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Barreneche-Calle LM, Marín-Arboleda RD, Gómez-Gómez SL, Agudelo-Suárez AA, Ramírez-Ossa DM. Dentoalveolar, periodontal and skeletal effects of maxillary expansion techniques assisted by temporary anchorage devices compared with conventional protocols in growing patients with transverse maxillary deficiency: A systematic review and meta-analysis. Int Orthod 2024; 22:100891. [PMID: 38865748 DOI: 10.1016/j.ortho.2024.100891] [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: 11/18/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To synthesise the dentoalveolar, periodontal and skeletal changes that occur when using maxillary expansion techniques assisted by temporary anchorage devices compared to conventional protocols. METHODS Five databases and grey literature were consulted, up to December 2023, focusing on intervention designs and excluding other type of studies. The quality assessment was conducted by using the adaptation for orthodontics of the CONSORT statement, the guidelines for reporting non-randomised studies, the RoB-2 tool, and the ROBINS-I tool. A descriptive summary and meta-analysis using RevMan 5.4 were performed. RESULTS Nine clinical trials were included (n=377 patients, mean age 13.2±0.6) with a diagnosis of transverse maxillary deficiency. The analysed studies showed qualitative dentoalveolar and periodontal changes after expansion, which were greater on the maxillary first premolars in tooth-borne appliances. Meta-analyses for some effects were included from two studies (n=64); patients who used tooth-borne appliances had greater effects of buccal intercoronal width between the premolars with statistically significant differences (Std Mean difference 2.34; 95% CI: 0.04-4.65 p=0.05). Conversely, those patients who used bone-borne or hybrid appliances had greater effects of buccal intercoronal width between molars with statistically significant differences (Std Mean difference -0.64; 95% CI: -1.38-0.10; p=0.09). CONCLUSIONS According to the studies analysed, all measurements increased in the intervention groups after expansion. Quantitative analyses show different findings at dentoalveolar level when tooth-borne, bone-borne or hybrid appliances are considered. Nevertheless, the results should be taken with caution due to the heterogeneity of the studies. The protocol was registered at PROSPERO (CRD42021283170), with no funding to report.
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Affiliation(s)
| | - Rober David Marín-Arboleda
- DDS, Posgraduate Orthodontic Program Student, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Sandra Liliana Gómez-Gómez
- DDS, Orthodontist, MSc in Epidemiology, Titular Professor and Department Chair, Department of Orthodontics, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Andrés A Agudelo-Suárez
- DDS, Public Health PhD, Titular Professor and Senior Researcher, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - Diana Milena Ramírez-Ossa
- DDS, Orthodontist, Professor, Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia.
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Ateş EM, Pamukçu H, Koç O, Altıparmak N. Effects of different expansion appliances and surgical incisions on maxillary expansion: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101936. [PMID: 38849083 DOI: 10.1016/j.jormas.2024.101936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE This study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures. METHODS Seven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD. RESULTS The largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD. CONCLUSION SARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD.
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Affiliation(s)
- Ece Mersan Ateş
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey
| | - Hande Pamukçu
- Department of Orthodontics, School of Dentistry, Baskent University, Ankara, Turkey.
| | - Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Nur Altıparmak
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey
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Leeisaramas C, Chantarapanich N, Inglam S, Insee K. Analysis of Stress Distribution and Displacement Based on the Miniscrew Positions of the Palatal Slope Bone-borne Expander: A Finite Element Study. Eur J Dent 2024. [PMID: 38555643 DOI: 10.1055/s-0043-1777823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the stress distribution pattern of the palatal slope bone-borne expander on the maxillary area according to a different anteroposterior position of anchored miniscrews using finite element analysis. MATERIALS AND METHODS Nasomaxillary stereolithography files with three different anteroposterior anchored miniscrew positions of the palatal slope bone-borne expander were determined as model A, B, and C. Each model consists of four supported miniscrews. Model A: two anterior miniscrews were located between the maxillary canine and the first premolar, and two posteriors between the second premolar and the first molar. Model B: two anteriors were between the lateral incisor and the canine, and two posteriors were the same as in model A. Model C: two anteriors were the same as in model A, and two posteriors were distal to the first molar. One turn of expander screws was applied. Maximum principal stress, equivalent elastic strain, equivalent von Mises stress, and transverse displacement were evaluated. RESULTS The maximum principal stress was mostly found at the bone-miniscrew interface. Model A exhibited an intersecting area of stress between the supported miniscrews. The highest value of principal stress was in model B, while model C showed a uniform distribution pattern. The elastic strain pattern was similar to the principal stress in all models. The highest value of equivalent von Mises stress was located on the expander screw. The largest amount of transverse displacement of teeth was in model A, while model C exhibited a more consistent transverse displacement than other models. Vertical displacement of posterior teeth was also noticed. CONCLUSION Based on the result, it revealed that the various anteroposterior miniscrew placements of the palatal slope bone-borne expander had various patterns of stress distribution and resulted in various outcomes. It may be inferred that model A's miniscrew location was advantageous for obtaining expansion quantities, but model C's miniscrew position was advantageous for maintaining consistent biomechanics.
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Affiliation(s)
- Chakree Leeisaramas
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Nattapon Chantarapanich
- Digital Industrial Design and Manufacturing Research Unit and Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
| | - Samroeng Inglam
- Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
| | - Kanlaya Insee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
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Paredes N, Gargoum A, Dominguez-Mompell R, Colak O, Bui J, Duong T, Giannetti M, Silva F, Brooks K, Moon W. Pattern of microimplant displacement during maxillary skeletal expander treatment: A cone-beam computed tomography study. Korean J Orthod 2023; 53:289-297. [PMID: 37666573 PMCID: PMC10547596 DOI: 10.4041/kjod23.056] [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: 04/17/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/06/2023] Open
Abstract
Objective To analyze the microimplant (MI) displacement pattern on treatment with a maxillary skeletal expander (MSE) using cone-beam computed tomography (CBCT). Methods Thirty-nine participants (12 males and 27 females; mean age, 18.2 ± 4.2 years) were treated successfully with the MSE II appliance. Their pre- and post-expansion CBCT data were superimposed. The pre- and post-expansion anterior and posterior inter-MI angles, neck and apical inter-MI distance, plate angle, palatal bone thickness at the MI positions, and suture opening at the MI positions were measured and compared. Results The jackscrew plate was slightly bent in both anterior and posterior areas. There was no significant difference in the extent of suture opening between the anterior and posterior MIs (p > 0.05). The posterior MI to hemiplate line was greater than that anteriorly (p < 0.05). The apical distance between the posterior MIs was greater than that anteriorly (p < 0.05). The palatal thickness at the anterior MIs was significantly greater than that posteriorly (p > 0.01). Conclusions In the coronal plane, the angulation between the anterior MIs in relation to the jackscrew plate was greater than that between the posterior MIs owing to the differential palatal bone thickness.
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Affiliation(s)
- Ney Paredes
- Private Practice, Houston, TX, USA
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Ausama Gargoum
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | | | - Ozge Colak
- Department of Orthodontics, State University of New York, Buffalo, NY, USA
| | - Joseph Bui
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Tam Duong
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Maya Giannetti
- Section of Orthodontics, UCSF School of Dentistry, San Francisco, CA, USA
| | - Fernanda Silva
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Kendra Brooks
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Won Moon
- Orthodontic and Craniofacial Development Research, Forsyth Institute, Cambridge, MA, USA
- Department of Orthodontics, Ajou University, School of Medicine, Suwon, Korea
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Inchingolo AM, Patano A, De Santis M, Del Vecchio G, Ferrante L, Morolla R, Pezzolla C, Sardano R, Dongiovanni L, Inchingolo F, Bordea IR, Palermo A, Inchingolo AD, Dipalma G. Comparison of Different Types of Palatal Expanders: Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1258. [PMID: 37508755 PMCID: PMC10378123 DOI: 10.3390/children10071258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Maxillary bone contraction is caused by genetics or ambiental factors and is often accompanied by dental crowding, with the possibility of canine inclusion, crossbite, class II and III malocclusion, temporomandibular joint disorder, and obstructive sleep apnea (OSAS). Transverse maxillary deficits, in which the maxillary growth is unusually modest, are frequently treated with maxillary expansion. The purpose of this study is to compare the dental and skeletal effects of different types of expanders, particularly the Leaf Expander, rapid and slow dental-anchored or skeletal-anchored maxillary expanders. METHODS We chose studies that compared effects determined by palatal expansion using a rapid palatal expander, expander on palatal screws, and leaf expander. RESULTS Reports assessed for eligibility are 26 and the reports excluded were 11. A final number of 15 studies were included in the review for qualitative analysis. CONCLUSIONS Clinically and radiographically, the outcomes are similar to those obtained with RME and SME appliances; Therefore, it might be a useful treatment choice as an alternative to RME/SME equipment in cases of poor patient compliance or specific situations. Finally, all of the devices studied produce meaningful skeletal growth of the palate. The use of skeletally anchored devices does, without a doubt, promote larger and more successful growth in adolescent patients.
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Affiliation(s)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Matteo De Santis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Sardano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | | | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
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Karaman A, Danisman H, Genc E, Buyuk SK. Comparison of skeletal and dental effects of two different tooth-tissue-borne types of rapid maxillary expansion appliances: A CBCT retrospective study. Orthod Craniofac Res 2023; 26:123-131. [PMID: 35699362 DOI: 10.1111/ocr.12593] [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: 04/22/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the skeletal and dental effects of different types of rapid maxillary expansion (RME) appliances using cone-beam computed tomography (CBCT). MATERIALS/METHODS This multi-centre study was conducted with a total of 56 patients. The sample consisted of two groups including the McNamara-Type RME (MNR) group with 30 patients (16 females, 14 males, mean age: 13.38 ± 1.16 years) and Full-Coverage RME (FCR) group with 26 patients (10 females, 16 males, mean age:13.78 ± 1.06 years). Twenty-one parameters were measured on CBCT images including 4 maxillary skeletal, 12 maxillary alveolar, and 5 maxillary dental measurements, and the data were analysed using the SPSS 20.0 software. RESULTS The rates of increase in the palatal maxillary width (PMW) (3), PMW(4), and PMW(6) were significantly higher in the MNR group (P < .05). While the rates of increase in the buccal maxillary width (BMW) (3) and BMW(4) were statistically higher in the MNR group, the rate of increase in BMW (6) was higher in the FCR group (P < .05). The increases in HPW (4), HPW (6), PAA4(°), and PAA6(°), which are parameters about hard palate width (HPW) and palatal alveolar angle (PAA), were also significantly higher in the MNR group (P < .05). The increases in PAW (4) and PAW (6), referring to the widths between the palatal root apices were significantly higher in the MNR group (P < .05).The increase in Slope-6(°) was also higher in the MNR group (P < .05). CONCLUSION Expansion in the palatal region on the alveolar level was higher in MNR than in FCR, while expansion in FCR was the highest in the posterior. In both appliances, there was tipping in the buccal direction in both alveolar bone and teeth, and the rate of this tipping was higher in MNR.
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Affiliation(s)
- Ahmet Karaman
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey
| | - Hikmetnur Danisman
- Department of Orthodontics, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, Turkey
| | | | - S Kutalmış Buyuk
- Department of Orthodontics, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Solano Mendoza P, Aceytuno Poch P, Solano Reina E, Solano Mendoza B. Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography. J Clin Med 2022; 11:jcm11164652. [PMID: 36012886 PMCID: PMC9410327 DOI: 10.3390/jcm11164652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.
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Management of Class III Malocclusion and Maxillary Transverse Deficiency with Microimplant-Assisted Rapid Palatal Expansion (MARPE): A Case Report. Medicina (B Aires) 2022; 58:medicina58081052. [PMID: 36013519 PMCID: PMC9415682 DOI: 10.3390/medicina58081052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Microimplant-assisted rapid palatal expansion (MARPE) has been demonstrated successfully in maxillary expansion in late adolescence and adulthood. The maxillary advancement accompanied by expansion is frequently anticipated, which is beneficial for the treatment of class III malocclusion. Airway volume increase can also be noted in some cases from the measurement of cone beam computerized tomography (CBCT) after expansion. The objective of this case report is to demonstrate the feasibility of applying MARPE on late adolescence patients with maxillary transverse deficiency and to present the changes in transverse and anteroposterior dimensions as well as the volume increase in velopharyngeal airway after MARPE. A 15-year-old female presented class III skeletal pattern. She had maxillary transverse deficiency with moderate crowding and posterior/anterior crossbites. Maxillary Skeletal Expander (MSE; Biomaterials Korea Inc.) type-2 was used as a MARPE device in this case. After four weeks of maxillary expansion, a significant amount of expansion was achieved and the anterior crossbite was spontaneously corrected. Fixed appliance treatment was commenced four weeks after MARPE with 0.022-slot preadjusted brackets (MBT prescription). Temporary anchorage devices (TADs) were placed over the mandibular buccal shelves for posterior teeth distalization and crowding relief. After 25 months of treatment, the facial profile was improved with maxillary advancement (SNA: 83° to 83.5°) and mandibular backward rotation (SNB: 83° to 82°; SN-MP: 34.5° to 35°). In this case, MARPE not only engenders significant transverse correction but also aids in anteroposterior change. The treatment effects of maxillary advancement and mandibular backward rotation can lead to a more esthetic profile in skeletal class III cases.
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Huang X, Han Y, Yang S. Effect and stability of miniscrew-assisted rapid palatal expansion: A systematic review and meta-analysis. Korean J Orthod 2022; 52:334-344. [PMID: 35844097 PMCID: PMC9512629 DOI: 10.4041/kjod21.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to systematically analyze the effect and stability of miniscrew-assisted rapid palatal expansion (MARPE) to provide a reference for the clinical treatment of patients with maxillary transverse deficiency (MTD). Methods We searched PubMed, Science Direct, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Database for relevant studies published before February 18, 2021 and selected them according to the eligibility criteria. The Cochrane Handbook for Systematic Reviews (version 5.1.0) criteria were used for the quality assessment of randomized controlled trials, while the scoring protocol of the methodological index for non-randomized studies was used for non-randomized controlled trials. Statistical analysis was performed using the RevMan5.3 software. Results All the included studies showed a relatively high success rate of expansion. The changes in both the intermolar and alveolar widths after MARPE were statistically significant. MARPE exhibited greater skeletal expansion effects than did conventional RPE. The midpalatal suture was opened in parallel after MARPE. A small amount of relapse was observed 1 year after expansion. MARPE caused tooth inclination and a decrease in alveolar height, but it was less significant than in conventional RPE. Conclusions MARPE may be an effective treatment modality for patients with MTD. It causes great transverse skeletal expansion in late adolescence. In comparison to conventional RPE, MARPE has lower detrimental periodontal effects and has certain clinical advantages.
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Affiliation(s)
- Xinyi Huang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jin
| | - Yu Han
- Department of Orthodontics, Hangzhou Dental Hospital, Hangzhou, China
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Yacout YM, Abdalla EM, El Harouny NM. Skeletal and dentoalveolar effects of slow vs rapid activation protocols of miniscrew-supported maxillary expanders in adolescents: A randomized clinical trial. Angle Orthod 2022; 92:483292. [PMID: 35771652 PMCID: PMC9374350 DOI: 10.2319/112121-856.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare between skeletal and dentoalveolar effects of slow and rapid activation of miniscrew-supported expanders. MATERIALS AND METHODS A total of 30 patients were randomly allocated to two groups using block randomization and the allocation ratio 1:1. Both groups received maxillary expanders anchored using four miniscrews. Activation protocol was once every other day in the slow expansion (SME) group and twice daily in the rapid expansion (RME) group. Cone-beam computed tomography (CBCT) scans were obtained before expansion and after removal of the expanders. Transverse skeletal and dentoalveolar changes were measured using CBCT. RESULTS A total of 12 patients in the SME group (mean age, 14.30 ± 1.37 years) and 12 patients in the RME group (mean age, 15.07 ± 1.59 years) were analyzed. RME showed significantly greater widening of the mid-palatal suture at the level of first molars (mean difference [SME - RME] = -0.61 mm), and a greater increase in right and left molar buccal inclination (mean difference= -3.83° and -2.03°, respectively). Percentage of skeletal expansion relative to the jackscrew opening was not significantly different between the groups. Palatal inflammation was evident following appliance removal. Miniscrew mobility and bending were observed with RME. CONCLUSIONS Both SME and RME were effective in correcting skeletal transverse maxillary deficiency. However, RME resulted in more buccal tipping of maxillary molars and in miniscrew failures and bending.
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An JS, Seo BY, Ahn SJ. Comparison of dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne hybrid nonsurgical rapid maxillary expansions in adults: a retrospective observational study. BMC Oral Health 2021; 21:658. [PMID: 34922526 PMCID: PMC8684621 DOI: 10.1186/s12903-021-02008-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite the gradual increase in the use of rapid maxillary expansion (RME), specifically RME with the aid of skeletal anchorage in adults, there have been no reports comparing dentoskeletal and soft tissue changes between nonsurgical tooth-borne and tooth-bone-borne RMEs in adults. This study aimed to analyse differences in dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne RMEs using a similar appliance design and the same expansion protocol in adult patients. METHODS Twenty-one patients with tooth-borne expansion (a conventional expansion screw with two premolars and two molar bands for dental anchorage [T-RME]) and the same number of patients with tooth-bone-borne hybrid expansion (a conventional expansion screw with two premolar and two molar bands for dental anchorage and four mini-implants in the palate for skeletal anchorage [H-RME]) were included. Dentoskeletal and soft tissue variables at pretreatment (T1) and after expansion (T2) were measured using posteroanterior and lateral cephalograms and frontal photographs. The sex distribution of the two groups was analysed using the chi-square test, and the change after RME in each group was evaluated using the Wilcoxon signed-rank test. Differences in pretreatment age, expansion duration, post-expansion duration, and dentoskeletal and soft tissue changes after RME between the two groups were determined using the Mann-Whitney U test. RESULTS There were no significant differences in the expansion protocol, pretreatment conditions, and sex distribution between the two groups. Despite similar degrees of dental expansion at the crown level between the two groups, H-RME induced increased skeletal and parallel expansion of the maxilla compared to T-RME. After expansion, H-RME demonstrated increased forward displacement of the maxilla without significant changes in the vertical dimension, while T-RME exhibited increased backward displacement of the mandible, increased vertical dimension, and decreased overbite. Both groups showed significant retroclination and extrusion of the maxillary incisors without significant intergroup differences. There were no significant soft tissue changes between the two groups. CONCLUSION This study suggests that using skeletal anchorage in RME may induce increased skeletal and parallel expansion of the maxilla without significant effects on the vertical dimension.
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Affiliation(s)
- Jung-Sub An
- Department of Orthodontics, Seoul National University Dental Hospital, 101, Deahak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Bo-Yeon Seo
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, 101, Deahak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sug-Joon Ahn
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, 101, Deahak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Jia H, Zhuang L, Zhang N, Bian Y, Li S. Age-dependent effects of transverse maxillary deficiency treated by microimplant-assisted rapid palatal expansion: A prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2021; 161:557-573. [PMID: 34903419 DOI: 10.1016/j.ajodo.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study investigated the results of maxillary discrepancy treated by microimplant-assisted rapid palatal expansion (MARPE) at different ages. METHODS Sixty patients (aged 11.0-34.1 years; 23 male and 37 female) were treated by MARPE. Cone-beam computed tomography scans and dental casts were taken before and after expansion. The data were compared among 4 age groups: early adolescents (aged 11-14 years), late adolescents (aged 15-19 years), young adults (aged 20-24 years), and old adults (aged 25-34.1 years). RESULTS The success rates of midpalatal suture separation were 100%, 100%, 88.2%, and 85.7% for early adolescents, late adolescents, young adults, and old adults, respectively. Palatal sutures at the level of the first molar were expanded by 4.02 mm, 3.48 mm, 2.63 mm, and 2.10 mm, corresponding to 66.7%, 58.1%, 42.0%, and 37.9% of the total dental expansion. Significant differences were found in the amounts of palatal suture expansion and the ratio of skeletal dental expansion between patients aged <20 years and patients aged ≥20 years (P <0.05). Skeletal expansion constituted 69.4%, 51.3%, 39.0%, and 29.8% of the total screw expansion. Except for the comparison between young adults and old adults, there were significant differences between groups for the ratio of skeletal screw expansion (P <0.05). CONCLUSIONS The midpalatal suture can be expanded by MARPE more easily in patients <20 years of age than in patients ≥20 years of age. The ratio of skeletal screw expansion decreases as age increases.
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Affiliation(s)
- Haichao Jia
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China.
| | - Li Zhuang
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Yuanyuan Bian
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Song Li
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China.
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de Oliveira CB, Ayub P, Ledra IM, Murata WH, Suzuki SS, Ravelli DB, Santos-Pinto A. Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment. Am J Orthod Dentofacial Orthop 2021; 159:733-742. [PMID: 33931257 DOI: 10.1016/j.ajodo.2020.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. METHODS The sample comprised 17 patients (mean age, 26 ± 11 years) selected for the MARPE group and 15 (mean age, 28.5 ± 10.5 years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. RESULTS MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. CONCLUSIONS The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.
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Affiliation(s)
- Cibele Braga de Oliveira
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil.
| | - Priscila Ayub
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ingrid Müller Ledra
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Wilson Humio Murata
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Dirceu Barnabé Ravelli
- Department of Pediatric Dentistry, Area of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ary Santos-Pinto
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
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Chuang YH, Chen JH, Ho KH, Wang KL, Hsieh SC, Chang HM. The role of micro-implant-assisted rapid palatal expansion (MARPE) in clinical orthodontics — a literature review. AUSTRALASIAN ORTHODONTIC JOURNAL 2021. [DOI: 10.21307/aoj-2021.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
A maxillary transverse deficiency is a common craniofacial problem. Rapid palatal expansion (RPE) has been traditionally considered for the treatment of children and young adolescents, but this is not applicable in late adolescents or adults due to the ossification of facial sutures. A surgically assisted rapid palatal expansion (SARPE) was initially advocated for this group of patients, but the surgical procedure is associated with morbidity. As temporary anchorage devices (TADs) have been recently and popularly applied in clinical orthodontics, micro-implant-assisted rapid palatal expansion (MARPE) has been employed to facilitate maxillary expansion in skeletally mature patients. There have been various proposed MARPE designs and the outcomes appear promising. The aim of the present article is to discuss the role of MARPE in clinical orthodontics by reviewing its background, design, indications, treatment effects, stability, and limitations in the current literature. The treatment effects of two types of MARPE, bone-borne and tooth-bone-borne (hybrid), will be individually assessed.
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Affiliation(s)
- Yun-Hsuan Chuang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Jen-Hsuan Chen
- DDS, Oromaxillofacial Department, Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kwok-Hing Ho
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kai-Long Wang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Shun-Chu Hsieh
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Heng-Ming Chang
- Chang Bing Show Chwan Memorial Hospital Changhua County , Changhua , Taiwan
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Differential assessment of skeletal, alveolar, and dental components induced by microimplant-supported midfacial skeletal expander (MSE), utilizing novel angular measurements from the fulcrum. Prog Orthod 2020; 21:18. [PMID: 32656601 PMCID: PMC7355053 DOI: 10.1186/s40510-020-00320-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background In order to assess skeletal expansion, alveolar bone bending, and dental tipping after maxillary expansion, linear and angular measurements have been performed utilizing different craniofacial references. Since the expansion with midfacial skeletal expander (MSE) is archial in nature, the aim of this paper is to quantify the differential components of MSE expansion by calculating the fulcrum locations and applying a novel angular measurement system. Methods Thirty-nine subjects with a mean age of 18.2 ± 4.2 years were treated with MSE. Pre- and post-expansion CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified by localizing the interfrontal distance and modified interfrontal distance. Based on the fulcrum, a novel angular measurement method is presented and compared with a conventional linear method to assess changes of the zygomaticomaxillary complex, dentoalveolar bone, and maxillary first molars. Results From 39 patients, 20 subjects have the rotational fulcrum of the zygomaticomaxillary complex at the most distant points of the interfrontal distance (101.6 ± 4.7 mm) and 19 subjects at the most distant points of the modified interfrontal distance (98.9 ± 5.7 mm). Linear measurements accounted for 60.16% and 56.83% of skeletal expansion, 16.15% and 16.55% of alveolar bone bending, and 23.69% and 26.62% of dental tipping for right and left side. Angular measurements showed 96.58% and 95.44% of skeletal expansion, 0.34% and 0.33% alveolar bone bending, and 3.08% and 4.23% of dental tipping for the right and left sides. The frontozygomatic, frontoalveolar, and frontodental angles were not significant different (P > 0.05). Conclusions In the coronal plane, the center of rotation for the zygomaticomaxillary complex was located at the most external and inferior point of the zygomatic process of the frontal bone or slightly above and parallel to the interfrontal distance. Due to the rotational displacement of the zygomaticomaxillary complex, angular measurements should be a preferred method for assessing the expansion effects, instead of the traditional linear measurement method.
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Chhutani P, Deshmukh S, Jethe S, Agarkar S, Yerawadekar S, Rahalkar J. Effect of Rapid Maxillary Expansion on Mandibular Rotation—A Systematic Review. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2020. [DOI: 10.1177/0301574219897318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the effect of rapid maxillary expansion (RME) on mandibular rotation. Materials and Method: A systematic review of articles selected from 4 electronic databases—PUBMED, Cochrane Central Register of Controlled Trials, Clinical Trials Registry, and Google Scholar—was carried out. Additional studies were hand-searched and retrieved from the reference lists of relevant articles. Studies published till August, 2019, were included in this study. Results: A total of 28 articles were identified through electronic database searching. 16 articles were obtained after elimination of duplicates which were then screened. Full-text articles were assessed according to the eligibility criteria. 2 randomized controlled trials (RCTs) and 14 clinical trials (CTs) were identified for inclusion in the review. These studies effectively highlighted the effect of RME on mandibular rotation, primarily in the clockwise direction. Conclusion: There is a moderate sum of evidence to illustrate the effect of RME on mandibular rotation. It can be concluded that RME brings about clockwise rotation of the mandible, ie in downward and backward directions, thereby increasing the lower anterior facial height. This effect could be attributed to the vertical maxillary movement and the extrusion of the maxillary molars.
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Affiliation(s)
- Priyanka Chhutani
- Department of Orthodontics & Dentofacial Orthopaedics, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
| | - Sonali Deshmukh
- Department of Orthodontics & Dentofacial Orthopaedics, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
| | - Sandeep Jethe
- Department of Orthodontics and Dentofacial Orthopedics, Dr. D.Y. Patil Dental School, Lohegaon, Pune, Maharashtra
| | | | - Sujata Yerawadekar
- Department of Orthodontics & Dentofacial Orthopaedics, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
| | - Jayesh Rahalkar
- Department of Orthodontics & Dentofacial Orthopaedics, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
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Three-dimensional changes of the zygomaticomaxillary complex after mini-implant assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2019; 156:653-662. [PMID: 31677674 DOI: 10.1016/j.ajodo.2018.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to investigate 3-dimensional changes of the zygomaticomaxillary complex (ZMC) after mini-implant assisted rapid maxillary expansion (MARME). METHODS A total of 15 pairs of cone-beam computed tomography 3-dimensional images taken before expansion (T0) and after expansion (T1) were analyzed by measuring changes in the coordinates of the landmarks of the ZMC. RESULTS Changes in the x coordinates of the landmarks showed significant expansion (P <0.01) and greater expansion at the lower than upper portion of the ZMC (P <0.05) in the transverse dimension. All y coordinates of the landmarks except the jugal point (J) showed forward displacement (P <0.05), and the z coordinates of ANS, PNS, Alare, A, and ectocanine showed downward displacement (P <0.01) in the sagittal and vertical dimensions. Also, z coordinates of the landmarks that were closer to the midsagittal plane and in a more posterior portion of the ZMC displaced further downward (P <0.05). SNA and ANB angles increased (P <0.05 and P <0.001, respectively) and the SNB angle decreased (P <0.01). There was a significant correlation between changes in the x coordinates of the ectomolare and ectocanine and the amount of expansion measured from the center of resistance of the maxillary first molars (CR6; P <0.05). There was no significant correlation between the amount of CR6 expansion and changes in y and z coordinates of the landmarks. CONCLUSIONS 3-Dimensional changes of the ZMC after MARME showed expansion in a pyramidal shape from the coronal view, downward and forward displacement from the sagittal view, and parallel palatal expansion from the axial view. These findings might be useful for understanding skeletal expansion patterns using MARME.
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Storto CJ, Garcez AS, Suzuki H, Cusmanich KG, Elkenawy I, Moon W, Suzuki SS. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion. Angle Orthod 2019; 89:713-720. [PMID: 30896250 DOI: 10.2319/070518-504.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). MATERIALS AND METHODS Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. RESULTS There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. CONCLUSIONS Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.
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Moylan HB, Carrico CK, Lindauer SJ, Tüfekçi E. Accuracy of a smartphone-based orthodontic treatment-monitoring application: A pilot study. Angle Orthod 2019; 89:727-733. [PMID: 30888840 DOI: 10.2319/100218-710.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the reliability and accuracy of a monitoring system in patients undergoing orthodontic treatment with a rapid maxillary expander. Specifically, the amount of tooth movement calculated by the software was compared with the actual measurements taken on plaster models obtained during an in-office visit. MATERIALS AND METHODS Patients took intraoral video scans using the monitoring software's smartphone application (Dental Monitoring, Paris, France), immediately followed by impressions for plaster models. Intercanine and intermolar width measurements were calculated by the software and compared with those made on the plaster models. Data were analyzed using two one-sided t-tests for equivalence with equivalence bounds of ±0.5 mm. The significance level was set at .05. RESULTS Thirty sets of measurements were compared. The intercanine and intermolar measurement differences were on average 0.17 mm and -0.02 mm, respectively, and were deemed equivalent. CONCLUSIONS The monitoring software seems to provide an accurate assessment of linear tooth movements.
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Extensiometric analysis of strain in craniofacial bones during implant-supported palatal expansion. J Mech Behav Biomed Mater 2017; 76:104-109. [PMID: 28576607 DOI: 10.1016/j.jmbbm.2017.05.028] [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: 01/17/2017] [Revised: 04/24/2017] [Accepted: 05/20/2017] [Indexed: 11/21/2022]
Abstract
Palatal expansion has several orthodontic and orthopedic applications, such as increasing maxillary transverse dimensions and correcting maxillary atresia, oral breathing, and skeletal cross-bites. Little is known about the strain to which craniofacial bones are submitted when a palatal expander is loaded. The objectives of the present work were to propose a new palatal bone-borne titanium device (expansion screw), to determine patterns of strain distribution in craniofacial bones during palatal expansion and to show the clinical results of a new palatal expander supported by implants. For in vitro testing, the palatal expander supported by two commercially pure titanium (cp Ti) implants was inserted parallel to the median palatine suture of four dry adult human skulls. Uniaxial and triaxial strain gauges were attached to craniofacial bones and connected to a signal acquisition system. An expansion screw was turned and strain data were collected during palatal expansion. The results showed that the bone strain distribution in craniofacial bones loaded by the palatal bone-borne titanium device was complex: the strain was tensile in the palatine cortical bone and compressive in pterygopalatine processes, nasal bones, and orbital floor. The maximum compressive strain occurs in the upper portion of the pterygopalatine processes and the strain changes from compressive to tensile in the zygomatic process. The experimental results suggest that the bone strain due to the palatal expander is distributed over all craniofacial bones and that the upper portions of pterygopalatine processes are the main sites of resistance to palatal expansion. The new palatal expander supported by two cp Ti implants proposed was employed on adult patient as an illustrative report, where adequate palatal expansion was achieved. The new protocol proposed was less invasive, risky, painful and costless for the correction of moderate maxillary transverse deficiency.
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Park JH, Bayome M, Zahrowski JJ, Kook YA. Displacement and stress distribution by different bone-borne palatal expanders with facemask: A 3-dimensional finite element analysis. Am J Orthod Dentofacial Orthop 2017; 151:105-117. [PMID: 28024761 DOI: 10.1016/j.ajodo.2016.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze displacement and stress distribution in the maxilla during maxillary expansion followed by protraction using bone-borne and conventional tooth-borne palatal expanders and a facemask via 3-dimensional finite element analysis. METHODS A finite element model of an adolescent skull was created, and 4 different types of appliances were integrated into it: facemask (type A); facemask with paramedian bone-borne expander (type B), facemask with palatal-slope bone-borne expander (type C), and facemask with conventional expander (type D). Expansion of 0.25 mm followed by 500 g of force per side was applied. RESULTS Type A showed anterior displacement of the dentition combined with downward displacement of posterior teeth and upward displacement of anterior teeth. The combination of protraction and expansion in type D showed the greatest anterior displacement. In types B and C, the expansion forces resulted in posterior displacement decreasing the net displacement of the combination. Stresses concentrated around the miniscrews in types B and C. In types A and D, stresses concentrated at the first premolar and first molar. Type B had the highest stresses followed by type C and then D. CONCLUSIONS The conventional tooth-borne expander (type D) enhanced the effect of maxillary protraction. Facemask alone (type A) resulted in more anterior displacement of the maxilla than the combination of facemask and bone-borne expanders (types B and C). The clinician should be aware of the initial stresses and movements from different expanders with facemask found in this study and confirm the movements in future clinical Class III studies.
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Affiliation(s)
- Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea.
| | - Mohamed Bayome
- Graduate School, Catholic University of Korea, Seoul, Korea; Department of Postgraduate Studies, Universidad Autonoma del Paraguay, Asuncion, Paraguay
| | | | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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Kılınç DD, Sayar G. Various Contemporary Intraoral Anchorage Mechanics Supported with Temporary Anchorage Devices. Turk J Orthod 2016; 29:109-113. [PMID: 30112484 DOI: 10.5152/turkjorthod.2016.16027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/27/2016] [Indexed: 11/22/2022]
Abstract
The aim of this review was to provide an overview of the various types of contemporary intaroral anchorage mechanics that are being used with temporary anchorage devices (TADs) and to briefly mention the design and clinical use of these appliances. Original articles on "mini-implants in orthodontics, temporary anchorage devices, orthodontic miniscrews, mini-implants, and skeletal anchorage" were searched for on the PubMed database. Articles published between 2004 and May 2015 were used. References of 10 articles were also searched for and used. Beneslider, Miniscrew-supported EZ slider, Implant-supported Distal Jet, Mini-implant-Borne Pendulum B Appliance, Noncompliance-supported Maxillary Molar Distalization Appliance, Temporary Skeletal Anchorage Device-Supported Rapid Maxillary Expansion Appliance (RME), Mini-Implant-Supported Maxillary Expansion, Implant-Supported RME, Hybrid Hyrax, Frog Appliance, Palatally Anchored Mesialslider, Mousetrap Appliance, Lever Arm, and Mini-implant System were evaluated. In contemporary orthodontics, TADs have an important place. They can be combined with different intraoral mechanics and be efficiently used. The future of orthodontic intraoral anchorage may be based on TADs.
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Affiliation(s)
- Delal Dara Kılınç
- Department of Orthodontics, İstanbul Medipol University School of Dentistry, İstanbul, Turkey
| | - Gülşilay Sayar
- Department of Orthodontics, İstanbul Medipol University School of Dentistry, İstanbul, Turkey
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