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Haas Júnior OL, Matje PRB, Rosa BMD, Piccoli VD, Rizzatto SMD, Oliveira RBD, Menezes LMD. MISMARPE protocol: minimally invasive surgical and miniscrew-assisted rapid palatal expansion. Dental Press J Orthod 2024; 29:e24spe3. [PMID: 39140569 PMCID: PMC11321491 DOI: 10.1590/2177-6709.29.3.e24spe3] [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: 04/11/2024] [Accepted: 05/29/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE The purpose of this article is to present the MISMARPE technique, a new minimally invasive surgical procedure to treat maxillary transverse atresia in adult patients under local anesthesia and on an outpatient basis. TECHNIQUE DESCRIPTION The technique consists of miniscrew-assisted rapid palatal expansion (MARPE) associated with a minimally invasive approach using maxillary osteotomies, latency and activation periods until the desired expansion is achieved. The present MISMARPE technique was performed in 25 consecutive cases with a success rate of 96%, yielding good skeletal outcomes with minimal trauma. The expander appliances, with their anchorage types, and a description of the surgical steps of the MISMARPE technique are presented. CONCLUSION MISMARPE is a new and effective alternative for less invasive treatment of maxillary transverse deficiency in adults, compared to conventional surgery. Emphasis is placed on the importance of systematic and well-established protocols, for executing the procedures safely and predictably.
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Affiliation(s)
- Orion Luiz Haas Júnior
- São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Department of Oral and Maxillofacial Surgery (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Paulo Ricardo Baccarin Matje
- Pontifical Catholic University of Rio Grande do Sul, School of Health and Life Sciences, Postgraduate Program in Dentistry (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Bibiana Mello da Rosa
- Pontifical Catholic University of Rio Grande do Sul, School of Health and Life Sciences, Postgraduate Program in Dentistry (Porto Alegre/RS, Brazil)
- São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Department of Oral and Maxillofacial Surgery (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Vicente Dias Piccoli
- Pontifical Catholic University of Rio Grande do Sul, School of Health and Life Sciences, Postgraduate Program in Dentistry (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Susana Maria Deon Rizzatto
- Pontifical Catholic University of Rio Grande do Sul, School of Health and Life Sciences, Department of Orthodontics (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Rogério Belle de Oliveira
- São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Department of Oral and Maxillofacial Surgery (Porto Alegre/RS, Brazil)
- Private Practice (Porto Alegre/RS, Brazil)
| | - Luciane Macedo de Menezes
- Pontifical Catholic University of Rio Grande do Sul, School of Health and Life Sciences, Department of Orthodontics (Porto Alegre/RS, Brazil)
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Bastos RM, Haas Junior OL, Piccoli V, da Rosa BM, de Oliveira RB, de Menezes LM. Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00088-2. [PMID: 38609790 DOI: 10.1016/j.ijom.2024.03.012] [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: 06/29/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia.
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Affiliation(s)
- R M Bastos
- Oral and Maxillofacial Surgery Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
| | - O L Haas Junior
- Oral and Maxillofacial Surgery Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - V Piccoli
- Department of Orthodontics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - B M da Rosa
- Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - R B de Oliveira
- Oral and Maxillofacial Surgery Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - L M de Menezes
- Department of Orthodontics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Sekertzi C, Koukouviti MM, Chatzigianni A, Kolokitha OE. Dental, Skeletal, and Soft Tissue Changes after Bone-Borne Surgically Assisted Rapid Maxillary Expansion: A Systematic Review and Meta-Analysis. Dent J (Basel) 2023; 11:143. [PMID: 37366666 DOI: 10.3390/dj11060143] [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: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/28/2023] Open
Abstract
(1) Background: For non-growing patients with marked transverse maxillary deficiency, bone-borne surgically assisted rapid maxillary expansion (SARME) has been proposed as an effective treatment option. Objective: To evaluate the dental, skeletal, and soft tissue changes following bone-borne SARME. (2) Methods: An unrestricted systematic electronic search of six databases, supplemented by manual searches, was performed up to April 2023. The eligibility criteria included prospective/retrospective clinical studies with outcomes pertaining to objective measurements of dental/skeletal/soft tissue effects of bone-borne SARME in healthy patients. (3) Results: Overall, 27 studies satisfied the inclusion criteria. The risk of bias of the non-randomized trials ranged between moderate (20) and serious (4). For the two RCTs, there were some concerns of bias. Trials with outcomes measured at the same landmarks within the scope of the prespecified timeframe were deemed eligible for quantitative synthesis. Eventually, five trials were included in the meta-analysis. SARME was associated with a statistically significant lengthening of the dental arch perimeter immediately after expansion, along with a marginally significant decrease in palatal depth during the post-SARME retention period. Post-treatment SNA values exhibited no statistically significant change. (4) Conclusion: Current evidence indicates that bone-borne SARME constitutes an effective treatment option for adult patients with maxillary transverse deficiency. Further long-term randomized clinical trials with robust methodology, large sample sizes, and 3D evaluation of the outcomes are needed.
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Affiliation(s)
| | | | - Athina Chatzigianni
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olga-Elpis Kolokitha
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Lin JH, Wang S, Abdullah UA, Le AD, Chung CH, Li C. Sagittal and Vertical Changes of the Maxilla after Surgically Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103488. [PMID: 37240593 DOI: 10.3390/jcm12103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Surgically assisted rapid palatal expansion (SARPE) is often performed to correct the transverse deficiency in the maxilla for skeletally mature patients. However, there is little consensus on the sagittal and vertical displacement of the maxilla after SARPE. This systematic review aims to analyze the position changes of the maxilla in the sagittal and vertical dimensions after the completion of SARPE. Registered with PROSPERO (registration number: CRD42022312103), this study complied with the 2020 PRISMA guideline and was conducted on 21 January 2023. Original studies were screened from MEDLINE (PubMed), Elsevier (SCOPUS), and Cochrane, and supplemented by hand-searching. Cephalometric changes of skeletal vertical and sagittal measurements were the focus. A fixed-effects model was applied in R for meta-analysis. After applying inclusion and exclusion criteria, seven articles were included in the final review. Four studies had a high risk of bias, and the other three had a medium risk of bias. Meta-analysis revealed that the SNA angle increased by 0.50° ± 0.08° (95% confidence interval, 0.33° to 0.66°), and the SN-PP angle increased by 0.60° ± 0.09° (95% confidence interval, 0.41° to 0.79°) after SARPE. In summary, the maxilla displayed statistically significant forward and clockwise downward movement after SARPE. However, the amounts were small and might not be clinically significant. Due to the high risk of bias of included studies, our results must be taken cautiously. Future studies are needed to discern the effects of direction and angulation of the osteotomies of SARPE on the displacement of the maxilla.
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Affiliation(s)
- Jia-Hong Lin
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Steven Wang
- Department of Oral and Maxillofacial Surgery/Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Usama Al Abdullah
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anh D Le
- Department of Oral and Maxillofacial Surgery/Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chun-Hsi Chung
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Camps-Perepérez I, Guijarro-Martínez R, da Rosa BM, Haas OL, Hernández-Alfaro F. Three-dimensional dentoskeletal changes following minimally invasive surgically assisted rapid palatal expansion: a prospective study. Int J Oral Maxillofac Surg 2023; 52:460-467. [PMID: 35909027 DOI: 10.1016/j.ijom.2022.07.004] [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: 11/01/2021] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm2 at the palate level and 23.3 mm2 at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed.
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Affiliation(s)
| | - R Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain; Institute of Maxillofacial Surgery and Implantology, Teknon Medical Centre, Barcelona, Spain, Universitat Internacional de Catalunya, Barcelona, Spain
| | - B M da Rosa
- Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - O L Haas
- Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery and Implantology, Teknon Medical Centre, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, and Program in Orthognathic Surgery, Universitat Internacional de Catalunya, Barcelona, Spain
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Comparison of the Accuracy of Two Transfer Caps in Positional Transmission of Palatal Temporary Anchorage Devices: An In Vitro Study. Dent J (Basel) 2023; 11:dj11020051. [PMID: 36826196 PMCID: PMC9954813 DOI: 10.3390/dj11020051] [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: 12/15/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The aim of this study was to compare the positional information transfer accuracy of palatal temporary anchorage devices (TADs) of two different brands of transfer caps: PSM and Leone. Thirty plaster casts of maxillary dental arches were chosen for master models. A couple of Leone TADs were inserted in each master model. For each master model, two analysis models were created: using two transfer caps, Leone and PSM, the impressions were taken, the analogues were connected on the transfer caps, and the casts were poured. Using digital methods and equipment, such as a 3D scanner, a 3D analysis and a comparison of the accuracy of the two transfer caps in transferring the positional information of the TADs was then made. The data obtained were analyzed using the Mann-Whitney U-test at a significance level of α = 0.05. PSM transfer caps showed higher error frequency in almost all measurements. Only two measurements had a larger error in the analysis models made with Leone transfer caps. The Mann-Whitney U-test found a significant difference between the error levels of TADs found in the analysis models created with PSM transfer caps. Leone transfer caps showed greater reliability in TADs positional information transmission.
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Alveolar bone changes after tooth-borne surgically assisted rapid maxillary expansion: A three-dimensional study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101331. [PMID: 36400391 DOI: 10.1016/j.jormas.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Surgically assisted rapid maxillary expansion (SARME) with a dental-anchorage appliance can induce dental and skeletal complications adjacent to the teeth supporting the device. The purpose of this study was to quantify the dentoskeletal changes observed after SARME using a tooth-borne device. MATERIALS AND METHODS Cone beam CT images from 39 patients were compared between the preoperative (T1) and the postoperative period (T2). The mean time to complete the second imaging was 13.8 ± 6.9 months after the SARME. Dental and bone parameters were assessed: the vestibular bone height (BH), the bone thickness (BT), the existence of fenestrations, and the root resorption at the level of first upper premolar (P1) and the first upper molar (M1). The maxillary expansion parameters were also collected. RESULTS Both vertical and horizontal vestibular bone loss were observed mainly in the first upper molar sectors: The BT decreased from 0.93 ± 0.50 mm to 0.53 ± 0.51 mm (p < 0.0001) and the BH decreased from 1.84 ± 1.05 mm to 0.93 ± 1.02 mm (p < 0.0001) for tooth #16. The bone loss also affected the first upper premolars but in a more limited manner. Significant fenestrations were observed at the apex of the mesio-vestibular root of teeth #16 and #26. We noted significant root resorption affecting the mesio-, disto-vestibular and palatal roots of tooth #16 (mean reductions of 0.32, 0.35, and 0.55 mm, respectively; p < 0.05), and the palatal root of tooth # 26 (loss of 0.58 mm; p = 0.004). The mean bone expansion was 3.76 mm and 1.41 mm at the premolar and molar levels, respectively (p < 0.0001), while a mean 6.24 mm and 4.23 mm inter-cuspid expansion was noted at the P1 and M1 levels (p < 0.0001). CONCLUSION Our results document the vestibular bone changes and low root resorption, mostly in the molar sectors, associated with SARME using dental-anchorage devices.
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Lin JH, Li C, Wong H, Chamberland S, Le AD, Chung CH. Asymmetric Maxillary Expansion Introduced by Surgically Assisted Rapid Palatal Expansion: A Systematic Review. J Oral Maxillofac Surg 2022; 80:1902-1911. [PMID: 36113583 DOI: 10.1016/j.joms.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE A commonly reported complication of surgically assisted rapid palatal expansion (SARPE) that has not been explored extensively is uneven expansion between left and right sides, which requires secondary surgery for correction. This systematic review aims to analyze the prevalence and potential causes of asymmetric expansion in the transverse dimension after SARPE to guide the clinical practice. METHODS Electronic databases and manual search were used to search for original articles published on SARPE on March 11, 2022. Original human studies that recorded the number and percentage of asymmetric expansion after two-piece SARPE were included. The 2020 Preferred Reporting Items for Systemic Reviews and Meta-Analyses guideline was implemented for the quality assessment and data analysis of the included articles. The study was registered at the International Prospective Register of Systematic Reviews under the number CRD42022300782. RESULTS After applying inclusion and exclusion criteria, 13 articles were included in the final review. The risk of bias was high in 8 studies and medium in the other 5 studies. Overall, the prevalence of asymmetric expansion in the transverse dimension (different amount of expansion between left and right sides) was 7.52%, with 12.90% of patients involved receiving a second surgery for correction. Expander design did not significantly affect the rate of asymmetry expansion. Pterygomaxillary fissure release significantly increased the rate of asymmetry expansion (11.02% vs 5.08%, P < .001). In comparison, lateral nasal wall osteotomy (4.26% vs 14.77%, P < .001) and release of the nasal septum (5.22% vs 17.15%, P < .001) significantly lowered the rate of asymmetry expansion, respectively. CONCLUSIONS Asymmetric dentoskeletal expansion between left and right sides is a common complication of SARPE procedures, mostly caused by variations in surgical cuts. However, the risk of bias in currently available publications is high. Further studies are warranted to fully understand the causes of asymmetric expansion.
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Affiliation(s)
- Jia-Hong Lin
- Orthodontic Resident, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chenshuang Li
- Assistant Professor, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Hilary Wong
- Dental Student, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Anh D Le
- Chair And Norman Vine Endowed Professor Of Oral Rehabilitation, Department of Oral and Maxillofacial Surgery/Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chun-Hsi Chung
- Associate Professor and Chauncey M. F. Egel Endowed Chair and Director, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
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de Andrade Vieira W, Oliveira MB, Machado LDS, Cericato GO, Lima IFP, Paranhos LR. Pulp changes from rapid maxillary expansion: A systematic review. Orthod Craniofac Res 2021; 25:320-335. [PMID: 34874608 DOI: 10.1111/ocr.12556] [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: 09/18/2021] [Revised: 11/06/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopaedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME). METHODS An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analysed with the NIH 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group' and the 'JBI for quasi-experimental studies' tool. The GRADE tool was used to assess the certainty of evidence. RESULTS The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence. CONCLUSIONS Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.
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Affiliation(s)
- Walbert de Andrade Vieira
- Department of Restorative Dentistry, Endodontics Division, State University of Campinas - Unicamp, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil
| | - Millena Barroso Oliveira
- Post-Graduation Program in Dentistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | | | - Graziela Oro Cericato
- Post-Graduation Program in Dentistry, Faculdade Meridional- IMED, Passo Fundo, RS, Brazil
| | - Igor Felipe Pereira Lima
- Post-Graduation Program in Dentistry, Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luiz Renato Paranhos
- Department of Community and Preventive Dentistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
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Nowak R, Olejnik A, Gerber H, Frątczak R, Zawiślak E. Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion-A Finite Element Analysis (FEA) Study. MATERIALS 2021; 14:ma14051152. [PMID: 33804454 PMCID: PMC7957660 DOI: 10.3390/ma14051152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
The aim of this study was to compare the reduced stresses according to Huber’s hypothesis and the displacement pattern in the region of the facial skeleton using a tooth- or bone-borne appliance in surgically assisted rapid maxillary expansion (SARME). In the current literature, the lack of updated reports about biomechanical effects in bone-borne appliances used in SARME is noticeable. Finite element analysis (FEA) was used for this study. Six facial skeleton models were created, five with various variants of osteotomy and one without osteotomy. Two different appliances for maxillary expansion were used for each model. The three-dimensional (3D) model of the facial skeleton was created on the basis of spiral computed tomography (CT) scans of a 32-year-old patient with maxillary constriction. The finite element model was built using ANSYS 15.0 software, in which the computations were carried out. Stress distributions and displacement values along the 3D axes were found for each osteotomy variant with the expansion of the tooth- and the bone-borne devices at a level of 0.5 mm. The investigation showed that in the case of a full osteotomy of the maxilla, as described by Bell and Epker in 1976, the method of fixing the appliance for maxillary expansion had no impact on the distribution of the reduced stresses according to Huber’s hypothesis in the facial skeleton. In the case of the bone-borne appliance, the load on the teeth, which may lead to periodontal and orthodontic complications, was eliminated. In the case of a full osteotomy of the maxilla, displacements in the buccolingual direction for all the variables of the bone-borne appliance were slightly bigger than for the tooth-borne appliance.
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Affiliation(s)
- Rafał Nowak
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
- Correspondence: ; Tel.: +48-71-734-3600
| | - Anna Olejnik
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
| | - Hanna Gerber
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
| | - Roman Frątczak
- NOBO Solutions S.A., Al. Kasztanowa 3A-5, 53-125 Wrocław, Poland;
| | - Ewa Zawiślak
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
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