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Meazzini MC, Moretti M, Canzi G, Sozzi D, Novelli G, Mazzoleni F. Maxillary Hypoplasia and Non-Invasive Ventilation: Literature Review and Proposed New Treatment Protocol. CHILDREN (BASEL, SWITZERLAND) 2024; 11:720. [PMID: 38929299 PMCID: PMC11201370 DOI: 10.3390/children11060720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
The impact of non-invasive ventilation (NIV) on pediatric maxillary growth is a subject of ongoing research considering its increased use in the pediatric population due to technological advancements and broader indications. This review examines the existing literature, encompassing original articles, case reports, and reviews, to evaluate the effects of NIV on maxillary development and explore potential treatment options. Although the majority of studies agree on the adverse effects of prolonged NIV on maxillary development, techniques for its correction remain understudied. Introducing a novel treatment protocol, we addressed the challenge of correcting severe midfacial hypoplasia in a child with congenital central hypoventilation syndrome (CCHS) undergoing NIV therapy, thus sidestepping the necessity for osteotomies. This proposed protocol holds promise in correcting the adverse impact of NIV on maxillary growth, emphasizing the need for further exploration into innovative treatment modalities.
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Affiliation(s)
- Maria Costanza Meazzini
- Pediatric Craniofacial Malformations Unit, Smile House Monza—Craniofacial Center, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (M.C.M.); (F.M.)
| | - Mattia Moretti
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Postgraduate School of Maxillo-Facial Surgery, University of Milan, 20122 Milan, Italy
| | - Gabriele Canzi
- Maxillo-Facial Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Davide Sozzi
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Giorgio Novelli
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Fabio Mazzoleni
- Pediatric Craniofacial Malformations Unit, Smile House Monza—Craniofacial Center, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (M.C.M.); (F.M.)
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
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Xu S, Liu Y, Hou Y, Li Y, Ge X, Wang L, Zhao L, Ma W. Maxillofacial growth changes after maxillary protraction therapy in children with class III malocclusion: a dual control group retrospective study. BMC Oral Health 2024; 24:7. [PMID: 38172784 PMCID: PMC10763385 DOI: 10.1186/s12903-023-03790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To investigate the balance between post-treatment effect and continued nature growth after maxillary protraction treatment in patients with skeletal class III malocclusion. METHODS 31 patients aged 8.79 ± 1.65 years with skeletal Class III malocclusion had been treated with maxillary protraction and the treatment lasted an average of 1.16 years. The average observation duration after treatment in the maxillary protraction group was 2.05 ± 0.39 years. In the control groups, a sample of 22 patients (9.64 ± 2.53 years) with untreated skeletal class III malocclusion and 24 patients (9.28 ± 0.96 years) with skeletal class I malocclusion were matched to the treatment group according to age, sex and observation period. The mean observation interval of the control groups was 2.39 ± 1.29 years in the class III group and 1.97 ± 0.49 years in the class I group. RESULTS The active orthopedic treatment effect showed a opposite trend to the natural craniomaxillofacial growth effect after treatment in many aspects. In the observation duration of treatment group, decrease in ANB, Wits appraisal and BAr-AAr were statistically significant compared to class I control group (p < 0.001), and there was a significant increase in NA-FH (P < 0.001) which was contrary to class III control group. Treatment group presented a significant increase in Gn-Co (P < 0.01) and Co-Go (P < 0.001), except for changes in the extent of the mandibular base (Pog-Go, P = 0.149) compared to class I control group. The vertical maxillomandibular skeletal variables (Gonial; MP-SN; MP-FH; Y-axis) in treatment group decreased significantly compared to those in class III control group (P < 0.01). U1-SN and L1-MP showed a significant increase, which was similar to the class I group (P > 0.05), and overjet decreased significantly relative to both of the two control groups (P < 0.05). CONCLUSION Maxillary protraction therapy led to stable outcomes in approximately 77.42% of children with Class III malocclusion approximately 2 years after treatment. Unfavorable skeletal changes were mainly due to the greater protrusion of the mandible but maxillary protraction did have a certain degree of postimpact on the mandibular base. Protraction therapy does not fundamentally change the mode of maxillary growth in Class III subjects except for the advancement of the maxilla. Craniomaxillofacial region tend to restabilize after treatment and lead to skeletal growth rotation and more dentoalveolar compensation.
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Affiliation(s)
- Shukui Xu
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Yang Liu
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Yan Hou
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Yinghui Li
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Xiaolei Ge
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Linna Wang
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Liru Zhao
- Department of Orthodontics, Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiahzuang, 050017, China
| | - Wensheng Ma
- Department of Orthodontics, School of Medicine, Tianjin Stomatological Hospital, Nankai University, Tianjin, 300041, China.
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstrution, Tianjin, 300041, China.
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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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Difference in Using Protrusion Face Mask before or after Rapid Palatal Expansion in Skeletal Class III Children: A Preliminary Study. CHILDREN 2022; 9:children9101535. [PMID: 36291471 PMCID: PMC9600127 DOI: 10.3390/children9101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
Abstract
Treatment of third-class malocclusions often presents a challenge for orthodontists. Skeletal disharmony is often associated with dental malposition. There are several therapeutic choices, including the use in combination of transverse expansion of the maxilla with rapid palatal expander (RPE) and posterior-anterior traction with a Delaire face mask (FM). The purpose of the study is to verify whether there are significant differences in the treatment outcome in the case of use of a face mask followed by a palatal expander or with the sequence of these auxiliaries reversed. Subject and Methods: The two groups were both made up of 13 patients, subdivided into group A, i.e., those whose sequence involved the use of extraoral traction first and then the disjunctor, and those with an inverted sequence in group B. Some cephalometric parameters and dento-skeletal characteristics were evaluated pre-treatment (t0) and at the end of therapy (t1). Results: Considering the T1-T0 of group A (Delaire + rapid palatal expander), the evaluation of the results obtained in this work allows us to observe how within group A there is a significant improvement in the Witts and Nanda indices and facial convexity. Group B (treated with the palate disjunctor sequence followed by traction with Delaire's mask) showed a significant improvement in ANB, in AoBo, and AppBpp values and in convexity. The two groups were comparable, and no statistically significant difference was highlighted. Discussion: The early therapy of the third skeletal classes by means of a rapid palate expander and face mask is effective. There is no statistically significant difference in the two groups who performed the therapy in reverse mode. This suggests that the clinician should choose the treatment sequence based on the skeletal and occlusal conditions of their patients at the start of treatment. Conclusion: Early therapy of third skeletal classes with sagittal expansion using a rapid palate expander can be performed earlier or later than posterior-anterior traction with a Delaire mask.
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Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: a retrospective follow-up study. Prog Orthod 2022; 23:44. [PMID: 36178519 DOI: 10.1186/s40510-022-00429-0] [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: 03/08/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regardless of the treatment protocol, stability in Class III patients always represents a major concern. The aim of this study was to assess the short and long-term skeletal and dentoalveolar modifications in a group of class III patients treated with hybrid rapid maxillary expander (RME) and facemask (FM). Indeed, no long-term studies have been conducted yet with the objective of evaluating the effects of this kind of approach when applied to patients who have already gone thought their peak of growth. MATERIAL AND METHODS 27 patients with skeletal Class III malocclusion were treated using hybrid RME according to alternating rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by 4 months of facemask therapy. After the orthopaedic phase, each patient underwent orthodontic treatment with fixed multibracket appliances. A mean follow-up of 7 years, 10 months was performed. Pre-treatment (TO), post-treatment (T1) and follow up (T2) cephalometric tracing were analysed, comparing dental and skeletal measurements. RESULTS Point A advanced by a mean of 3.5 mm with respect to VerT, then relapsed by 0.7 in the post-facemask period, thereby yielding of a mean advancement of 2.7 at T2. The sagittal relationship significantly changed after RME + facemask protraction (3.8° of ANB and 5.189 mm of Wits). Although both Wits and ANB values worsened over time, the improvement from T0 is still appreciable at T2. CONCLUSION Despite the physiological relapse due to mandibular growth, the long-term cephalometric follow-up confirms the maintenance of all positive outcomes of the previous orthopaedic treatment with hybrid RME and facemask.
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