansion in adults.
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Affiliation(s)
- My Huy Thuc Le
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng Fong Lau
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Selangor, Malaysia
| | - Norliza Ibrahim
- Department of Diagnostic and Intergrated Dental Practice, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Abu Kasim Noor Hayaty
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Zamri Bin Radzi
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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LaBlonde B, Vich ML, Edwards P, Kula K, Ghoneima A. Three dimensional evaluation of alveolar bone changes in response to different rapid palatal expansion activation rates. Dental Press J Orthod 2018; 22:89-97. [PMID: 28444010 PMCID: PMC5398847 DOI: 10.1590/2177-6709.22.1.089-097.oar] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this multi-center retrospective study was to quantify the changes in alveolar bone height and thickness after using two different rapid palatal expansion (RPE) activation protocols, and to determine whether a more rapid rate of expansion is likely to cause more adverse effects, such as alveolar tipping, dental tipping, fenestration and dehiscence of anchorage teeth. METHODS The sample consisted of pre- and post-expansion records from 40 subjects (age 8-15 years) who underwent RPE using a 4-banded Hyrax appliance as part of their orthodontic treatment to correct posterior buccal crossbites. Subjects were divided into two groups according to their RPE activation rates (0.5 mm/day and 0.8 mm/day; n = 20 each group). Three-dimensional images for all included subjects were evaluated using Dolphin Imaging Software 11.7 Premium. Maxillary base width, buccal and palatal cortical bone thickness, alveolar bone height, and root angulation and length were measured. Significance of the changes in the measurements was evaluated using Wilcoxon signed-rank test and comparisons between groups were done using ANOVA. Significance was defined at p ≤ 0.05. RESULTS RPE activation rates of 0.5 mm per day (Group 1) and 0.8 mm per day (Group 2) caused significant increase in arch width following treatment; however, Group 2 showed greater increases compared to Group 1 (p < 0.01). Buccal alveolar height and width decreased significantly in both groups. Both treatment protocols resulted in significant increases in buccal-lingual angulation of teeth; however, Group 2 showed greater increases compared to Group 1 (p < 0.01). CONCLUSION Both activation rates are associated with significant increase in intra-arch widths. However, 0.8 mm/day resulted in greater increases. The 0.8 mm/day activation rate also resulted in more increased dental tipping and decreased buccal alveolar bone thickness over 0.5 mm/day.
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Affiliation(s)
- Brian LaBlonde
- School Dentistry, Indiana University, Indianapolis, IN, USA
| | | | - Paul Edwards
- School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - Katherine Kula
- School Dentistry, Indiana University, Indianapolis, IN, USA
| | - Ahmed Ghoneima
- School of Dentistry, Indiana University, Indianapolis, IN, USA
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Lo Giudice A, Barbato E, Cosentino L, Ferraro CM, Leonardi R. Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review. Eur J Orthod 2017; 40:296-303. [DOI: 10.1093/ejo/cjx057] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antonino Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging—Section of Orthodontics, School of Dentistry, University of Messina, Italy
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences, School of Dentistry, “Sapienza” University of Rome, Italy
| | - Leandro Cosentino
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Claudia Maria Ferraro
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties—Section of Orthodontics, School of Dentistry, University of Catania, Italy
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Nucera R, Lo Giudice A, Bellocchio AM, Spinuzza P, Caprioglio A, Perillo L, Matarese G, Cordasco G. Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults. Angle Orthod 2017; 87:745-751. [PMID: 28598220 DOI: 10.2319/011117-34.1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the buccal bone thickness, bone depth, and cortical bone depth of the mandibular buccal shelf (MBS) to determine the most suitable sites of the MBS for mini-screw insertion. MATERIALS AND METHODS The sample included cone-beam computed tomographic (CBCT) records of 30 adult subjects (mean age 30.9 ± 7.0 years) evaluated retrospectively. All CBCT examinations were performed with the i-CAT CBCT scanner. Each exam was converted into DICOM format and processed with OsiriX Medical Imaging software. Proper view sections of the MBS were obtained for quantitative and qualitative evaluation of bone characteristics. RESULTS Mesial and distal second molar root scan sections showed enough buccal bone for mini-screw insertion. The evaluation of bone depth was performed at 4 and 6 mm buccally to the cementoenamel junction. The mesial root of the mandibular second molar at 4 and 6 mm showed average bone depths of 18.51 mm and 14.14 mm, respectively. The distal root of the mandibular second molar showed average bone depths of 19.91 mm and 16.5 mm, respectively. All sites showed cortical bone depth thickness greater than 2 mm. CONCLUSIONS Specific sites of the MBS offer enough bone quantity and adequate bone quality for mini-screw insertion. The insertion site with the optimal anatomic characteristics is the buccal bone corresponding to the distal root of second molar, with screw insertion 4 mm buccal to the cementoenamel junction. Considering the cortical bone thickness of optimal insertion sites, pre-drilling is always recommended in order to avoid high insertion torque.
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Algharbi M, Bazargani F, Dimberg L. Do different maxillary expansion appliances influence the outcomes of the treatment? Eur J Orthod 2017; 40:97-106. [DOI: 10.1093/ejo/cjx035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Morris JW, Campbell PM, Tadlock LP, Boley J, Buschang PH. Prevalence of gingival recession after orthodontic tooth movements. Am J Orthod Dentofacial Orthop 2017; 151:851-859. [DOI: 10.1016/j.ajodo.2016.09.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 10/19/2022]
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Pham V, Lagravère MO. Alveolar bone level changes in maxillary expansion treatments assessed through CBCT. Int Orthod 2017; 15:103-113. [PMID: 28065704 DOI: 10.1016/j.ortho.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Determine changes in alveolar bone levels during expansion treatments as assessed through cone-beam computer tomography (CBCT). METHODS Sixty-one patients from Edmonton, Canada, with maxillary transverse deficiencies were split into three groups. One group was treated with a bone-anchored expander, another group was treated with a tooth-borne maxillary expander (Hyrax) and one group was untreated. CBCTs were obtained from each patient at two time points (initialT1 and at removal of appliance after 6 months T2). CBCTs were analyzed using AVIZO software and landmarks were placed on different dental and skeletal structures. Intra-examiner reliability for landmarks was done by randomly selecting 10 images and measuring each landmark 3 times, 1 week apart. Descriptive statistics, intraclass correlation coefficients (ICC) and ANOVA analysis were used to determine if there were changes to the alveolar bone levels and if these changes were statistically significant within each group. RESULTS Landmarks reliability showed an ICC of at least 0.99 with a 95% confidence interval and a mean measurement error of at least 0.2067mm. Descriptive statistics show that changes in alveolar bone levels were less than 1mm for all three groups and therefore clinically insignificant. Changes between groups were not statistically different (P<0.05) from one another with the exception of 8 distances. However, since the distances were small, they were not considered clinically significant. CONCLUSION Alveolar bone level changes were similar in maxillary expansion treatments and in the control group. The effects of maxillary expansion treatments on alveolar bone levels are not clinically significant.
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Affiliation(s)
- Vi Pham
- ECHA 5-524, Department of Dentistry, University of Alberta, T5G 2N8 Edmonton, AB, Canada
| | - Manuel O Lagravère
- ECHA 5-524, Department of Dentistry, University of Alberta, T5G 2N8 Edmonton, AB, Canada.
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Changements du niveau de l’os alvéolaire lors du traitement par expansion maxillaire évalué par CBCT. Int Orthod 2017; 15:103-113. [PMID: 28065705 DOI: 10.1016/j.ortho.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Garib D, Lauris RDCMC, Calil LR, Alves ACDM, Janson G, De Almeida AM, Cevidanes LHS, Lauris JRP. Dentoskeletal outcomes of a rapid maxillary expander with differential opening in patients with bilateral cleft lip and palate: A prospective clinical trial. Am J Orthod Dentofacial Orthop 2016; 150:564-574. [PMID: 27692413 PMCID: PMC5495880 DOI: 10.1016/j.ajodo.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this 2-arm parallel study was to evaluate the dentoskeletal effects of rapid maxillary expansion with differential opening (EDO) compared with the hyrax expander in patients with complete bilateral cleft lip and palate. METHODS A sample of patients with complete bilateral cleft lip and palate was prospectively and consecutively recruited. Eligibility criteria included participants in the mixed dentition with lip and palate repair performed during early childhood and maxillary arch constriction with a need for maxillary expansion before the alveolar bone graft procedure. The participants were consecutively divided into 2 study groups. The experimental and control groups comprised patients treated with rapid maxillary expansion using EDO and the hyrax expander, respectively. Cone-beam computed tomography examinations and digital dental models of the maxillary dental arches were obtained before expansion and 6 months postexpansion. Standardized cone-beam computed tomography coronal sections were used for measuring maxillary transverse dimensions and posterior tooth inclinations. Digital dental models were used for assessing maxillary dental arch widths, arch perimeters, arch lengths, palatal depths, and posterior tooth inclinations. Blinding was used only during outcome assessment. The chi-square test was used to compare the sex ratios between groups (P <0.05). Intergroup comparisons were performed using independent t tests with the Bonferroni correction for multiple tests. RESULTS Fifty patients were recruited and analyzed in their respective groups. The experimental group comprised 25 patients (mean age, 8.8 years), and the control group comprised 25 patients (mean age, 8.6 years). No intergroup significant differences were found for age, sex ratio, and dentoskeletal variables before expansion. No significant differences were found between the EDO and the hyrax expander groups regarding skeletal changes. The EDO promoted significantly greater increases of intercanine width (difference, 3.63 mm) and smaller increases in canine buccal tipping than the conventional hyrax expander. No serious harm was observed other than transitory variable pressure sensations on the maxillary alveolar process in both groups. CONCLUSIONS The EDO produced skeletal changes similar to the conventional hyrax expander. The differential expander is an adequate alternative to conventional rapid maxillary expanders when there is need for greater expansion in the maxillary dental arch anterior region. REGISTRATION This trial was not registered. PROTOCOL The protocol was not published before trial commencement. FUNDING This study received financial support from FAPESP (process number 2009/17622-9). As a possible conflict of interest, a patent with an EDO was submitted in March 2011 to the National Institute of Industry Property and is still in process. However, we believe that this is a natural step of translational research (bench-to-bedside), and we guarantee that the scientific results are true.
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Affiliation(s)
- Daniela Garib
- Associate professor, Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Rita De Cássia Moura Carvalho Lauris
- Orthodontist, Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Louise Resti Calil
- Postgraduate student, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Arthur César De Medeiros Alves
- Postgraduate student, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Guilherme Janson
- Professor and head, Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Araci Malagodi De Almeida
- Orthodontist, Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - José Roberto Pereira Lauris
- Professor, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial. Clin Oral Investig 2016; 21:1789-1799. [PMID: 27550292 DOI: 10.1007/s00784-016-1943-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The purpose of this "two-arm parallel" trial was to compare the orthopedic, dental, and alveolar bone plate changes of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP). MATERIAL AND METHODS Forty-six patients with BCLP and maxillary arch constriction in the late mixed dentition were randomly and equally allocated into two groups. Computer-generated randomization was used. Allocation was concealed with sequentially, numbered, sealed, opaque envelopes. The SME and RME groups comprised patients treated with quad-helix and Haas/Hyrax-type expanders, respectively. Cone-beam computed tomography (CBCT) exams were performed before expansion and 4 to 6 months post-expansion. Nasal cavity width, maxillary width, alveolar crest width, arch width, palatal cleft width, inclination of posterior teeth, alveolar crest level, and buccal and lingual bone plate thickness were assessed. Blinding was applicable for outcome assessment only. Interphase and intergroup comparisons were performed using paired t tests and t tests, respectively (p < 0.05). RESULTS SME and RME similarly promoted significant increase in all the maxillary transverse dimensions at molar and premolar regions with a decreasing expanding effect from the dental arch to the nasal cavity. Palatal cleft width had a significant increase in both groups. Significant buccal inclination of posterior teeth was only observed for RME. Additionally, both expansion procedures promoted a slight reduction of the alveolar crest level and the buccal bone plate thickness. CONCLUSIONS No difference was found between the orthopedic, dental, and alveolar bone plate changes of SME and RME in children with BCLP. Both appliances produced significant skeletal transverse gains with negligible periodontal bone changes. Treatment time for SME, however, was longer than the observed for RME. CLINICAL RELEVANCE SME and RME can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.
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Bressane LB, Janson G, Oltramari-Navarro PVP, Henriques JFC, Garib DG. Long-term changes of alveolar buccal bone after rapid maxillary expansion in an adolescent patient. J World Fed Orthod 2016. [DOI: 10.1016/j.ejwf.2016.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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