Age-dependent effects of transverse maxillary deficiency treated by microimplant-assisted rapid palatal expansion: A prospective cone-beam computed tomography study

Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion

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.

Skeletal and dentoalveolar modifications in adults with different sagittal facial patterns after personalized miniscrew-assisted rapid palatal expansion: A prospective cone-beam computed tomography study

INTRODUCTION

This study aimed to compare the skeletal and dental modifications in adults with different sagittal facial patterns by a personalized miniscrew-assisted rapid palatal expander (pMARPE).

METHODS

Forty subjects (aged 18-28 years; 15 females and 25 males) with maxillary transverse deficiency were assigned to 1 of 3 groups (Class I, II, and III relationship) on the basis of their sagittal facial patterns. Each patient was treated with an individually customized expander. A similar expansion protocol was used for all patients. Cone-beam computed tomography scans were obtained before and after expansion. One-way analysis of variance was used to analyze differences among 3 groups in skeletal, dentoalveolar, and periodontal changes (P <0.05).

RESULTS

The success rates of expansion were higher in patients with a Class I or II relationship than those with a Class III relationship. Patients with a Class I or II relationship had greater changes in the anterior nasal spine and maxillary basal bone widths. A more parallel sutural opening in the anteroposterior direction was seen in those with a Class II relationship. The tipping of the maxillary first molar increased, and the buccal alveolar bone thickness decreased in all groups after expansion, especially in patients with a Class III relationship.

CONCLUSIONS

The pMARPE effectively split the midpalatal suture among adults. However, midpalatal suture expansion was more difficult, and there were more dentoalveolar side effects and fewer orthopedic effects in patients with a Class III relationship than in those with Class I or II relationships.

Association Between Maxillary Segmentation and Perioperative Complications in Le Fort I Osteotomy

The Le Fort I osteotomy is used to reposition the maxilla to correct numerous maxillofacial and occlusal deformities. The aim of this study was to delineate perioperative complication rates associated with Le Fort I osteotomy and determine whether the number of maxillary segments or bone grafting yielded increased complication rates. Patients undergoing Le Fort I osteotomy from 2012 to 2019 were identified from the multi-institution "National Surgical Quality Improvement Program" database using Current Procedure Terminology codes. The predictor variables of interest included maxillary segmentation defined as 1, 2, or 2 pieces and the presence or absence of bone graft. Perioperative complications were collected as the primary outcome variable, including superficial and deep space infections, wound dehiscence, airway complication, peripheral nerve injury, and hemorrhage. The secondary outcome variables included readmission and reoperation rate within the 30-day postoperative period. Complication rates were compared using multivariate analysis across groups stratified by the number of maxillary segments and inclusion of bone grafting. Of the 532 patients that met the inclusion criteria, 333 (63%) underwent 1-piece, 114 (21%) 2-piece, and 85 (16%) 2-piece Le Fort I osteotomy procedures. A total of 48 patients exhibited complications (9%), with hemorrhage (2.3%) being the most common complication observed. The number of maxillary segments was not a significant predictor of perioperative complications ( P = 0.948) nor was the use of bone grafting ( P = 0.279).

Evaluation of palate-related factors of the effectiveness of microimplant-assisted rapid palatal expansion in late adolescents and adults

INTRODUCTION

This study investigated the factors of the effectiveness of microimplant-assisted rapid palatal expansion (MARPE) in late adolescents and adults, such as age, midpalatal suture maturation (MPSM) stage, palate length (PL), palatal index (PI), and midpalatal bone thickness (MBT), and at each microimplant position, the palate bone thickness (PBT), the nasal cortical bone thickness (CoTN), the cancellous bone thickness (CaT), and the palate cortical bone thickness (CoTP) were evaluated.

METHODS

Cone-beam computed tomography (CBCT) images of 50 patients (mean, 23.30 ± 7.03 years; range, 16-51 years) treated with MARPE were evaluated. Maxillary expansion ratio (MER) was used to assess the MARPE effectiveness and grouped patients into low and high MER groups according to the mean of MER. MER was the ratio of maxillary expansion width to MARPE screw expansion measured in CBCT images. The t-test was used to analyze the differences between the low and high MER groups. The Pearson correlation test was performed to investigate the correlation between MER and age, MPSM stage, PL, PI, MBT, PBT, CoTN, CaT, and CoTP.

RESULTS

Age, MPSM stage, and MBT in regions 18 mm and 21 mm behind the incisor foramen correlated negatively with MER ([Formula: see text], - 0.390, - 0.386, and - 0.335, respectively, all [Formula: see text]), whereas PBT and CoTN of anterior microimplant positions correlated positively with MER ([Formula: see text] and 0.418, respectively, all [Formula: see text]). No correlation was observed between other variables and MER.

CONCLUSIONS

MARPE effectiveness decreased as age and midpalatal suture maturation stage increased, respectively. Thinner midpalatal suture bone in regions 18 mm and 21 mm behind the incisor foramen, thicker palate bone, and nasal cortical bone of anterior microimplant positions were related to more effective MARPE.

CLINICAL RELEVANCE

In patients with older chronological age and later MPSM stages, MARPE effectiveness might be unsatisfactory. Clinicians should carefully evaluate the palate bone thickness before MARPE treatment.

Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: a prospective clinical cohort study

OBJECTIVES

To provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED).

MATERIALS AND METHODS

D-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed.

RESULTS

Thirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (- 0.31 ± 0.49 mm M1; - 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated.

CONCLUSIONS

MARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults.

CLINICAL RELEVANCE

Higher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.