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Bharti L, Daigavane P, Shrivastav S, Kamble R, Bharadwaj S, Shirbhate U, Bhargava A. Expanding Horizons: A Case Report of Cleft Expansion in the Mixed Dentition Stage. Cureus 2023; 15:e51091. [PMID: 38274940 PMCID: PMC10808886 DOI: 10.7759/cureus.51091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
A nine-year-old boy with a cleft lip and palate had midface retrusion as a result of maxillary complex growth inhibition. He sought treatment for total crossbite with a Class III skeletal pattern. The maxillary expansion widened the maxilla to improve the sagittal and transverse skeletal relationship. In skeletal Class III patients with a repaired cleft lip and palate, maxillary expansion and protraction usually provide effective improvement. The individual growth of the maxilla and mandible is crucial to the success of the orthopedic procedure.
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Affiliation(s)
- Lovely Bharti
- Orthodontics & Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Daigavane
- Orthodontics & Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunita Shrivastav
- Orthodontics & Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjit Kamble
- Orthodontics & Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shourya Bharadwaj
- Orthodontics and Dentofacial Orthopaedics, Jaipur Dental College and Hospital, Jaipur, IND
| | - Unnati Shirbhate
- Periodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aksha Bhargava
- Oral and Maxillofacial Surgery, Mahatma Gandhi Medical College and Research Institute, Jaipur, IND
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Cardinal L, da Rosa Zimermann G, Mendes FM, Andrade I, Oliveira DD, Dominguez GC. Dehiscence and buccal bone thickness after rapid maxillary expansion in young patients with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:16-23. [PMID: 35153114 DOI: 10.1016/j.ajodo.2021.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The present study aimed to evaluate the consequences of rapid maxillary expansion in the buccal bone thickness and dehiscence of subjects with unilateral cleft lip and palate. METHODS This prospective cohort study consisted of 30 participants, 20 males and 10 females, between 8 and 15 years old. Participants were allocated into 3 groups, according to the type of maxillary constriction, and were treated with different types of expanders: G1, hyrax; G2, fan-type; G3, inverted mini-hyrax. Cone-beam computed tomography scans were performed immediately before treatment and after 90 days of retention. Linear measurements were obtained by the same calibrated and blinded examiner. RESULTS An average of 0.8 mm decrease in buccal bone thickness (P <0.001) and a 0.5 mm increase in dehiscence (P <0.001) were observed. There was no significant difference between the cleft and noncleft side for all variables (P >0.05), as there was no significant difference between groups (P >0.05). CONCLUSION The findings in this study allow the conclusion that the orthopedic forces of rapid maxillary expansion lead to a decrease in the posterior buccal bone volume in unilateral cleft lip and palate patients.
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Affiliation(s)
- Lucas Cardinal
- Deformities Orofacial Institute, Joana de Gusmão Children Hospital, Florianópolis, Brazil.
| | | | - Fausto Medeiros Mendes
- Department of Orthodontics and Pediatric Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Ildeu Andrade
- Department of Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Dauro Douglas Oliveira
- Department of Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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Silveira GS, Abreu LG, Palomo JM, da Matta Cid Pinto LS, de Sousa AA, Gribel BF, Oliveira DD. Mini Hyrax vs Hyrax expanders in the rapid palatal expansion in adolescents with posterior crossbite: a randomized controlled clinical trial. Prog Orthod 2021; 22:30. [PMID: 34467450 PMCID: PMC8408292 DOI: 10.1186/s40510-021-00365-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this study was to compare the dental effects, impact on quality of life, and pain perception of adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion. METHODS Thirty-four adolescents aged 11 to 16 years, with maxillary transverse deficiency (unilateral or bilateral posterior crossbite), were randomly allocated into two groups, Mini Hyrax group and Hyrax group (1:1 ratio). Dental effects were evaluated by digitally superimposed pretreatment and postretention three-dimensional intraoral scans on the palatal rugaes using the software 3DSlicer. Impact on quality of life was assessed with the OHIP-14 questionnaire applied in the pretreatment, posttreatment and postretention. Visual analog scale was applied 24, 48, and 72 h and 7 days after the first activation of the expander. RESULTS Thirty of the 34 adolescents recruited completed the study. There were no statistically significant differences in dentoalveolar effects between groups. OHIP-14 scores across time among Mini Hyrax wearers were similar to those of the Hyrax wearers. The inter-group comparisons showed no difference between groups with respect to the OHIP-14 scores in posttreatment and postretention (p > 0.05). There were no differences in pain perception between groups. Considering intra-group comparison, the reduction in pain perception among adolescents in the Mini Hyrax group was gradual. Among adolescents in the Hyrax group, a statistically significant reduction between 48 and 72 h was observed. CONCLUSION There were no significant differences in dental effects, impact on quality of life and pain perception between adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion.
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Affiliation(s)
- Giordani Santos Silveira
- School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juan Martin Palomo
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH, USA
| | | | - Adriana Alkmim de Sousa
- School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Dauro Douglas Oliveira
- School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
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Figueiredo DSF, Cardinal L, Bartolomeo FUC, Palomo JM, Horta MCR, Andrade I, Oliveira DD. Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders. Dental Press J Orthod 2018; 21:82-90. [PMID: 27683832 PMCID: PMC5278937 DOI: 10.1590/2177-6709.2016-001.aop] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/29/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid
maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two
groups, according to the type of expander used: (I) modified Hyrax and (II)
inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was
taken as part of the initial orthodontic records and three months after RME, for
bone graft planning (T1). Results: In general, there was no significant difference among groups (p
> 0.05). Both showed a significant transverse maxillary expansion
(p < 0.05) and no significant forward and/or downward
movement of the maxilla (p > 0.05). There was greater dental
crown than apical expansion. Maxillary posterior expansion tended to be larger
than anterior opening (p < 0.05). Cleft and non-cleft sides
were symmetrically expanded and there was no difference in dental tipping between
both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla.
However, these appliances should be better indicated to cleft cases also
presenting posterior transverse discrepancy, since there was greater expansion in
the posterior maxillary region than in the anterior one.
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Affiliation(s)
| | - Lucas Cardinal
- Former Orthodontic residents, Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Belo Horizonte, Brazil
| | | | - Juan Martin Palomo
- Associate Professor and Program Director, Case Western Reserve University, Department of Orthodontics, and Director of the Craniofacial Imaging Center, School of Dental Medicine, Cleveland, Ohio, USA
| | - Martinho Campolina Rebello Horta
- Associate Professor and Dean of Graduate Studies, Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Belo Horizonte, Brazil
| | - Ildeu Andrade
- Associate Professor of Orthodontics, Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Belo Horizonte, Brazil
| | - Dauro Douglas Oliveira
- Associate Professor and Program Director of Orthodontics, Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Belo Horizonte, Brazil
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The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects. Clin Oral Investig 2017; 22:369-376. [DOI: 10.1007/s00784-017-2121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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Mordente CM, Palomo JM, Horta MCR, Souki BQ, Oliveira DD, Andrade I. Upper airway assessment using four different maxillary expanders in cleft patients: A cone-beam computed tomography study. Angle Orthod 2015; 86:617-24. [PMID: 26595658 DOI: 10.2319/032015-174.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the anterior and posterior maxillary width, the nasal passage volume, the oropharyngeal minimum axial area, and volume changes in unilateral cleft lip and palate patients treated with one of the following four expanders: Hyrax, Fan-Type, inverted mini-hyrax supported on the first permanent molars (iMini-M), or inverted mini-hyrax supported on the first premolars (iMini-B). MATERIALS AND METHODS A total of 40 patients with transverse maxillary deficiency who were submitted for rapid maxillary expansion were divided in four groups according to type of expander used. Cone-beam computed tomography images were taken before and 3 months after expansion. One-way analysis of variance was used to analyze the differences among the groups, and paired t-tests were used to evaluate the changes in each group. RESULTS All groups showed a significant increase in the anterior maxillary width, with no intergroup differences. The iMini-B was the only group that did not show a significant increase in the posterior maxillary width. The intergroup comparison demonstrated differences among all groups except between Hyrax and iMini-M, which showed the greatest posterior expansions. The intragroup analysis showed a significant increase in the nasal passage volume in hyrax and inverted mini-hyrax on the molar groups, but the intergroup comparison revealed a significant difference only between Fan-Type and inverted mini-hyrax on the molars. None of the expanders caused significant changes in the oropharyngeal measurements. CONCLUSIONS Only the Hyrax and inverted mini-hyrax on the molar expanders effectively increased the nasal passage volume, and none of the expanders evaluated in this study modified the oropharyngeal airway.
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Affiliation(s)
- Carolina Morsani Mordente
- a Resident, Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Juan Martin Palomo
- b Associate Professor and Program Director, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.,c Director, Craniofacial Imaging Center, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Martinho Campolina Rebello Horta
- d Associate Professor and Dean of Graduate Studies, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo Quiroga Souki
- e Associate Professor, Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Dauro Douglas Oliveira
- f Associate Professor and Program Director, Department of Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Ildeu Andrade
- e Associate Professor, Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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Zhu S, Yang Y, Gu M, Khambay B. A Comparison of Three Viewing Media for Assessing Dental Arch Relationships in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 53:578-83. [PMID: 26406557 DOI: 10.1597/15-144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine the repeatability and reproducibility of using three different viewing media to assess the outcomes of the dental arch relationships of patients with unilateral cleft lip and palate (UCLP) using the GOSLON Yardstick. DESIGN The GOSLON Yardstick was used to rate the dental arch relationships of 29 patients with UCLP. Three experienced calibrated orthodontists rated the plaster study models, digital study models, and stereoscopic projected three-dimensional (3D) study models separately. There was a minimum of a 1-week interval between each rating session. All three rating sessions were repeated 1 month later. A linear weighted kappa statistic was performed to assess intra-rater repeatability and inter-rater reproducibility, as well as the comparison between different viewing media using Kendall's Coefficient of Concordance (Kendall's W) statistic. RESULTS Intra-rater repeatability was very good for all three viewing media (kappa = 0.83-0.92). Inter-rater reproducibility was good to very good across the three viewing media (kappa = 0.63-0.88). Agreements between plaster study models and digital study models or stereoscopic projected 3D study models were good to very good (kappa = 0.78-0.97 and kappa = 0.72-0.97, respectively), and a Kendall's W ranging from 0.86 to 0.92 (P < .001). CONCLUSIONS Stereoscopic projected 3D is an alternative method to assess the outcomes of dental arch relationships in patients with cleft lip and palate using the GOSLON Yardstick. It could also be used for viewing patient records, as it recovers the full 3D information captured at the time of the clinical examination.
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