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Guo F, Li Q, Ngan P, Guan G, Chen X, Yang X, Lv C, Hua F, Zhao T, He H. Impact of tonsillectomy on the efficacy of Alt-RAMEC/PFM treatment protocols in children with class III malocclusion and tonsillar hypertrophy: protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e084703. [PMID: 38950988 DOI: 10.1136/bmjopen-2024-084703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Orthodontic treatment using face mask protraction combined with an alternate rapid maxillary expansion and constriction/protraction face mask (Alt-RAMEC/PFM) protocol is effective in the early treatment of patients with class III malocclusion, but the stability of treatment outcomes represents a major concern. Previous studies have suggested that tonsillar hypertrophy can be a risk factor for class III malocclusion and tonsillectomy may prompt the normalisation of dentofacial growth. However, these studies had a low-to-moderate level of evidence. This study was designed to identify the impact of tonsillectomy before orthodontic treatment on the efficacy and stability of Alt-RAMEC/PFM protocols and the sleep quality and oral health in children with anterior crossbite and tonsillar hypertrophy. METHODS AND ANALYSIS This is a two-arm, parallel-group, superiority cluster randomised controlled trial, with four clinics randomly assigned to the surgery-first arm and the orthodontic-first arm in a 1:1 ratio. The Alt-RAMEC protocol involves alternate activation and deactivation of the expander's jet screw over 6 weeks to stimulate maxillary suture distraction. Patients will be instructed to wear the PFM for a minimum of 14 hours per day. The primary outcomes are changes in Wits appraisal and the degree of maxillary advancement from baseline to the end of orthodontic treatment. Lateral cephalometric radiographs, polysomnography, Obstructive Sleep Apnoea-18 questionnaire and Oral Health Impact Profile-14 questionnaire will be traced, collected and measured. We will recruit 96 patients intofor the study. To assess differences, repeated multilevel linear mixed modelling analyses will be used. ETHICS AND DISSEMINATION This study has been granted ethical approval by the Ethics Committee of the School & Hospital of Stomatology, Wuhan University (approval No. 2023-D10). Written informed consent will be obtained from the participants and their guardians. The results of the trial will be disseminated through academic conferences and journal publications. TRIAL REGISTRATION NUMBER ChiCTR2300078833.
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Affiliation(s)
- Feiyang Guo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qiujing Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Guoqiang Guan
- Department of Orthodontics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiuping Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chenxing Lv
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tingting Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Zhou C, Duan P, He H, Song J, Hu M, Liu Y, Liu Y, Guo J, Jin F, Cao Y, Jiang L, Ye Q, Zhu M, Jiang B, Ruan W, Yuan X, Li H, Zou R, Tian Y, Gao L, Shu R, Chen J, Liu R, Zou S, Li X. Expert consensus on pediatric orthodontic therapies of malocclusions in children. Int J Oral Sci 2024; 16:32. [PMID: 38627388 PMCID: PMC11021504 DOI: 10.1038/s41368-024-00299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Malocclusion, identified by the World Health Organization (WHO) as one of three major oral diseases, profoundly impacts the dental-maxillofacial functions, facial esthetics, and long-term development of ~260 million children in China. Beyond its physical manifestations, malocclusion also significantly influences the psycho-social well-being of these children. Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition, by mitigating the negative impact of abnormal environmental influences on the growth. Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development, ranging from fetal stages to the early permanent dentition phase. From an economic and societal standpoint, the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated, underlining its profound practical and social importance. This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children, emphasizing critical need for early treatment. It elaborates on corresponding core principles and fundamental approaches in early orthodontics, proposing comprehensive guidance for preventive and interceptive orthodontic treatment, serving as a reference for clinicians engaged in early orthodontic treatment.
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Affiliation(s)
- Chenchen Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Peipei Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hong He
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & Key Laboratory of Oral Biomedicine Ministry of Education & Hubei Key Laboratory of Stomatology & Department of Orthodontics & Center for Dentofacial Development and Sleep Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jinlin Song
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing Medical University & College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Yuehua Liu
- Department of Orthodontic & Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yan Liu
- Department of Orthodontics, Central Laboratory, Peking University School and Hospital for Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jie Guo
- Department of Orthodontics, School and Hospital of Stomatology, College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, Jinan, China
| | - Fang Jin
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi'an, China
| | - Yang Cao
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Lingyong Jiang
- Center of Craniofacial Orthodontics, Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Qingsong Ye
- Center of Regenerative Medicine, Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Zhu
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Beizhan Jiang
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Tongji University & Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Wenhua Ruan
- Department of Stomatology, The Children's Hospital, Zhejiang University School of Medicine & National Clinic Research Center for Child Health, Hangzhou, China
| | - Xiao Yuan
- Department of Orthodontics, The Affiliated Hospital of & School of Stomatology, Qingdao University, Qingdao, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Zou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases & College of Stomatology, Xi'an Jiaotong University & Department of Orthodontics, Xi'an Jiaotong University, Xi'an, China
| | - Yulou Tian
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University & Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Li Gao
- Department of Pediatric Dentistry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Shu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jianwei Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Renkai Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shujuan Zou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Xiaobing Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Zhu L, Ruan WH, Han WQ, Gu WZ. Anatomical and immunohistochemical analyses of the fusion of the premaxillary-maxillary suture in human fetuses. J Orofac Orthop 2024; 85:123-133. [PMID: 35810249 DOI: 10.1007/s00056-022-00410-w] [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: 01/10/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The development of the premaxillary-maxillary suture (PMS) in human fetuses and a possible association between the fusion time of the PMS and maxillary deficiency were investigated. Expression of transforming growth factor beta (TGF-β1 and TGF-β3) and of fibulins (fibulin‑1 and fibulin-5) were also investigated. METHODS We analyzed 36 human fetus cadavers (19 males, 17 females; average age 23.97 ± 2.57 gestational weeks [gws], range 11-35 gws). Two cases, diagnosed with Down syndrome (DS), were characterized with maxillary deficiency; 34 fetus cadavers did not show any craniofacial abnormalities. The PMS was analyzed anatomically, followed by semi-quantitative immunohistochemical (IHC)-based expression analyses (i.e., TGF-β1/-β3, fibulin-1/-5). Spearman correlation test was conducted to investigate correlations. RESULTS In the fetuses without DS, the labial region of the PMS was open at 11 gws, after which it began to ossify from the middle to the upper and lower ends of the suture, typically fusing completely at 27 gws. Fetuses with DS demonstrated complete fusion of the labial region of PMS with a spongy bone structure at 23 gws and those without DS at 27 gws. IHC revealed similar patterns of TGF-βs and fibulins expression in the PMS during the human fetal period. There were significant positive correlations between the expression of TGF-β1 and TGF-β3 (r = 0.64, p = 0.009), TGF-β1 and fibulin‑1 (r = 0.66, p = 0.008), and TGF-β3 and fibulin‑1 (r = 0.67, p = 0.006). CONCLUSION Premature fusion of the PMS in the labial region during the human fetal period may be associated with maxillary deficiency, which is related to a class III malocclusion. Overall, the similar expression patterns of TGF-β1, TGF-β3 and fibulin‑1 suggested a close relationship between these factors in regulating the development of the PMS.
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Affiliation(s)
- Ling Zhu
- Department of Stomatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Health, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Wen-Hua Ruan
- Department of Stomatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Health, 3333 Binsheng Road, 310052, Hangzhou, China.
| | - Wu-Qun Han
- Department of Ultrasound, The First People's Hospital of Fuyang District, 311400, Hangzhou, China
| | - Wei-Zhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Health, 310052, Hangzhou, China
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Hsu LF, Moon W, Chen SC, Chang KWC. Digital workflow for mini-implant-assisted rapid palatal expander fabrication-a case report. BMC Oral Health 2023; 23:887. [PMID: 37985987 PMCID: PMC10659097 DOI: 10.1186/s12903-023-03589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Non-surgical mini-implant assisted rapid palatal expansion, or midfacial skeletal expansion, is a paradigm-shifting concept that in recent years has expanded the envelope of orthopedic movement in the transverse direction for adult patients. Although adding mini-screws to a rapid palatal expander is not complicated, accurate and successful expansion strongly depends on the device's position and its relation to the resisting structures of the maxillofacial complex. CASE PRESENTATION This article presents a digital workflow to locate the optimal position of the Midfacial Skeletal Expander (MSE) device in a CBCT-combined intraoral scan file and describes how to transfer the MSE position intra-orally with properly sized bands during the device fabrication. The complete digital workflow of MSE fabrication and its application for a Class III orthognathic surgical case is presented in detail. CONCLUSIONS This report describes a completely digital process that can accurately position the MSE device according to the orientation and morphology of maxillary basal bone, which is crucial in adult cases demand maxillary expansion.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Won Moon
- The Forsyth Institute, Cambridge, MA, USA
- Ajou University School of Medicine, Suwon-si, Korea
| | - Shih-Chin Chen
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, CA, USA
| | - Kelvin Wen-Chung Chang
- Breeze Dental Center, No. 588, Xianzheng 2Nd Rd., Zhubei City, Hsinchu County, Taiwan (R.O.C.).
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Ozbilen EO, Ari MO, Yilmaz HN, Biren S. Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol : A controlled 3D study. J Orofac Orthop 2023; 84:200-209. [PMID: 36169663 DOI: 10.1007/s00056-022-00428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate soft tissue changes following maxillary protraction with different expansion protocols using three-dimensional (3D) stereophotogrammetry. METHODS Pretreatment (T0) and postprotraction (T1) stereophotogrammetry and lateral cephalometric images of skeletal class III patients were included in this retrospective study. In all, 32 patients were treated either with a combination of rapid palatal expansion and facemask (RPE/FM; n = 16; mean age: 9.94 ± 0.68 years) or with alternate rapid maxillary expansion and constriction together with a facemask (Alt-RAMEC/FM; n = 16; mean age: 9.74 ± 1.35 years). As a control group 16 untreated patients were recruited (mean age: 9.46 ± 0.8 years). For superimpositioning of the 3D images taken at T0 and T1, the face was divided into defined regions and 3D and differences between the groups were evaluated using 3‑matic software (Materialise Europe, Leuven, Belgium). Cephalometric analyses were also performed. RESULTS While the increases in the cephalometric parameters SNA and ANB were significantly greater in the treatment groups, the value for SNB also increased in the control group (p < 0.05). The results of the stereophotogrammetry analyses demonstrated that the mean changes in the RPE/FM and in the Alt-RAMEC/FM groups were significantly different for the midface compared to the control group (0.33 ± 0.26 mm, 0.3 ± 0.31 mm, 0.1 ± 0.18 mm). The maximum positive, negative, and mean changes were also significantly different between the treatment and control groups for the upper lip (p < 0.05). For the lower lip and the chin significant backward movements in the RPE/FM as well as in the Alt-RAMEC/FM group (-1.06 ± 1.26 mm, -0.68 ± 0.45 mm) were observed, while the control group (0.09 ± 0.53 mm) presented changes in the opposite direction. Regarding soft tissue changes, no significant differences were found between the RPE/FM and Alt-RAMEC/FM groups. CONCLUSION Both treatment protocols improved the soft tissue profile due to a forward movement of the midface and the upper lip, and a backward movement of the lower lip and chin, compared to the control group.
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Affiliation(s)
- Elvan Onem Ozbilen
- Department of Orthodontics, Faculty of Dentistry, Marmara University, 9/34854, Maltepe/Istanbul, Turkey.
| | | | - Hanife Nuray Yilmaz
- Department of Orthodontics, Faculty of Dentistry, Marmara University, 9/34854, Maltepe/Istanbul, Turkey
| | - Sibel Biren
- Department of Orthodontics, Faculty of Dentistry, Istanbul Kent University, Istanbul, Turkey
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Çoban G, Öztürk T, Erdem ME, Kış HC, Yağcı A. Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position : A retrospective cohort study. J Orofac Orthop 2023; 84:172-185. [PMID: 36107225 DOI: 10.1007/s00056-022-00426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess changes in pharyngeal airway dimensions, head posture and hyoid position after maxillary expansion and face mask (FM) treatment compared to untreated class III patients. METHODS This study examined 24 class III patients (10 girls, 14 boys, mean age: 10.97 ± 0.88 years) treated with expansion and a petit-type FM appliance and 24 untreated class III patients (16 girls, 8 boys, mean age: 10.50 ± 1.06 years). Pre- and posttreatment cephalometric radiographs were digitally analysed. Parametric data were analysed with paired and independent-samples t‑tests, nonparametric data were analysed with Wilcoxon signed-rank and Mann-Whitney U tests. Spearman's correlation analysis was used to examine the relationship between dental/skeletal treatment changes and those of craniocervical postural position, pharyngeal airway dimension and hyoid position. RESULTS With respect to the hypopharyngeal airway dimension, the hypopharyngeal sagittal length (CV3'-LPW), velar angle (HRL/U-PNS) and velar length (U-PNS) significantly increased in the treatment group. All the parameters describing head posture and those describing the distances of the hyoid bone to the HRL changed significantly after treatment, but these changes were not significantly different from the control group. In the treatment group, there also occurred a significant increase in the sagittal growth of the maxilla (SNA, Co‑A, Na-Perp A, Wits), vertical growth of the maxillomandibular complex (SN-GoGN, N‑ANS, N‑Me), counterclockwise rotation of the maxilla (SN-PP) and overjet, while a clockwise rotation (y-axis) and a nonsignificant inhibition of the sagittal growth (Co-Gn) of the mandible were observed. The treatment induced increases of hypopharyngeal sagittal length (CV3'-LPW), soft palate thickness and anteroposterior movement of hyoid bone (H-CV3) demonstrated a positive correlation with changes of craniocervical angles (NSL/OPT, NSL/CVT) and a negative correlation with craniohorizontal angles (OPT/HOR, CVT/HOR). The change of the anteroposterior movement of hyoid bone (H-CV3) was also positively correlated with oropharyngeal sagittal length (CV2'-MPW), the hypopharyngeal sagittal length (CV3'-LPW) and the minimal dimension of the pharyngeal airway space (PASmin). CONCLUSION While expansion and FM treatment did not affect the head posture and hyoid bone position, positive effects were observed in the hypopharyngeal airway region.
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Affiliation(s)
- Gökhan Çoban
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Türkiye
| | - Taner Öztürk
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Türkiye.
| | - Merve Ece Erdem
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Türkiye
| | - Hatice Cansu Kış
- Department of Orthodontics, Faculty of Dentistry, Tokat Gaziosmanpasa University, 60030, Tokat, Türkiye
| | - Ahmet Yağcı
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Türkiye
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Akbulut S, Yilmaz S, Yagci A. Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol : A retrospective study. J Orofac Orthop 2023; 84:278-286. [PMID: 35257194 DOI: 10.1007/s00056-022-00380-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to compare the short-term effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) with conventional rapid maxillary expansion (RME) followed by facemask (FM) therapy. METHODS A total of 30 patients who had received facemask therapy after RME or Alt-RAMEC protocols were included in the study. The Alt-RAMEC/FM and RME/FM groups were created to be well-matched regarding cervical vertebral maturation stage and sex. In the Alt-RAMEC group (10 males and 5 females, 10.99 ± 1.80 years), expansion screws were activated for a week (two turns/day), then deactivated in the following week (two turns/day). The activation-deactivation protocol continued for 6 or 7 weeks. In the RME/FM group (10 males and 5 females, 11.61 ± 1.20 years), screw activation was performed according to the patients' requirements. Lateral cephalograms which had been taken at the beginning of treatment and at the end of the facemask therapy were analyzed. Intragroup and intergroup differences were statistically analyzed. RESULTS Both groups showed a significant sagittal advancement of the maxilla. However, the Alt-RAMEC/FM group showed statistically greater improvements than the RME/FM group for SNA (3.11 ± 1.79 vs. 1.45 ± 1.34, p = 0.008), ANB (4.29 ± 1.80 vs. 2.95 ± 1.19, p = 0.023), convexity (8.91 ± 4.29 vs. 5.61 ± 2.51, p = 0.016), and overjet (5.86 ± 2.29 vs. 4.61 ± 2.10, p < 0.001). The sagittal mandibular, vertical skeletal, dental, and soft tissue changes were similar between the groups (p > 0.05). CONCLUSION The Alt-RAMEC protocol was found to be more effective in the correction of skeletal class III malocclusion in the short term.
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Affiliation(s)
- Sibel Akbulut
- Faculty of Dentistry, Department of Orthodontics, Tokat Gaziosmanpasa University, Tokat, Turkey.
| | - Sema Yilmaz
- Faculty of Dentistry, Department of Orthodontics, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Ahmet Yagci
- Faculty of Dentistry, Department of Orthodontics, Erciyes University, Kayseri, Turkey
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Sami QUA, Ali B, Farooqui WA. Effects of Alt-RAMEC protocol with facemask therapy in cleft lip palate patients in a sample of Pakistani population. BMC Oral Health 2023; 23:401. [PMID: 37328830 PMCID: PMC10276445 DOI: 10.1186/s12903-023-03093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE The objective of the study is to evaluate the skeletal, dentoalveolar and soft tissue changes before and after treatment with Alt-RAMEC protocol and protraction headgear in comparison to the controls. MATERIAL AND METHODS A quasi experimental study was conducted in the orthodontic department on 60 patients of cleft lip and palate. These patients were divided into two groups. Group I was the Alt-RAMEC group that underwent Alt-RAMEC protocol followed by facemask therapy while group II was the control group that underwent RME and facemask therapy. Total treatment time in both the groups was approximately 6 to 7 months. Mean and standard deviation was calculated for all the quantitative variables. Pre and post treatment changes between treatment and control groups were made using paired t-test. Intergroup comparison between treatment and control group was analyzed using independent t-test. Significance for all tests was predetermined at a P-value of ≤ 0.05. RESULTS The Alt-RAMEC group showed significant forward movement of maxilla and improvement in the maxillary base. A remarkable improvement in SNA was seen. The overall outcome was better maxillo-mandibular relationship as shown by positive ANB values and angle of convexity. More effect on maxilla and least effect on mandible was notified with Alt-RAMEC protocol and facemask therapy. Improvement in transverse relationship was also evident in the Alt-RAMEC group. CONCLUSION Alt-RAMEC protocol in combination with protraction headgear is a better alternative to treat cleft lip and palate patients in comparison to the conventional protocol.
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Affiliation(s)
- Qurrat-Ul-Ain Sami
- Department of Orthodontics, Dr. Ishrat-Ul-Ebad Khan Institute Of Oral Health Sciences (DIKIOHS), Dow University of Health Sciences, Karachi, Pakistan.
| | - Batool Ali
- Department of Orthodontics, Dow Dental Collage (DDC), Dow University of Health Sciences, Karachi, Pakistan
| | - Waqas Ahmed Farooqui
- Department of Research, School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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Maino GB, Maino G, Cremonini F, Lombardo L. Class III treatment with mini-implants anchorage in young adult patients: short and long-term results. Dental Press J Orthod 2023; 28:e23spe2. [PMID: 37283427 DOI: 10.1590/2177-6709.28.2.e23spe2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. OBJECTIVE To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. CONCLUSION The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.
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Affiliation(s)
| | - Giovanna Maino
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
| | | | - Luca Lombardo
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
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刘 伟, 王 怡, 王 雪, 周 彦. [A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:346-355. [PMID: 35435203 PMCID: PMC9069022 DOI: 10.19723/j.issn.1671-167x.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask. METHODS In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis. RESULTS Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%. CONCLUSION RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.
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Affiliation(s)
- 伟涛 刘
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 怡然 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 雪东 王
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 彦恒 周
- />北京大学口腔医学院·口腔医院正畸科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Yilmaz BS, Seker ED, Yilmaz HN, Kucukkeles N. Do we pay for maxillary protraction? Evaluation of the effects of Alt-RAMEC protocol and face mask treatment on root development. Clin Oral Investig 2022; 26:3203-3211. [PMID: 34821977 DOI: 10.1007/s00784-021-04302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate root development of pediatric patients treated with Alt-RAMEC + Face mask therapy. MATERIAL AND METHODS The 19 subjects (9 girls, 10 boys; mean age: 8.6 ± 1.1 years) treated with Alt-RAMEC and a Petit-type face mask were included to the study. The cone-beam tomography (CBCT) records of these patients were used to quantify the root length. The root length measurements of 456 permanent teeth (maxillary-mandibular incisors, canines, premolars, and first molars) were performed at the beginning of the treatment (T0), after the Alt-RAMEC protocol (T1), and at the end of the face mask treatment (T2) using Planmeca Romexis software. RESULTS Tooth length values increased significantly in the maxillary teeth except the central incisors, left lateral incisor, the palatal root of the right first molar, and distal and palatinal roots of the left first molar (p < 0.05). Mandibular teeth also showed significant increase in the root length except mandibular central incisors and the distal root of left first molar (p < 0.05). The change in tooth lengths from T0 to T1 showed positive delta values. The comparison of the change in tooth lengths after the Alt-RAMEC protocol and after the face mask therapy showed that ∆T2-T1 was statistically significantly higher compared with ∆T1-T0 (p < 0.05). CONCLUSIONS Alt-RAMEC + Face mask therapy seem not to inhibit root development of maxillary and mandibular teeth in the mixed dentition. CLINICAL RELEVANCE These findings suggest that early Alt-RAMEC + Face mask interventions have not played a negative role in root development. However, further studies involving a control group need to be performed.
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Affiliation(s)
- Berza Sen Yilmaz
- Department of Orthodontics Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Elif Dilara Seker
- Department of Orthodontics Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey.
| | - Hanife Nuray Yilmaz
- Department of Orthodontics Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Nazan Kucukkeles
- Department of Orthodontics Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Masucci C, Franchi L, Franceschi D, Pierleoni F, Giuntini V. Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study. Eur J Orthod 2021; 44:303-310. [PMID: 34405235 DOI: 10.1093/ejo/cjab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the stability of the effects of the modified Alt-RAMEC and facial mask (FM) protocol at a post-pubertal observation. METHODS Twenty-one Class III patients (11 males and 10 females, 6.5 ± 0.7 years) treated consecutively with the Alt-RAMEC/FM approach and presenting with lateral cephalograms taken before treatment (T1), after treatment (T2), and at post-pubertal observations (T3) were compared with 22 Class III patients (9 males and 13 females, 6.9 ± 1.2 years) treated with the rapid maxillary expansion (RME) and FM protocol and with 15 Class III untreated subjects (7 males and 8 females, 6.2 ± 2.2 years). At T3, all patients showed a post-pubertal skeletal maturation stage (CS4-CS6). Descriptive statistics and statistical comparisons between the three groups at T1 and for the T3-T1, T2-T1, and T3-T2 changes were assessed by means of the ANOVA or Kruskal-Wallis test. RESULTS During the overall observation period, Alt-RAMEC/FM and RME/FM protocols produced statistically significant favourable effects when compared with the Control group (ANB + 2.8° and +2.2°, respectively; Wits appraisal +4.4 mm and +2.7 mm, respectively). No statistically significant differences were found between the outcomes of the Alt-RAMEC/FM and RME/FM protocols neither at the post-pubertal or short-term observations. LIMITATIONS Retrospective study and the comparison with an historical control sample of subjects with untreated Class III malocclusion. CONCLUSIONS The Alt-RAMEC/FM protocol cannot be recommended as the approach of choice for the therapy of Class III dentoskeletal disharmony in very young subjects compared to the conventional RME/FM protocol.
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Affiliation(s)
- Caterina Masucci
- Sous-section Orthopédie Dento-Faciale, Faculté de Chirurgie dentaire, Université Côte d'Azur, Nice, France
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Debora Franceschi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Felicita Pierleoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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