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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; 53:821-828. [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] [MESH Headings] [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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Alqahtani KA, Shaheen E, Da Costa Senior O, Politis C, Jacobs R. Three dimensional assessment of root changes after multi-segments Le Fort I osteotomy. J Craniomaxillofac Surg 2024:S1010-5182(24)00264-6. [PMID: 39289041 DOI: 10.1016/j.jcms.2024.08.022] [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: 09/11/2023] [Revised: 01/31/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] Open
Abstract
The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies.
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Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Oliver Da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Machado Pasqua BDP, Sendyk M, Barros André C, Batista de Paiva J, Wilmes B, Rino Neto J. Periodontal evaluation after maxillary expansion with a tooth-bone-borne expander in growing patients : A randomized clinical trial. J Orofac Orthop 2024:10.1007/s00056-024-00536-z. [PMID: 39102072 DOI: 10.1007/s00056-024-00536-z] [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: 09/04/2023] [Accepted: 05/21/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE This two-arm parallel randomized controlled trial aimed to evaluate and compare periodontal changes due to rapid maxillary expansion (RME) using tooth-bone-borne and tooth-borne devices in growing patients via clinical examinations and cone-beam computed tomography (CBCT). MATERIALS AND METHODS Forty-two eligible patients (aged 11-14 years; transverse maxillary deficiency, posterior crossbite) were screened and divided into two groups based on the treatment received (randomization was performed using computer-generated numeric sequences): hybrid hyrax tooth-bone-borne group (TBB) and hyrax tooth-borne group (TB). The primary outcome was the change in cortical bone thickness (by CBCT). In addition, the clinical attachment level (CAL), gingival recession, and bleeding were assessed. Both examinations were performed before and 3 months after the activation phase. Intergroup comparisons were performed using analysis of covariance (ANCOVA; P < 0.05). RESULTS Twenty-one patients (12 girls and 9 boys; mean initial age, 13.3 years) were included in the TBB group and 21 (5 girls and 16 boys; mean initial age, 13.2 years) were included in the TB group. The TB group exhibited a decrease in buccal bone thickness in the first premolars and first molars at all three evaluated levels. Specifically, tooth 14 at 3 mm from the enamel-cement junction showed a significant width reduction (0.7 mm; p < 0.001), accompanied by a notable increase in palatal cortical thickness at 6 mm of enamel-cement junction (1.13 mm; p < 0.001). CONCLUSIONS RME resulted in buccal bone thickness reduction at the first premolar with hyrax treatment. In the molar region, both devices resulted in cortical bone alterations that were less pronounced in the TBB group.
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Affiliation(s)
| | - Michelle Sendyk
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
| | - Cristiane Barros André
- Technology Research Center, University of Mogi das Cruzes, Reverendo Henrique de Oliveira Camargo Street 374, 18090-170, Mogi das Cruzes, Brazil
| | - João Batista de Paiva
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - José Rino Neto
- School of Orthodontics, University of São Paulo, Professor Lineu Prestes Avenue 2227, 05508-000, São Paulo, Brazil
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Alqahtani KA, Shaheen E, Politis C, Jacobs R. Three-dimensional assessment of root changes after Le Fort I osteotomy. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00214-5. [PMID: 39004545 DOI: 10.1016/j.ijom.2024.07.003] [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: 03/23/2023] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
The study aim was to assess the volumetric, linear, and morphological changes of the maxillary incisor, canine, and premolar roots following Le Fort I osteotomy. Sixty patients (585 teeth) were included retrospectively from among individuals who underwent combined orthodontics and orthognathic surgery. The study group comprised 30 patients who underwent orthodontics and one-piece Le Fort I osteotomy, while the control group consisted of 30 patients who underwent orthodontics and bilateral sagittal split osteotomy but no maxillary surgery. CBCT scans were obtained at four time points: preoperative, 6 months, 1 year, and 2 years postoperative. A fully automated three-dimensional evaluation protocol was utilized to assess root changes of the maxillary teeth. Significant differences in the apical and middle parts of the teeth were observed between the study and control groups at 1 and 2 years postoperative, with greater percentage changes in the study group (all P < 0.05). Greater root remodelling in the canines, first and second premolars was observed in the study group (all P < 0.005). Spearman correlation analysis indicated a positive relationship between root remodelling and maxillary advancement, with larger advancements contributing to increased root remodelling in the apical and middle root parts (both P < 0.05). These findings can be valuable for surgeons and orthodontists in evaluating root changes.
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Affiliation(s)
- K A Alqahtani
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - E Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Alqahtani KA, Jacobs R, Da Costa Senior O, Politis C, Shaheen E. Recommendations to minimize tooth root remodeling in patients undergoing maxillary osteotomies. Sci Rep 2024; 14:13686. [PMID: 38871741 DOI: 10.1038/s41598-024-62059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.
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Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Oliver Da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Lobiondo P, Lagravère M, Romero M. Tooth-Bone-Borne vs Bone-Borne Rapid Maxillary Expanders on Dentoskeletal Changes. J Multidiscip Healthc 2024; 17:1877-1886. [PMID: 38706502 PMCID: PMC11068038 DOI: 10.2147/jmdh.s433693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose This study compared the insertion and thickness of the cortical bone, the parallelism of the midpalatal suture, and the skeletal transverse dimension using a microimplant-assisted rapid palatal expansion (MARPE) with those produced by bone-anchored maxillary expander (BAME) in adults. Patients and Methods The sample comprised 18 patients (mean age, 29.9±9.4 years) selected for the MARPE group and 18 (mean age 24.8±6.8 years) selected for the BAME group. Cone-Beam computed tomography scans taken just before and after the expansion. Results After treatment, there was a significant palatal depth decrease. In addition, maxillary and mandibular width were increased in both groups. Regarding the cortical bone insertion and cortical bone width, it is shown an increase in both groups but those changes are not significant. However, the anterior suture opening effect occurs more frequently in the BAME than in the MARPE device. There are no differences in the frequency of opening of the midpalatal suture in the cases treated with MARPE and BAME, in both cases the most frequent opening morphology is parallel, independently of midpalatal suture maturation. Conclusion There are no differences in the use of MARPE or BAME in the parallelism of the middle palatal suture, the cortical bone insertion, and thickness according to the maturation stages of the midpalatal suture but significantly increases the transverse dimensions of the maxillary skeleton.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Móstoles, Madrid, Spain
| | | | | | - Manuel Lagravère
- Division of Orthodontics, Faculty of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Alcorcón, Madrid, Spain
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Koç O, Koç N, Jacob HB. Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis. Dental Press J Orthod 2024; 29:e2423195. [PMID: 38451569 PMCID: PMC10914319 DOI: 10.1590/2177-6709.29.1.e2423195.oar] [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: 08/29/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. OBJECTIVE The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. MATERIAL AND METHODS Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. RESULTS Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). CONCLUSIONS Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.
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Affiliation(s)
- Osman Koç
- Yildiz Technical University, Department of Mechanical Engineering (Yildiz, Istanbul/Turkey)
| | - Nagihan Koç
- Independent researcher (Yildiz, Istanbul/Turkey)
| | - Helder Baldi Jacob
- The University of Texas Health Science Center Houston School of Dentistry, Department of Orthodontics (Houston/TX, USA)
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Gokturk M, Yavan MA. Comparison of the short-term effects of tooth-bone-borne and tooth-borne rapid maxillary expansion in older adolescents. J Orofac Orthop 2024; 85:43-55. [PMID: 35612594 DOI: 10.1007/s00056-022-00401-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the short-term effects of tooth-bone-borne and tooth-borne rapid maxillary expansion (RME) devices on dentofacial structures in older adolescents. METHODS The retrospective study reviewed pre- and posttreatment lateral and posteroanterior cephalometric images and orthodontic model records of patients who underwent maxillary expansion. Two groups were formed, in which the same upper jaw expansion protocol was applied with two different maxillary expansion devices: the first group consisted of 15 individuals treated with tooth-bone-borne (hybrid) RME (HRME; 9 girls and 6 boys; mean age, 16.9 ± 0.42 years) and the second group consisted of 15 individuals treated with tooth-borne (conventional) RME (CRME; 8 girls and 7 boys; mean age, 16.74 ± 0.54 years). Cephalometric and orthodontic model measurements were conducted on the records taken before and after treatment. RESULTS Significant skeletal and dental expansions were observed in both groups (p < 0.05). However, the increase in nasal width measurements in the HRME group (2.24 ± 0.61 mm) was significantly higher than the increase in the CRME group (1.12 ± 0.25 mm; p < 0.01). Buccal tipping of the premolars was significantly less in the HRME group (0.46 ± 0.35°) than in the CRME group (2.46 ± 0.63°; p < 0.01). The amount of tipping of the molars was higher in the HRME group (4.76 ± 0.88°) compared to the CRME group (2.9 ± 1.03°; p < 0.01). CONCLUSION Although the HRME device increase the nasal width in older adolescents to a greater extent, more dental side effects were seen at the maxillary first molars.
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Affiliation(s)
- Mustafa Gokturk
- Department of Orthodontics, Faculty of Dentistry, Adıyaman University, 02240, Adıyaman, Turkey
| | - Mehmet Ali Yavan
- Department of Orthodontics, Faculty of Dentistry, Adıyaman University, 02240, Adıyaman, Turkey.
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Rajkumar K, Walia BS, Viswambaran M, Ganesh V, Padmavati. Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite. J Maxillofac Oral Surg 2023; 22:900-907. [PMID: 38105837 PMCID: PMC10719231 DOI: 10.1007/s12663-022-01756-9] [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: 05/24/2021] [Accepted: 06/12/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.
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Affiliation(s)
- K. Rajkumar
- Oral and Maxillofacial Surgery, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - B. S. Walia
- Orthodontics & Dentofacial Orthopaedics, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - M. Viswambaran
- Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - V. Ganesh
- Fracktal Works Pvt Ltd, Bangalore, India
| | - Padmavati
- Sree Balaji Dental College and Hospital, Chennai, India
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders. BMC Oral Health 2023; 23:714. [PMID: 37794400 PMCID: PMC10552363 DOI: 10.1186/s12903-023-03461-6] [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: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Madrid, Spain
| | - María José González-Olmo
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain.
| | | | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain
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Pasqua BDPM, André CB, Paiva JBD, Rino Neto J. Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial. Dental Press J Orthod 2023; 28:e2322220. [PMID: 37729286 PMCID: PMC10508049 DOI: 10.1590/2177-6709.28.4.e2322220.oar] [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: 09/21/2022] [Accepted: 04/22/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. METHODS Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. RESULTS Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. CONCLUSIONS Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.
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Affiliation(s)
| | | | | | - José Rino Neto
- University of São Paulo, Department for Orthodontics (São Paulo/SP, Brazil)
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Schmid JQ, Gerberding E, Hohoff A, Kleinheinz J, Stamm T, Middelberg C. Non-Surgical Transversal Dentoalveolar Compensation with Completely Customized Lingual Appliances versus Surgically Assisted Rapid Palatal Expansion in Adults-Tipping or Translation in Posterior Crossbite Correction? J Pers Med 2023; 13:jpm13050807. [PMID: 37240977 DOI: 10.3390/jpm13050807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to investigate buccolingual tooth movements (tipping/translation) in surgical and nonsurgical posterior crossbite correction. A total of 43 patients (f/m 19/24; mean age 27.6 ± 9.5 years) treated with surgically assisted rapid palatal expansion (SARPE) and 38 patients (f/m 25/13; mean age 30.4 ± 12.9 years) treated with dentoalveolar compensation using completely customized lingual appliances (DC-CCLA) were retrospectively included. Inclination was measured on digital models at canines (C), second premolars (P2), first molars (M1), and second molars (M2) before (T0) and after (T1) crossbite correction. There was no statistically significant difference (p > 0.05) in absolute buccolingual inclination change between both groups, except for the upper C (p < 0.05), which were more tipped in the surgical group. Translation, i.e., bodily tooth movements that cannot be explained by pure uncontrolled tipping, could be observed with SARPE in the maxilla and with DC-CCLA in both jaws. Dentoalveolar transversal compensation with completely customized lingual appliances does not cause greater buccolingual tipping compared to SARPE.
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Affiliation(s)
- Jonas Q Schmid
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Elena Gerberding
- Department of Orthodontics, Hannover Medical School (MHH), 30625 Hannover, Germany
- Private Practice, 49152 Bad Essen, Germany
| | - Ariane Hohoff
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University of Münster, 48149 Münster, Germany
| | - Thomas Stamm
- Department of Orthodontics, University of Münster, 48149 Münster, Germany
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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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Kaya N, Seker ED, Yücesoy T. Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study. Prog Orthod 2023; 24:7. [PMID: 36872417 PMCID: PMC9986190 DOI: 10.1186/s40510-023-00459-2] [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: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 03/07/2023] Open
Abstract
AIM To compare the effects of three different maxillary expansion appliances with five different types of expansion modalities on stress distribution and displacement on the maxilla and its adjacent craniofacial structures using the finite element method (FEM). MATERIALS AND METHODS Cone-beam computed tomography data of a patient with maxillary transverse deficiency were rendered into a three-dimensional model of craniomaxillary structures. The expansion appliances included tooth-borne, hybrid, and bone-borne expanders. Five different expansion modalities were applied to each expander [conventional Rapid Maxillary Expansion (RME) (type 1), midpalatal suture cortico-puncture-assisted RME (type 2), LeFort l cortico-puncture-assisted RME (type 3), surgically assisted RME (SARME) without pterygomaxillary junction (PMJ) separation (type 4), and SARME with bilateral PMJ separation (type 5)]. The numerical and visual data were analyzed. RESULTS The highest amount of stress accumulation on teeth was found in the tooth-borne and hybrid groups. On the other hand, more stress concentration on the maxilla was observed in the bone-borne group. SARME cuts with PMJ separation increased total movement by reducing the stress on the midpalatal suture in all groups. While types 1, 2, and 3 were similar in terms of the amounts of displacement, types 4 and 5 increased the total amount of displacement in all groups. The total amounts of displacements from the highest value to the lowest value for the anterior and posterior maxilla were in the bone-borne, tooth-borne, and hybrid groups. CONCLUSIONS SARME cuts were effective in reducing stress on the teeth, but the cortico-puncture application affected neither the stress values on the teeth nor the transverse displacement in the tooth-borne expanders. Surgical procedures such as SARME and corticotomy should be used with bone-borne devices to improve the outcomes of maxillary expansion procedures.
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Affiliation(s)
- Nihal Kaya
- Department of Orthodontics, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
| | - Elif Dilara Seker
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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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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Alqahtani KA, Jacobs R, Shujaat S, Politis C, Shaheen E. Automated three-dimensional quantification of external root resorption following combined orthodontic-orthognathic surgical treatment. A validation study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101289. [PMID: 36122841 DOI: 10.1016/j.jormas.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Three-dimensional (3D) quantitative assessment of external root resorption (ERR) following combined orthodontic-orthognathic surgical treatment is vital for ensuring an optimal long-term tooth prognosis. In this era, lack of evidence exists applying automated 3D approaches for assessing ERR. Therefore, this study aimed to validate a protocol for 3D quantification of ERR on cone-beam computed tomography (CBCT) images following combined orthodontic-orthognathic surgical treatment. MATERIAL AND METHODS Twenty patients who underwent combined orthodontic-orthognathic surgical treatment were recruited. Each patient had CBCT scans acquired with NewTom VGi evo (NewTom) at three time-points i.e., 4-weeks prior to surgery (T0), 1-week (T1) and 1-year after surgery (T2). Patients were divided into two groups, group A (surgical Le Fort I osteotomy group: 10 patients) and group B (orthodontic group without maxillary surgical intervention: 10 patients). Root resorption was assessed by measuring length and volumetric changes of maxillary premolar to premolar teeth (central and lateral incisors, canines, 1st and 2nd premolars= 10 teeth) at T0-T1 and T0-T2 time intervals in both groups. The protocol consisted of convolutional neural network based segmentation followed by surface-based superimposition and automated 3D analysis. RESULTS The intra-observer intra-class correlation coefficient (ICC) was found to be excellent (1.0) with an average error of 0 mm and 0 mm3 for assessing root length and volume, respectively. The entire protocol took 56.8 ± 7 s for quantifying ERR. Both group of patients showed negligible changes in length and volumetric ratio at T0-T1 time-interval. Furthermore, group A had lower ERR ratio with decreased root volume and length compared to group B at T0-T2 time-interval. CONCLUSIONS The proposed protocol was found to be time efficient, accurate and reliable for 3D quantification of ERR on CBCT images. It could act as a viable automated option for assessing ERR. CLINICAL SIGNIFICANCE The automated protocol could provide a time efficient method to allow a reliable and accurate 3D follow up root resorption after orthognathic and orthodontic treatment procedures. These new insights could allow clinicians to implement strategies for minimizing the risk of root resorption and to further enhance treatment predictability.
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Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, AlKharj, Saudi Arabia.
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Pasqua BDPM, André CB, Paiva JB, Tarraf NE, Wilmes B, Rino-Neto J. Dentoskeletal changes due to rapid maxillary expansion in growing patients with tooth-borne and tooth-bone-borne expanders: A randomized clinical trial. Orthod Craniofac Res 2022; 25:476-484. [PMID: 34951124 DOI: 10.1111/ocr.12559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare, using cone-beam computed tomography, the dentoskeletal changes in rapid maxillary expansion with tooth-bone-borne (Hybrid Hyrax) and tooth-borne (Hyrax) appliances. SETTING AND SAMPLE POPULATION Forty-two patients who met the eligibility criteria (aged 11-14 years; transverse maxillary deficiency, posterior crossbite, and presence of upper first premolars and molars) were screened and allocated into two groups: HHG (treatment with Hybrid Hyrax) and HG (treatment with Hyrax). MAIN OUTCOME MEASURES The primary outcomes included nasomaxillary dimensional changes. CBCT was performed before and 3 months after the activation phase. Measurements were performed using Dolphin® . Baseline data were compared using one-way ANOVA. For intergroup comparison, ANCOVA was used to analyze the initial age, appliance activations (mm), and mid-palatal suture maturation data as covariates. Statistical significance was set at 5%. RESULTS The premolar region in HHG showed increased skeletal changes than in HG, with the difference being 1.5 mm (0.5; 2.6) in the nasal cavity (P = .004), 1.4 mm (0.3; 2.5) in the nasal floor (P = .019), and 1.1 mm (0.2; 2.1) in the maxilla (P = .022). The molar region in HHG showed increased skeletal changes with the difference being 0.9 mm (0.2; 1.5) in the nasal cavity (P = .005), and 0.9 mm (0; 1.8) in the maxilla (P = .042) than in HG. Premolar inclination was higher in HG. CONCLUSION Hybrid Hyrax showed more skeletal changes and fewer dental side effects, especially in the first premolar region. The amount of activation influenced the higher nasal skeletal changes in the Hybrid hyrax group.
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Affiliation(s)
| | | | - João Batista Paiva
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Nour Eldin Tarraf
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany
| | - José Rino-Neto
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Zambon C, Cherobin G, Utumi E, Machado G, de Vasconcellos F, Peres M, Pilan R, Voegels R, Pinna F. Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00422-2. [DOI: 10.1016/j.ijom.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 02/09/2023]
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Alqahtani KA, Shaheen E, Morgan N, Shujaat S, Politis C, Jacobs R. Impact of orthognathic surgery on root resorption: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e260-e267. [PMID: 35477011 DOI: 10.1016/j.jormas.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR). MATERIAL AND METHODS An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools. RESULTS The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy. CONCLUSIONS The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.
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Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam bin Abdulaziz University, AlKharj, Saudi Arabia.
| | - Eman Shaheen
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nermin Morgan
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Gokce G, Basoglu OK, Veli I. Polygraphic evaluation of the effects of different rapid maxillary expansion appliances on sleep quality: A randomized clinical trial. Sleep Breath 2022; 27:651-659. [DOI: 10.1007/s11325-022-02677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
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Esen Ç, Esen A, Güler AY, Menziletoğlu D, Soğancı AE. Assessment of Alveolar Bone Loss and Buccal Bone Thickness After Surgically Assisted Rapid Maxillary Expansion. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2020.97752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:4509-4523. [PMID: 35211817 DOI: 10.1007/s00784-022-04415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency. MATERIALS AND METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99). CONCLUSIONS MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination. REGISTRATION This study is registered with PROSPERO, CRD42021256750. CLINICAL RELEVANCE MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.
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Romano F, Sverzut CE, Trivellato AE, Saraiva MCP, Nguyen TT. Surgically assisted rapid palatal expansion (SARPE): three-dimensional superimposition on cranial base. Clin Oral Investig 2022; 26:3885-3897. [PMID: 35013784 DOI: 10.1007/s00784-021-04355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 12/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate dental and skeletal changes caused by surgically assisted rapid palatal expansion (SARPE) using the superimposition of three-dimensional cone-beam computed tomography (CBCT) images on the cranial base. MATERIAL AND METHODS This is a retrospective quasi-experiment before-and-after study using a convenience sample. Twenty-four adult patients (13 male and 11 female) were evaluated before SARPE (T0), immediately after expansion (T1), and after 6 months of retention (T2). CBCT scans were superimposed on the anterior cranial base using voxel-based registration. Measurements from different reference points were used for comparisons between times. RESULTS At T1, all teeth had significant buccal tipping. At T2, most teeth remained in the same position as at T1, except the first premolar and the first molar, whose buccal roots moved slightly. The amount of bony expansion was 65 to 70% of the amount of tooth movement. The A point and maxillary incisors moved anteriorly from T0 to T1 and T2 (p < 0.0001). Inter-nasal distance had increased significantly at T1 (p < 0.0001) and remained stable at T2 (p = 0.478). No expansion was achieved at the zygomatic arch (p = 0.114). CONCLUSION SARPE promoted substantial buccal tipping of posterior teeth and some bone displacement; it also moved the maxilla and teeth forward and increased nasal width. CLINICAL RELEVANCE No other clinical studies have evaluated dental and skeletal changes caused by SARPE using superimposition of 3D CBCT images on the cranial base. This study findings may help clinical dentists plan treatments using safe and reliable information.
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Affiliation(s)
- Fábio Romano
- Department of Pediatric Dentistry, Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. .,Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
| | - Cássio Edvard Sverzut
- Department of Oral & Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral & Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Maria Conceição Pereira Saraiva
- Department of Pediatric Dentistry, Epidemiology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Tung T Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Skeletal, dentoalveolar, and buccal bone changes using hybrid and tooth-borne expanders for RME and SARME in different growth stages. AUSTRALASIAN ORTHODONTIC JOURNAL 2022. [DOI: 10.2478/aoj-2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
To compare the skeletal, dentoalveolar and buccal bone thickness of tooth–bone-borne (Hybrid-H) and tooth-borne (TB) maxillary expanders used for rapid maxillary expansion (RME) in early and late adolescents and for surgically-assisted RME (SARME) in young adults.
Materials and methods:
This two-centre clinical study included initial and 6 months post-retention CBCT records of 60 patients (27 males, 33 females; mean age 15.7 ± 3.75 years). The cohort was divided into two groups according to the expander type (H or TB) and subdivided into a further three groups determined by cervical vertebrae maturation stages: early adolescents (EA), late adolescents (LA), and young adults (A). EA and LA patients underwent RME and young adults received a SARME.
Results:
The hybrid-designed appliance increased the internal skeletal maxillary width and nasal width more than the TB-designed appliance anteriorly in EA and posteriorly in SARME young adults. The TB expanders tipped and expanded the first premolars more than the Hybrid SARME expanders in young adults and caused a greater reduction in buccal alveolar bone thickness at the level of the first premolars and molars at the three growth stages.
Conclusion
The hybrid expanders, with relatively greater skeletal and nasal widening potential and fewer dentoalveolar side effects, were a favourable alternative to tooth-borne expanders for RME in the early and late adolescents, and for SARME in young adults.
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Minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) in adult patients. J Craniomaxillofac Surg 2021; 50:211-217. [PMID: 34973887 DOI: 10.1016/j.jcms.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/08/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate maxillary expansion, operative time and pain associated with a new minimally invasive surgical technique to treat maxillary hypoplasia in adult patients. Consecutive patients were included and prospectively analyzed. The technique consists in miniscrew-assisted rapid palatal expansion (MARPE), minimally invasive approach to maxillary osteotomies, latency period and activation period until the desired expansion. The parameters evaluated included operative time, treatment-related pain by the visual analog scale (VAS), and transverse maxillary expansion. The Shapiro-Wilk test was used to assess the normality of data distribution. A paired t-test was used to compare the data between T0 (preoperative) and T1 (postoperative - end of activation). The significance level was set at 5%. Eleven patients were included. Mean operative time was 24.11 min (14.4-32 min) and overall postoperative VAS score was 2.81 (0-9). A comparative analysis showed significant increases in maxillary width at the skeletal, alveolar, and dental levels (p < 0.0001 for all), with a mean range of 1.8 (SD 0.3) mm to 4.7 (SD 0.5) mm. The present minimally invasive surgical MARPE (MISMARPE) technique appears to yield good skeletal outcomes with minimal trauma. It might have potential for clinical use, but larger comparative studies are needed to confirm the clinical relevance of the approach.
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Vidalón JA, Loú-Gómez I, Quiñe A, Diaz KT, Liñan Duran C, Lagravère MO. Periodontal effects of maxillary expansion in adults using non-surgical expanders with skeletal anchorage vs. surgically assisted maxillary expansion: a systematic review. Head Face Med 2021; 17:47. [PMID: 34753493 PMCID: PMC8579525 DOI: 10.1186/s13005-021-00299-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Describe and compare harmful periodontal effects as a consequence of maxillary expansion in adult patients with different types of anchorage devices in non-surgical expanders with skeletal anchorage and surgically assisted maxillary expansion. MATERIALS AND METHODS An exhaustive search was carried out on the electronic databases PubMed (MEDLINE), Embase, Cochrane and LILACS. Additionally, journal references and grey literature were searched without any restrictions. After the selection and extraction process; risk of bias was assessed by the ROB-1 Cochrane tool and Newcastle-Ottawa Scale (NOS) for randomized trials and cohort studies, respectively. RESULTS Of 621 studies retrieved from the searches, six were finally included in this review. One of them presented a low risk bias, while five were excellent respective to selection, comparability and outcomes. Results showed that maxillary expansion in adults using non-surgical expanders (bone-borne or tooth-bone-borne with bicortical skeletal anchorage) produce less harmful periodontal effects, such as: alveolar bending with an average range from 0.92° to 2.32°, compared to surgically assisted maxillary expansion (tooth-borne) of 6.4°; dental inclination with an average range from 0.07° to 2.4°, compared to surgically assisted maxillary expansion (tooth-borne) with a range from 2.01° to 5.56°. CONCLUSIONS Although limited, the current evidence seems to show that the bone-borne or tooth-bone-borne with bicortical skeletal anchorage produces fewer undesirable periodontal effects.
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Affiliation(s)
- José Antonio Vidalón
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ismael Loú-Gómez
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Aldo Quiñe
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karla T Diaz
- Stomatology Second Speciality, Universidad Privada San Juan Bautista, Lima, Peru
| | - Carlos Liñan Duran
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuel O Lagravère
- University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
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Alcin R, Malkoç S. Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study. Korean J Orthod 2021; 51:241-249. [PMID: 34275880 PMCID: PMC8290090 DOI: 10.4041/kjod.2021.51.4.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the volume, amount, and localization of root resorption in the maxillary first premolars using micro-computed tomography (micro-CT) after expansion with four different rapid maxillary expansion (RME) appliances. METHODS In total, 20 patients who required RME and extraction of the maxillary first premolars were recruited for this study. The patients were divided into four groups according to the appliance used: miniimplant- supported hybrid RME appliance, hyrax RME appliance, acrylic-bonded RME appliance, and full-coverage RME appliance. The same activation protocol (one activation daily) was implemented in all groups. For each group, the left and right maxillary first premolars were scanned using micro-CT, and each root were divided into six regions. Resorption craters in the six regions were analyzed using special CTAn software for direct volumetric measurements. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test with Bonferroni adjustment. RESULTS The hybrid expansion appliance resulted in the lowest volume of root resorption and the smallest number of craters (p < 0.001). In terms of overall root resorption, no significant difference was found among the other groups (p > 0.05). Resorption was greater on the buccal surface than on the lingual surface in all groups except the hybrid appliance group (p < 0.05). CONCLUSIONS The findings of this study suggest that all expansion appliances cause root resorption, with resorption craters generally concentrated on the buccal surface. However, the mini-implant-supported hybrid RME appliance causes lesser root resorption than do other conventional appliances.
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Stress distribution and displacement of three different types of micro-implant assisted rapid maxillary expansion (MARME): a three-dimensional finite element study. Prog Orthod 2021; 22:20. [PMID: 34152492 PMCID: PMC8217479 DOI: 10.1186/s40510-021-00357-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract Background/objective Until 2010, adults underwent surgical treatment for maxillary expansion; however, with the advent of micro-implant-assisted rapid maxillary expansion (MARME), the availability of less invasive treatment options has increased. Nevertheless, individuals with severe transverse maxillary deficiency do not benefit from this therapy. This has aroused interest in creating a new device that allows the benefit of maxillary expansion for these individuals. The aim of this study was to evaluate the efficacy of three MARME models according to tension points, force distribution, and areas of concentration in the craniofacial complex when transverse forces are applied using finite element analysis. Materials and methods Digital modeling of the three MARME models was performed. Model A comprised five components: one body screw expander and four adjustable arms with rings for mini-implant insertion. These arms have an individualized height adjustment that allows MARME positioning according to the patient’s palatal anatomy, thereby preventing body screw expander collision with the lateral mucosa in severe cases of maxillary deficiency. Model B was a maxillary expander with screw rings joined to the body, and model C was similar to model B, except that model C had open rings for the insertion of the mini-implants. Through the MEF (Ansys software), the stresses, distribution, and area of concentration of the stresses were evaluated when transverse forces of 7.85 N were applied. Results The three models maintained the following pattern: model C presented weak stress peaks with limited distribution and lower concentration area, model B obtained median stress peaks with better distribution when compared to that of model C, and model A showed better stress distribution and larger concentration area. In model A, tensions were located in the lateral lamina of the pterygoid process, which is an important site for maxillary expansion. The limitation of the present study was that it did not include the periodontal tissues and muscles in the finite element method evaluation. Conclusions Model A showed the best stress distribution conditions. In cases of severe atresia, model A seems to be an excellent option. Supplementary Information The online version contains supplementary material available at 10.1186/s40510-021-00357-5.
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Gökçe G, Akan B, Veli İ. A postero-anterior cephalometric evaluation of different rapid maxillary expansion appliances. J World Fed Orthod 2021; 10:112-118. [PMID: 34031017 DOI: 10.1016/j.ejwf.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate dental and skeletal changes induced by tooth-bone-borne, tooth-tissue-borne, and tooth-borne rapid maxillary expansion (RME) appliances using postero-anterior (PA) cephalometric radiographs. METHODS A total of 54 patients' (25 boys, 29 girls) PA cephalometric radiographs who had bilateral posterior crossbite and RME treatment were included and divided into three groups according to the type of appliance used during treatment: tooth-bone-borne RME appliance (hybrid Hyrax) (7 boys, 11 girls, mean age 13.28 ± 1.20 years), tooth-tissue-borne RME appliance (TTB) (8 boys, 10 girls, mean age 13.08 ± 1.06 years) and tooth-borne RME appliance (Hyrax) (10 boys, 8 girls, mean age 12.05 ± 1.35 years). Pretreatment (T0) and posttreatment (T1) PA cephalometric radiographs were analyzed with Dolphin software v. 11.7 (Chatsworth, CA). The comparisons of the groups were performed with Two-way analysis of variance. P < 0.05 was considered statistically significant. RESULTS Significant and equal increase of right molar relationship and upper intermolar molar widths occurred in all groups. Dental midline discrepancy showed significant increase in only hybrid Hyrax group between T0 and T1. Significant increases were reported for lateronasal width in hybrid Hyrax and tooth-tissue-borne groups (P < 0.05). CONCLUSIONS Both skeletal and dental changes were observed after RME in all groups. However, the greatest skeletal changes were seen in hybrid Hyrax and tooth-tissue-borne groups.
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Affiliation(s)
- Gökçenur Gökçe
- Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey.
| | - Burçin Akan
- Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - İlknur Veli
- Associate Professor, Department of Orthodontics, Izmir Katip Celebi University, Izmir, Turkey
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Effect of vomer position following surgically assisted rapid palatal expansion. Oral Maxillofac Surg 2021; 26:113-121. [PMID: 33987751 DOI: 10.1007/s10006-021-00968-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of vomer position and prevalence of periodontal dehiscence in patients who underwent surgically assisted rapid palatal expansion (SARPE). The null hypotheses were the following: (1) vomer position in the coronal plane does not influence the degree of skeletal and dental expansion; and (2) there is no association between expansion, periodontal dehiscence and vomer position. METHODS Twenty-one patients were evaluated before treatment (T0) and immediately after SARPE expansion (T1). After SARPE, the vomer was in the right side in 11 patients and in the left in 10 patients. Skeletal and dental effects were evaluated using CBCT, landmarks and measurements. RESULTS The maxilla and the nasal cavity expanded asymmetrically. The side containing the vomer had less skeletal expansion but more dental tipping. Dehiscence increased significantly from T0 to T1 and was associated with the amount of skeletal displacement, especially when greater than 3.20 mm. In the first premolars region, there was more than 2 mm of asymmetric expansion observed in 38.5% of the patients. CONCLUSION The null hypotheses were rejected. The side containing the vomer had less skeletal expansion of the maxilla and nasal cavity but more dental tipping. Dehiscence increased after expansion, but there were no differences between sides.
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Wilmes B, Tarraf N, Drescher D. Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination. Am J Orthod Dentofacial Orthop 2021; 160:147-154. [PMID: 33906772 DOI: 10.1016/j.ajodo.2020.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
Bone-borne rapid maxillary expansion distraction devices are used to achieve a more skeletal expansion and to avoid dental side effects of conventional expanders such as tipping of anchorage teeth. In this article, we report the use of a prefabricated expander fixed on 2 mini-implants in the anterior palate. This allows for the insertion of the mini-implants and the expander to occur without the need for an impression or any laboratory procedures. Especially when aligners are going to be used, the use of a mini-implant-borne expander seems to be reasonable because the expander can be left in place as a skeletal retainer during the aligner finishing.
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Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany.
| | - Nour Tarraf
- Private practice, Sydney, Australia, and Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Dieter Drescher
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
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Xia K, Sun WT, Yu LY, Liu J. Influence of different types of rapid maxillary expansion on root resorption: a systematic review. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:38-47. [PMID: 33723935 DOI: 10.7518/hxkq.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to assess the influence of different types of rapid maxillary expansion on root resorption (RR). METHODS Literature searches were carried out electronically in five English and two Chinese databases. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, and case-control studies were included. The data were extracted by three authors. The risk of bias in the RCTs and nonrandomized studies were assessed in accordance with corresponding scales. RESULTS Among the 400 articles identified, seven were included for the final analysis. Three studies were graded as high value of evidence, while two and another two studies were graded as moderate value and low value, respectively. According to the available evidence, the tooth-borne maxillary expansion caused more obvious RR of anchorage teeth than the bone-borne one. In addition, the Haas-type palatal acrylic pads could not effectively reduce the degree of RR. The difference in the design of the retainer between the tooth-borne maxillary expansion (the use of a band or wire framework to connect the anchorage tooth) did not cause the difference in the incidence and degree of RR. CONCLUSIONS Clinical evidence suggested that bone-borne maxillary expansion may decrease the amount of RR, while the amounts of resorption did not significantly differ between Haas and Hyrax and between different retainer types of Hyrax.
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Affiliation(s)
- Kai Xia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wen-Tian Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li-Yuan Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jun Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Akbari M, Prabhu R, Khanna S, Turner MD. Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)? J Oral Maxillofac Surg 2021; 79:e1-e3. [PMID: 33386086 DOI: 10.1016/j.joms.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Maryam Akbari
- Resident, Mount Sinai Health Care system, New York, NY
| | - Rohan Prabhu
- Resident, Mount Sinai Health Care system, New York, NY
| | - Sagar Khanna
- Resident, Mount Sinai Health Care system, New York, NY
| | - Michael D Turner
- Chief and Program Director of Oral and Maxillofacial Surgery, Mount Sinai Hospital, New York, NY.
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Sankar SG, Prashanth B, Rajasekhar G, Prasad M, Reddy GV, Priyanka JSY. A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study. Natl J Maxillofac Surg 2021; 12:171-180. [PMID: 34483573 PMCID: PMC8386258 DOI: 10.4103/njms.njms_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance. MATERIALS AND METHODS A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test. RESULTS Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05). CONCLUSIONS Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.
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Affiliation(s)
- Singaraju Gowri Sankar
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India,Address for correspondence: Prof. Singaraju Gowri Sankar, Department of Orthodontics, Narayana Dental College, Nellore - 524 003, Andhra Pradesh, India. E-mail:
| | - Bathini Prashanth
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Galli Rajasekhar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Mandava Prasad
- Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
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Bortolotti F, Solidoro L, Bartolucci ML, Incerti Parenti S, Paganelli C, Alessandri-Bonetti G. Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials. Eur J Orthod 2020; 42:434-440. [PMID: 31365925 DOI: 10.1093/ejo/cjz057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Surgically assisted rapid maxillary expansion (SARME) is a surgical technique developed to correct transverse discrepancies in skeletally mature patients. However, there is limited evidence concerning the immediate skeletal and dental changes obtained only due to SARME. OBJECTIVE The aim of the present systematic review is to investigate the immediate skeletal and dental effects of SARME in adult patients with transverse maxillary hypoplasia. SEARCH METHODS An electronic search of the literature in MEDLINE, The Cochrane Library, Lilacs and Scopus databases was performed. SELECTION CRITERIA Only randomized controlled trials (RCTs) studies investigating the skeletal and dental effects of SARME procedures in adult patients were included. DATA COLLECTION AND ANALYSIS The included studies received a methodological quality scoring according to the revised Cochrane risk-of-bias tool for randomized trials. The quality of evidence was assessed by means of the Grading Recommendation Assessment, Development and Evaluation (GRADE) system. For each included study and for each analysed parameter, the difference in means and 95 per cent confidence interval was calculated between baseline and immediate post-expansion. A meta-analysis of original outcome data, if possible, was conducted. RESULTS Nine articles were selected. The methodological quality ratings indicated that one study was at low risk of bias, seven presented some concerns and only one was at high risk of bias. In all the included studies, the SARME procedure resulted in a significant expansion of the maxillary transverse dimension. The meta-analysis compared skeletal and dental inter-molar width before and after treatment: the mean difference was of 3.3 mm (2.8-3.9) and 7.0 mm (6.1-7.8), respectively (P-value less than 0.001). The quality of evidence was low-moderate. CONCLUSIONS SARME is effective in obtaining a significant expansion of the maxillary transverse dimension. However, the immediate SARME effect is mainly a molar expansion rather than a pure bone transverse widening of the maxilla. REGISTRATION The review protocol was registered at PROSPERO database with the registration number CRD42018117967.
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Affiliation(s)
- Francesco Bortolotti
- Department of Biomedical Sciences, Section of Orthodontics, University of Bologna
| | - Livia Solidoro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Italy
| | | | | | - Corrado Paganelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Italy
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Muñoz-Pereira ME, Haas-Junior OL, Da Silva Meirelles L, Machado-Fernández A, Guijarro-Martínez R, Hernández-Alfaro F, de Oliveira RB, Pagnoncelli RM. Stability and surgical complications of tooth-borne and bone-borne appliances in surgical assisted rapid maxillary expansion: a systematic review. Br J Oral Maxillofac Surg 2020; 59:e29-e47. [PMID: 33431313 DOI: 10.1016/j.bjoms.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
The objective of this systematic review was to evaluate the stability and complications of tooth-borne (TB), bone-borne (BB) and hybrid (TB-BB) appliances in surgically assisted rapid maxillary expansion (SARME). Database searches were conducted (PubMed, Embase, Cochrane Library and SciELO), as well as a grey literature search (Google Scholar) and hand searches of reference lists. Forty-six articles were included after study selection (κ=0.854). After eligibility assessment, 16 articles and one article from the grey literature were processed (κ=0.866) and six articles were selected by hand searching, for a total of 23 articles included. Regarding stability, TB appliances showed width relapse rates ranging from 4 to 35% in canines, from 1 to 37% in premolars and from 0.2 to 49.5% in molars. In BB appliances, width relapse rates were 1.7-21% in canines, 1.5% in premolars and 4.6-11.5% in molars. In hybrid appliances, the width relapse rate was 14% in premolars, with a 1.8% overexpansion reported in the molar region. In TB and BB appliances, skeletal relapse rates were similar on the nasal floor (11-53% and 41.6%, respectively) and at the level of the maxilla (18% and 16%, respectively). The most common complications were bone resorption in TB appliances (18.14%) and appliance-related complications in BB appliances (17.9%). The risk of bias was high in 19 studies, medium in three studies and low in one study. The TB and BB appliances used in SARME were considered to have a high long-term stability. BB appliances appeared to have fewer relapses than TB appliances due to a more parallel distribution of forces exerted. However, relapse appears to be highly influenced by postorthodontic treatments, where arch-form coordination is achieved in the consolidation period with the purpose of overexpansion correction, alignment and final vertical adjustments. Further randomised controlled trials with long-term data and large sample sizes are needed to support evidence-based clinical decision-making and to allow meta-analytic studies of stability outcomes regarding the type of anchorage in SARME.
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Affiliation(s)
- M E Muñoz-Pereira
- Professor at Division of Oral and Maxillofacial Surgery, Department of Diagnostic and Surgical Sciences, University of Costa Rica - San Pedro de Montes de Oca, San José́; PhD Program at Department of Oral and Maxillofacial Surgery, Pontifical University of Rio Grande do Sul (PUCRS)- Porto Alegre, RS, Brazil.
| | - O L Haas-Junior
- Professor at Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS) - Porto Alegre, RS. Brazil; Institute of Maxillofacial Surgery, Teknon Medical Center - Barcelona, Spain
| | - L Da Silva Meirelles
- PhD Program at Department of Oral and Maxillofacial Surgery, Pontifical University of Rio Grande do Sul (PUCRS)- Porto Alegre, RS, Brazil
| | - A Machado-Fernández
- PhD Program at Department of Oral and Maxillofacial Surgery, Pontifical University of Rio Grande do Sul (PUCRS)- Porto Alegre, RS, Brazil
| | - R Guijarro-Martínez
- Institute of Maxillofacial Surgery, Teknon Medical Center - Barcelona, Spain; Assistant Professor, Department of Orthodontics, Cardenal Herrera-CEU, Universidad de Valencia- Valencia, Spain
| | - F Hernández-Alfaro
- Department Head at Institute of Maxillofacial Surgery, Teknon Medical Center - Barcelona, Spain; Department Head Professor at Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya - Sant Cugat del Vallès, Barcelona, Spain
| | - R B de Oliveira
- Professor at Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS) - Porto Alegre, RS. Brazil
| | - R M Pagnoncelli
- Professor at Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS) - Porto Alegre, RS. Brazil
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Keskin-Yalcin B, Cakarer S, İşler S, Özel-Yıldız S, Beycan K, Koçak-Berberoglu H. Evaluation of skeletal changes associated with surgically rapid palatal expansion without pterygomaxillary separation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:254-258. [DOI: 10.1016/j.jormas.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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Ploder O, Winsauer H, Juengling K, Grill F, Bissinger O, Wolff KD, Kolk A. Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances? J Oral Maxillofac Surg 2020; 79:213-224. [PMID: 32422194 DOI: 10.1016/j.joms.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For surgically assisted rapid palatal expansion (SARPE), studies comparing different devices are missing. The aim was to evaluate expansion, relapse, and the complication rates for 3 different appliances. PATIENTS AND METHODS In this retrospective cohort study, tooth-borne (TB, n = 29), bone-borne (BB, n = 12), or orthodontic mini-implant (OMI)-borne (n = 13) appliances were used for SARPE in 2 clinical centers. Patients presenting with a maxillary width discrepancy greater than 5 mm were included. Measurements of cast models and radiographs were performed preoperatively, immediately after consolidation, and at 1 year postoperatively. All distances were measured between canines, premolars, and molars. Complications (tooth damage, infection, technical failure) were evaluated. The outcome variables were expansion, relapse, and complications. Type of appliance was selected as predictor variable. Within- and between-group differences regarding expansion, relapse, and complications for the 3 appliances were statistically analyzed. RESULTS In 54 patients (aged 28.8 ± 8.6 years), mean expansion (±standard deviation) for the TB, BB, and OMI appliances immediately after consolidation was 5.29 ± 1.39 mm, 5.22 ± 1.72 mm, and 3.81 ± 2.19 mm, respectively, at the dental level, and 5.51 ± 1.40 mm, 4.66 ± 2.03 mm, and 3.51 ± 1.66 mm, respectively, at the bone level. Mean (±standard deviation) relapse for the TB, BB, and OMI appliances at 1 year postoperatively measured 1.44 ± 1.01 mm, 0.76 ± 1.37 mm, and 0.27 ± 1.63 mm, respectively, at the tooth level and 1.19 ± 0.93 mm, 0.71 ± 0.96 mm, and 0.12 ± 1.56 mm, respectively, at the bone level. Analysis of variance and the Tukey test showed significant differences between the TB and OMI appliances for expansion and relapse (P = .034 and P = .024, respectively). The overall complication rate differed significantly (P < .001), with rates of 17.2%, 66.7%, and 15.4% for the TB, BB, and OMI appliances, respectively. CONCLUSIONS BB and OMI appliances resulted in less relapse. Owing to the high complication rate, the further use of BB appliances is questionable.
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Affiliation(s)
- Oliver Ploder
- Head of Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Katharina Juengling
- Postdoctoral Student, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Florian Grill
- Resident, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Oliver Bissinger
- Senior Physician, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Klaus-Dietrich Wolff
- Head of Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Kolk
- Head of Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria; Formerly, Executive Senior Physician, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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Baranto H, Weiner CK, Burt IA, Rosén A. Satisfactory outcomes after orthognathic surgery with surgically assisted rapid maxillary expansion using a hybrid device. J Oral Sci 2020; 62:107-111. [PMID: 31996512 DOI: 10.2334/josnusd.19-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The self-reported functional outcomes, clinical findings, and results of dental cast analysis before and after orthognathic surgery with surgically assisted rapid maxillary expansion (SARME) using a hybrid rapid maxillary expander (RME) were evaluated. Data were collected from 43 patients who underwent orthognathic surgery with SARME using a hybrid RME between 2001 and 2013. The patients were recruited during a follow-up clinical examination and were required to complete a questionnaire about their opinions and self-reported functional outcomes. Dental casts were used to analyze posttreatment palatal expansion. The mean follow-up time was 68 months (range: 25-135 months). The most common indication for SARME was the presence of a crossbite. Of the 30 patients who underwent a follow-up clinical examination (69.8% answer rate), 4 (13.3%) had symptoms of temporomandibular disorder (TMD), 1 (3.3%) experienced myalgia, and 3 (10.0%) experienced arthralgia on clinical palpation. Cast analysis revealed significant palatal expansion. The intercanine distance, intermolar distance, and palatal height were increased by 3, 5, and 2 mm, respectively. Overall, the patients were satisfied with the preoperative information, improved functions, and aesthetic results. The prevalence of TMD symptoms and other side effects following orthognathic surgery with SARME using a hybrid RME was low, and significant palatal expansions were achieved.
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Affiliation(s)
- Helen Baranto
- Department of Oral and Maxillofacial Surgery, Folktandvården Eastman Institutet
| | - Carina K Weiner
- Department of Oral and Maxillofacial Surgery, Folktandvården Eastman Institutet
| | - Idil A Burt
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institute
| | - Annika Rosén
- Department of Clinical Dentistry, Section of Oral & Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Bergen
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Khosravi M, Ugolini A, Miresmaeili A, Mirzaei H, Shahidi-Zandi V, Soheilifar S, Karami M, Mahmoudzadeh M. Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review. Int Orthod 2019; 17:425-436. [PMID: 31280998 DOI: 10.1016/j.ortho.2019.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.
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Affiliation(s)
- Mahdieh Khosravi
- Orthodontic Department Dental Faculty, 17 Shahrivar boulevard, Seman, Iran
| | - Alessandro Ugolini
- University of Genoa, Orthodontic Department, Largo Rosanna Benzi 10, Genova, Italy
| | - Amirfarhang Miresmaeili
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Hamed Mirzaei
- Faculty of Management of University of Tehran, Tehran, Iran
| | - Vahid Shahidi-Zandi
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Sepideh Soheilifar
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Manoochehr Karami
- Hamedan University of medical sciences, Department of Epidemiology School of Health, Shahid Fahmide boulevard, Hamedan, Iran
| | - Majid Mahmoudzadeh
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran.
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Carvalho FSR, Studart Soares EC, Ferreira Barbosa DA, de Araújo Mouta AE, Marinho Bezerra TM, Ribeiro TR, Gurgel Costa FW. Does surgically assisted rapid maxillary expansion associated with pterygomaxillary disjunction result in changes in mandibular position? A PROSPERO-compliant systematic review of the literature. J Craniomaxillofac Surg 2019; 47:1046-1053. [DOI: 10.1016/j.jcms.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/07/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
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Kim KA, Oh SH, Kim BH, Kim SJ. Asymmetric nasomaxillary expansion induced by tooth-bone-borne expander producing differential craniofacial changes. Orthod Craniofac Res 2019; 22:296-303. [PMID: 31066172 DOI: 10.1111/ocr.12320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate three-dimensional (3D) craniofacial changes induced by a non-surgical tooth-bone-borne rapid palatal expander (TBB-RPE) according to the symmetrical pattern of expansion, to investigate the 3D changes between the sides in patients with asymmetric expansion, and to identify the related factors of asymmetric expansion. SETTING AND SAMPLE POPULATION Sixty-six patients (mean age: 19.3 ± 5.7 years) treated with TBB-RPE were divided into a symmetric expansion group (Group S, n = 46) or asymmetric expansion group (Group A, n = 20). Group S was subdivided into Group Ss (n = 27), with bilateral frontomaxillary suture (FMS) split, and Group Sn (n = 19), with no FMS split. MATERIALS AND METHODS Pre- and post-expansion cone-beam computed tomography images were superimposed, and the common coordinated system was set. All landmarks were designated as coordinate pairs, and treatment changes were automatically calculated. Analysis of variance was conducted for intergroup comparison of craniofacial changes, and logistic regression analysis was performed to identify the related factors of asymmetric expansion. RESULTS The frequency of asymmetric expansion was 30.3%. Group A with unilateral FMS split showed less craniofacial changes than Group Ss and more changes than Group Sn. Group A exhibited different nasomaxillary displacement between the two halves, showing greater changes in the FMS-split side. Among the tested six variables (age, gender, Angle's classification, unilateral crossbite, maxillary cant and chin deviation), chin deviation was uniquely associated with asymmetric expansion. CONCLUSIONS Tooth-bone-borne rapid palatal expander had a risk of asymmetric expansion, especially in facial asymmetric patients with chin deviation, producing different craniofacial changes from symmetric expansion.
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Affiliation(s)
- Kyung-A Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Song-Hee Oh
- Department of Oral and Maxillofacial Radiology, Kyung Hee University School of Dentistry, Seoul, Korea
| | | | - Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
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Surgically assisted rapid maxillary expansion with bone-borne versus tooth-borne distraction appliances—a systematic review. Int J Oral Maxillofac Surg 2019; 48:492-501. [DOI: 10.1016/j.ijom.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022]
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Alomari EB, Sultan K. Efficacy of injectable platelet-rich plasma in reducing alveolar bone resorption following rapid maxillary expansion: A cone-beam computed tomography assessment in a randomized split-mouth controlled trial. Angle Orthod 2019; 89:705-712. [PMID: 30920874 DOI: 10.2319/091018-661.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of platelet-rich plasma (PRP) with its growth factors in minimizing the side effects of rapid maxillary expansion (RME) on the periodontal tissue of anchoring teeth using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A randomized, split-mouth clinical trial was conducted on 18 patients aged 12-16 years (14 ± 1.65) with a skeletal maxillary constriction who underwent RME using a Hyrax appliance. The sample was randomly divided into two groups: intervention and control sides. PRP was prepared and injected on the buccal aspect of supporting teeth in the intervention group. High-resolution CBCT imaging (H-CBCT) was carried out preoperatively (T0) and after 3 months of retention (T1) to study the buccal bone plate thickness (BBPT) and buccal bone crest level (BBCL) of anchoring teeth. Changes induced by expansion were evaluated using paired sample t-test (P < .05). RESULTS Results showed that there was no significant difference in BBPT and BBCL between the two groups after RME (P > .05). The prevalence of dehiscence and fenestrations was increased at (T1) in both groups and the percentage was higher in the PRP group. CONCLUSIONS RME induced vertical and horizontal bone loss. PRP did not minimize alveolar defects after RME.
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Kayalar E, Schauseil M, Hellak A, Emekli U, Fıratlı S, Korbmacher-Steiner H. Nasal soft- and hard-tissue changes following tooth-borne and hybrid surgically assisted rapid maxillary expansion: A randomized clinical cone-beam computed tomography study. J Craniomaxillofac Surg 2019; 47:1190-1197. [PMID: 31307850 DOI: 10.1016/j.jcms.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The aim of this study was to assess the effects of tooth/bone-borne (hybrid) and tooth-borne (TB) surgically assisted rapid maxillary expansion (SARME) on the width of the nasal soft and hard tissue. PATIENTS AND METHODS Twenty skeletally mature patients (nine males and 11 females; mean age 19.4 years) with transverse maxillary hypoplasia were randomly assigned to hybrid or TB devices. The patients had undergone SARME operations, performed by the same surgical team using the same procedure (Le Fort I osteotomy with pterygomaxillary dysjunction, midline osteotomy, and no down-fracture). Nasal soft- and hard-tissue changes were analyzed using CBCT preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). The study was approved by the relevant ethics committee. RESULTS The skeletal and soft-tissue nasal parameters increased significantly in the T0-T1 and T0-T2 periods in both groups (P < 0.05). No statistically significant differences between the groups were observed. The mean piriform aperture width increased from 1.26 mm in T0-T1 to 0.97 mm in T1-T2 and 2.17 mm in T0-T2 (P < 0.008). In the soft tissue, the alar base width increased to 2.78 mm and the alar width to 2.95 mm in T0-T2 (P = 0.001). There was a positive correlation (63.6%) between the changes in skeletal and soft-tissue values. CONCLUSION The hybrid and TB devices led to similarly significant widening effects in nasal soft and hard tissues in both the short term and 6 months after SARME.
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Affiliation(s)
- Emre Kayalar
- Departments of Orthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey; Private Practice, Orthodontist (PhD), Istanbul, Turkey.
| | - Michael Schauseil
- Department of Orthodontics, University of Marburg, Marburg, Germany.
| | - Andreas Hellak
- Department of Orthodontics, University of Marburg, Marburg, Germany.
| | - Ufuk Emekli
- Department of Oral and Maxillofacial Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sönmez Fıratlı
- Departments of Orthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
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Graf S, Vasudavan S, Wilmes B. CAD-CAM design and 3-dimensional printing of mini-implant retained orthodontic appliances. Am J Orthod Dentofacial Orthop 2018; 154:877-882. [PMID: 30477785 DOI: 10.1016/j.ajodo.2018.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 10/27/2022]
Abstract
The objective of this article was to illustrate the digital process in the custom fabrication of metallic mini-implant supported appliances. An implant-supported appliance was produced for a patient using a CAD-CAM procedure without a physical impression or a printed model. The work flow consisted of mini-implant insertion into the palate, recording an intraoral digital scan, digital design with incorporation of a scanned expansion mechanism, direct 3-dimensional metal printing via laser melting, laser welding of the hyrax mechanism, insertion, and activation of the appliance. The favorable clinical outcome demonstrated that this procedure is an efficient and viable method for constructing an implant-supported palatal metallic appliance.
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Affiliation(s)
| | - Sivabalan Vasudavan
- Private Practice, Perth, Australia; Faculty of Science, University of Western Australia, Crawley, Western Australia, Australia; Department of Dentistry, Boston Children's Hospital, Boston, Mass; Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Mass
| | - Benedict Wilmes
- Department of Orthodontics, University of Düsseldorf, Düsseldorf, Germany.
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Mohammed H, Wafaie K, Rizk MZ, Almuzian M, Sosly R, Bearn DR. Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis. Prog Orthod 2018; 19:36. [PMID: 30246217 PMCID: PMC6151309 DOI: 10.1186/s40510-018-0225-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/21/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. Search methods An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. Eligibility criteria Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included. Data collection and analysis Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. Results Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7). Conclusions Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies. Electronic supplementary material The online version of this article (10.1186/s40510-018-0225-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Khaled Wafaie
- School of Dentistry, University of Dundee, Dundee, UK
| | - Mumen Z Rizk
- School of Dentistry, University of Dundee, Dundee, UK
| | - Mohammed Almuzian
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Rami Sosly
- School of Dentistry, University of Dundee, Dundee, UK
| | - David R Bearn
- School of Dentistry, University of Dundee, Dundee, UK
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Surgically assisted rapid maxillary expansion in lingual orthodontics - optimizing of coupling and timing : Best oral presentation from the 21st Meeting of German Society of Lingual Orthodontics. Head Face Med 2018; 14:16. [PMID: 30231897 PMCID: PMC6146767 DOI: 10.1186/s13005-018-0172-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. Treatment times in such cases are often long with adult patients usually requesting invisible appliances. Lingual appliances can provide the mechanical control required as well as fulfil the aesthetic demands in such cases. However lingual appliances are usually custom made and indirectly bonded. Due to tooth movement following surgery there is usually a long delay before impressions can be made for customized lingual appliances. This results in a long delay before alignement and leveling can be commenced post-surgery. Case presentations Three cases are presented here demonstrating the simultaneous placement of bone anchored expansion devices for surgically assisted rapid maxillary expansion with customized lingual appliances. Conclusions The combination of the two procedures allows the alignement and leveling to commence very soon after surgery significantly reducing treatment times. The design of the appliances and the clinical procedures are described and discussed.
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Lo Giudice A, Galletti C, Gay-Escoda C, Leonardi R. CBCT assessment of radicular volume loss after rapid maxillary expansion: A systematic review. J Clin Exp Dent 2018; 10:e484-e494. [PMID: 29849974 PMCID: PMC5971075 DOI: 10.4317/jced.54745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/11/2018] [Indexed: 02/03/2023] Open
Abstract
Background The present systematic review analyzed the current literature to investigate whether rapid maxillary expansion (RME) causes radicular resorption, assessed by cone-beam computed tomography (CBCT). Material and Methods Eighteen electronic databases and reference lists of studies were searched up to November 2017. Grey literature was also screened. To be included, articles must be human studies on growing subjects with transversal maxillary deficiency treated with maxillary expansion protocol and with 3-D radiographic assessment of radicular volume by CBCT images. Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, teeth evaluated, CBCT settings), and study outcomes (radicular volume loss) were reported according to the PRISMA statement. Results Only 3 articles were considered eligible and an individual analysis of the selected articles was undertaken. The risk of bias assessment revealed low methodological quality for all the studies included. In all the considered studies, significant radicular volume loss was observed in posterior teeth, following RME. When reported in percentage, the radicular volumetric loss was similar between anchored (first molars and first premolars) and unanchored teeth (second premolars). Conclusions A preliminary evaluation of the patient-related risk factors for RR is warmly advisable when administering RME. Key words:RME, maxillary expansion, root resorption, external root resorption.
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Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging - Section of Orthodontics, School of Dentistry, University of Messina, Policlinico Universitario "G. Martino", Via Consolare Valeria - 98123 Messina, Italy
| | - Cosimo Galletti
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy
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Möhlhenrich S, Modabber A, Kniha K, Peters F, Steiner T, Hölzle F, Fritz U, Raith S. Simulation of three surgical techniques combined with two different bone-borne forces for surgically assisted rapid palatal expansion of the maxillofacial complex: a finite element analysis. Int J Oral Maxillofac Surg 2017; 46:1306-1314. [DOI: 10.1016/j.ijom.2017.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/06/2017] [Accepted: 05/21/2017] [Indexed: 11/16/2022]
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