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da Silva AAF, Lima CAA, Montano-Pedroso JC, Pereira MD. Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study. J Craniofac Surg 2024:00001665-990000000-01693. [PMID: 38856203 DOI: 10.1097/scs.0000000000010402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments. METHODS Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture. RESULTS The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density. CONCLUSIONS The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.
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Affiliation(s)
- Alexandre Augusto Ferreira da Silva
- Department of Craniomaxillofacial Surgery, Division of Plastic Surgery, Postgraduate Program in Translational Surgery, Federal University of São Paulo São Paulo, Brazil
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Barone S, Bennardo F, Salviati M, Calabria E, Bocchino T, Michelotti A, Giudice A. Can different osteotomies have an influence on surgically assisted rapid maxillary expansion? A systematic review. Head Face Med 2024; 20:16. [PMID: 38459578 PMCID: PMC10921779 DOI: 10.1186/s13005-024-00415-3] [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: 11/27/2023] [Accepted: 02/10/2024] [Indexed: 03/10/2024] Open
Abstract
The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Marianna Salviati
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Elena Calabria
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Tecla Bocchino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy.
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Buyukcavus MH, Aydogan Akgun F, Solak S, Ucar MHB, Fındık Y, Baykul T. Facial recognition by cloud-based APIs following surgically assisted rapid maxillary expansion. J Orofac Orthop 2023:10.1007/s00056-023-00494-y. [PMID: 37773456 DOI: 10.1007/s00056-023-00494-y] [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: 04/13/2022] [Accepted: 07/25/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION This study aimed to investigate whether the facial soft tissue changes of individuals who had undergone surgically assisted rapid maxillary expansion (SARME) would be detected by three different well-known facial biometric recognition applications. METHODS To calculate similarity scores, the pre- and postsurgical photographs of 22 patients who had undergone SARME treatment were examined using three prominent cloud computing-based facial recognition application programming interfaces (APIs): AWS Rekognition (Amazon Web Services, Seattle, WA, USA), Microsoft Azure Cognitive (Microsoft, Redmond, WA, USA), and Face++ (Megvii, Beijing, China). The pre- and post-SARME photographs of the patients (relaxed, smiling, profile, and semiprofile) were used to calculate similarity scores using the APIs. Friedman's two-way analysis of variance and the Wilcoxon signed-rank test were used to compare the similarity scores obtained from the photographs of the different aspects of the face before and after surgery using the different programs. The relationship between measurements on lateral and posteroanterior cephalograms and the similarity scores was evaluated using the Spearman rank correlation. RESULTS The similarity scores were found to be lower with the Face++ program. When looking at the photo types, it was observed that the similarity scores were higher in the smiling photos. A statistically significant difference in the similarity scores (P < 0.05) was found between the relaxed and smiling photographs using the different programs. The correlation between the cephalometric and posteroanterior measurements and the similarity scores was not significant (P > 0.05). CONCLUSION SARME treatment caused a significant change in the similarity scores calculated with the help of three different facial recognition programs. The highest similarity scores were found in the smiling photographs, whereas the lowest scores were found in the profile photographs.
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Affiliation(s)
| | - Filiz Aydogan Akgun
- Faculty of Dentistry, Department of Orthodontics, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Serdar Solak
- Faculty of Technology, Department of Information Systems Engineering, Kocaeli University, Kocaeli, Turkey
| | | | - Yavuz Fındık
- Faculty of Dentistry, Department of Department of Oral and Maxillofacial Surgery, Süleyman Demirel University, Isparta, Turkey
| | - Timucin Baykul
- Faculty of Dentistry, Department of Department of Oral and Maxillofacial Surgery, Süleyman Demirel University, Isparta, Turkey
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Krijt LL, Kapetanović A, Sijmons WJL, Bruggink R, Baan F, Bergé SJ, Noverraz RRM, Xi T, Schols JGJH. What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study. Clin Oral Investig 2023; 27:5343-5351. [PMID: 37507601 PMCID: PMC10492756 DOI: 10.1007/s00784-023-05154-4] [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: 10/05/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS 3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS. RESULTS Twenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06). CONCLUSIONS Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited. CLINICAL RELEVANCE MARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.
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Affiliation(s)
- Laura L Krijt
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands.
| | - Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Wouter J L Sijmons
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Robin Bruggink
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - René R M Noverraz
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jan G J H Schols
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
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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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Karabiber G, Yılmaz HN. Does unilateral surgically assisted rapid maxillary expansion (SARME) lead to perinasal asymmetry? J Orofac Orthop 2023; 84:1-9. [PMID: 34357410 DOI: 10.1007/s00056-021-00333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/25/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE True unilateral posterior crossbite (TUPC) requires unilateral expansion to prevent nonocclusion at the noncrossbite (NC) side. The recommended osteotomies for TUPC after sutural closure are anterior, lateral, and posterior osteotomies only on the crossbite (C) side and median osteotomy of the midpalatal suture, i.e., unilateral surgically assisted rapid maxillary expansion (SARME). The goal was to assess airway and perinasal soft tissue outcomes after SARME. METHODS Data from 16 patients (8 males, 8 females; mean age 18.38 ± 1.45 years) were retrospectively assessed after unilateral SARME. The expansion (twice daily: 0.5 mm/day) and retention periods comprised 3 weeks and 6 months, respectively. Stereophotogrammetric images were used for soft tissue assessment; cone beam computed tomography (CBCT) was used to evaluate the anterior nasal airway. Statistical analyses were performed. RESULTS Using linear measurements, soft tissue distances of the alar base and alare to midsagittal plane (MSP) were significantly increased on the C side. A significant decrease was observed for the distance from the lower nostril point to the MSP on the NC side compared to a significant increase on the C side. Comparing the C and NC sides, the changes were significantly higher on the C side for all parameters except the upper nostril point to the MSP distance. Cheek volume was significantly higher on the C side. Volume changes of the anterior nasal airway (ANA) were significantly increased on the C side, but volume changes between NC and C were not significantly different. CONCLUSIONS Unilateral SARME led to significant expansion of ANA on the C side, but did not lead to asymmetry in the nasal region or have adverse effects on the airway or perinasal soft tissues. Thus, this novel treatment method may be useful in the treatment of patients with TUPC.
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Affiliation(s)
- Gülden Karabiber
- Faculty of Dentistry, Department of Orthodontics, İstanbul Medeniyet University, Fatih Mah., Eski Ankara Asfaltı Cad., No:28 Tuzla/Orhanlı, 34956, Istanbul, Turkey.
| | - Hanife Nuray Yılmaz
- Faculty of Dentistry, Department of Orthodontics, Marmara University, Istanbul, 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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Kang JH, Kim HJ, Song SI. Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents. PLoS One 2022; 17:e0272262. [PMID: 35925992 PMCID: PMC9352039 DOI: 10.1371/journal.pone.0272262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to reveal the associations between skeletal and soft tissue features of the nasomaxillary complex and development and severity of obstructive sleep apnea (OSA) in adolescents. A total of 100 adolescents (mean age, 14.9 ± 1.4 years; age range, 13–17 years) were enrolled. All participants underwent full-night polysomnography and had an assessment of size and position of the tongue, tonsillar size, body mass index (BMI), and circumference of the waist, neck, and hip. The skeletal features of the nasomaxillary complex, including the zygomatic arch width, nasal cavity width, nasal base width, intercanine width, intermolar width, maxillary dental arch length, palatal vault angle, palatal depth, and SNA were measured on the three-dimensional images constructed with computed tomography data. Participants with an apnea and hypopnea index (AHI) of lower than 5 (AHI ≤ 5) were classified as control and participants while those with an AHI of greater than 5 were classified as OSA group. Each variable with a significant outcome in the independent T-test and age and sex factors were integrated into the multivariate linear regression and the dependent variable was AHI. There were significant differences in the BMI and hip circumference between two groups. The width of nasal base, palatal vault angle and SNA also showed significant differences between groups. The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Hyun Jun Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Gyeonggi-do, Korea (ROK)
| | - Seung Il Song
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
- * E-mail:
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Wallner J, Denoiseux B, Van de Casteele E, Bila M, Van Hemelen G, Nadjmi N, Vercruysse H. Do sex and age influence nasal soft tissue widening after bone-borne transpalatal distraction ? J Oral Maxillofac Surg 2022; 80:1613-1627. [DOI: 10.1016/j.joms.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
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Evaluation of Sagittal and Vertical Changes in Maxillary Dental, Skeletal, and Soft Tissue Following Surgically Assisted Rapid Maxillary Expansion: A Retrospective Longitudinal Study. J Craniofac Surg 2022; 33:e398-e401. [DOI: 10.1097/scs.0000000000008256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zupan J, Ihan Hren N, Verdenik M. An evaluation of three-dimensional facial changes after surgically assisted rapid maxillary expansion (SARME): an observational study. BMC Oral Health 2022; 22:155. [PMID: 35501780 PMCID: PMC9063160 DOI: 10.1186/s12903-022-02179-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The abnormal facial features in maxillary transverse deficiency (MTD) are minimal and limited to a deficiency of the middle facial third, narrow nares and nasal base, and deepened nasolabial folds. The surgical expansion of the narrow maxilla has most obvious effects on widening of the maxillary dental arch and expansion of the maxillary and palatal structures in the transverse plane, however sagittal changes also occurs. The purpose of this observational study was to evaluate the three-dimensional (3D) facial soft tissue changes following surgically assisted rapid maxillary expansion (SARME). METHODS In 15 skeletally mature patients with severe maxillary transverse deficiency, the planned maxillary expansion (on average 8.8 mm ± 2.3 mm) was achieved with a bone-borne palatal distractor. The 3D optical scans of the facial surface were obtained before and six months after SARME. In the first part, we defined different anatomical landmarks on both scans and compared cephalometric measurements. In the second part, we registered both 3D scans in the same workplace using the regional best-fit method (forehead, supraorbital and nasal root regions were selected for the superimposition) and conducted surface analysis. RESULTS The largest differences between the pre- and post-operation scans were observed in the paranasal and cheek area (1.4 ± 1.0 mm). Significant differences occurred for an increased nasal width, a decreased upper-face height with an unchanged lower height, an increased vertical philtrum height and an increased nasolabial angle. A significant increase in the facial profile angle was also observed, resulting in an increased facial convexity and anterior displacement of the upper-lip area. CONCLUSIONS The widening of the nose and increased projection in the cheek and paranasal area in the lateral direction after maxillary expansion were confirmed; moreover, facial convexity increases, reflecting the underlying advancement of the maxilla.
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Affiliation(s)
- Jurij Zupan
- Faculty of Dental Medicine, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Nataša Ihan Hren
- Faculty of Medicine, Department of Maxillofacial and Oral Surgery, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Miha Verdenik
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre Ljubljana, UKCLJ, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
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Ngan P, Song J, Xiang J, He H, Martin CA, Weaver B. Changes in the nasal and pharyngeal airway volume with miniscrew-assisted rapid palatal expansion appliances. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_175_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The purpose of this study was to assess the volumetric changes in the nasal and pharyngeal airway volume in patients with maxillary transverse deficiency treated with miniscrew-assisted rapid palatal expansion (MARPE) appliances.
Material and Methods:
The pre- and post-treatment cone-beam computed tomography scans of 20 subjects who underwent treatment with the MARPE appliance as part of their orthodontic treatment were included in the study. Pre- and post-expansion airway volume measurements of the nasal cavity, nasopharynx, and oropharynx were measured. Linear measurements of the skeletal structures surrounding the nasal cavity were taken to assess the pattern of airway expansion. Paired t-tests were used to evaluate nasal and pharyngeal airway volume changes with expansion. Pearson correlation test was utilized to assess the relationship between nasal and pharyngeal volume changes.
Results:
A total of 17 out of 20 samples had a successful split of the mid-palatal sutures. A significant increase in nasal airway volume (12.0%) was found post-expansion. In addition, a significant increase in linear measurements of the nasal cavity base width in the frontal plane (7.1%) and both the anterior and posterior widths in the transverse dimension (9.4% and 3.4%, respectively) were found. Significant positive correlations were found between airway volumes and increase in width of the maxillary expansion appliance.
Conclusion:
The effects of maxillary expansion with a MARPE appliance include an increase in nasal cavity volume, but not the nasopharyngeal and the oropharyngeal airway volume. The nasal cavity expands in a triangular pattern in both the frontal and transverse dimensions following orthopedic expansion with the MARPE appliance. Increase in airway volume is a result of the increase in width of the maxillary expansion appliance.
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Affiliation(s)
- Peter Ngan
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Joanna Song
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Jun Xiang
- Department of Family Medicine, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Hong He
- Department of Stomatology, Wuhan University School of Stomatology, Wuhan, China,
| | - Chris A. Martin
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Bryan Weaver
- Department of Oral and Maxillofacial Surgery, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
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Venezia P, Nucci L, Moschitto S, Malgioglio A, Isola G, Ronsivalle V, Venticinque V, Leonardi R, Lagraverè MO, Lo Giudice A. Short-Term and Long-Term Changes of Nasal Soft Tissue after Rapid Maxillary Expansion (RME) with Tooth-Borne and Bone-Borne Devices. A CBCT Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12040875. [PMID: 35453923 PMCID: PMC9031355 DOI: 10.3390/diagnostics12040875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
The objective of the study was to assess the changes in nasal soft tissues after RME was performed with tooth-borne (TB) and bone-borne (BB) appliances. Methods. This study included 40 subjects with a diagnosis of posterior cross-bite who received tooth-borne RME (TB, average age: 11.75 ± 1.13 years) or bone-borne RME (BB, average age: 12.68 ± 1.31 years). Cone-beam computed tomography (CBCT) was taken before treatment (T0), after a 6-month retention period (T1), and one year after retention (T2). Specific linear measurements of the skeletal components and of the soft-tissue region of the nose were performed. All data were statistically analyzed. Results. Concerning skeletal measurements, the BB group showed a greater skeletal expansion of the anterior and posterior region of the nose compared to the TB group (p < 0.05) immediately after RME. Both TB and BB RME induce a small increment (>1 mm) of the alar base and alar width, without significant differences between the two expansion methods (p > 0.05). A high correlation was found between skeletal and soft-tissue expansion in the TB group; instead, a weaker correlation was found in the BB group. Conclusion. A similar slight increment of the alar width and alar base width was found in both TB and BB groups. However, the clinical relevance of these differences, in terms of facial appearance, remains questionable.
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Affiliation(s)
- Pietro Venezia
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio 6, 80138 Naples, Italy;
| | - Serena Moschitto
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Alessia Malgioglio
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Gaetano Isola
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Vincenzo Ronsivalle
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Valeria Venticinque
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
| | - Manuel O. Lagraverè
- Orthodontic Graduate Program, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | - Antonino Lo Giudice
- Department of Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (P.V.); (S.M.); (A.M.); (G.I.); (V.R.); (V.V.); (R.L.)
- Correspondence:
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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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Two- and Three-Segment Surgically Assisted Rapid Maxillary Expansion: A Clinical Trial. Plast Reconstr Surg 2021; 148:1086-1097. [PMID: 34705783 DOI: 10.1097/prs.0000000000008491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The literature shows no consensus on whether two- or three-segment surgically assisted rapid maxillary expansion is the best operative technique. METHODS The present clinical trial was designed to compare the outcome of two- and three-segment osteotomy surgically assisted rapid maxillary expansion. Thirty-two adult patients with transverse maxillary deficiency greater than or equal to 5 mm were randomly assigned to two- and three-segment groups (n = 16). Dimensional and psychological assessments (Oral Health Impact Profile and Brazilian Orthognathic Quality of Life Questionnaire) were carried out before surgical intervention and at one of the following time points: completion of expansion, removal of expanding device, 6 months after completion of expansion, or 10 months after completion of expansion. Dimensional assessments for asymmetric expansion of the maxilla and for changes in the area and volume of the palatine vault were performed on digital data from tomographic and laser scanning with the aid of an engineering inspection software. RESULTS No statistically significant differences were found in asymmetry or stability outcomes between groups. The psychological benefit provided by the three-segment technique did not spread through the domains of the quality-of-life questionnaires. CONCLUSIONS The current findings suggest that three-segment surgically assisted rapid maxillary expansion outcomes do not exceed those obtained with its two-segment counterpart regarding symmetry of maxillary expansion and stability of area and volume of the palatine vault. Furthermore, psychological nuances evidenced in two- and three-segment groups with the tools used play a limited, short-lasting role, or a specific, more sensitive assessment tool needs to be developed. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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16
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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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Li J, Shi L, Zhang X, Weng L, Chen H, Lin J. Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics. J Zhejiang Univ Sci B 2021; 22:146-155. [PMID: 33615755 DOI: 10.1631/jzus.b2000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Midpalatal corticotomy-assisted rapid maxillary expansion (MCRME) is a minimally invasive treatment of maxillary transverse deficiency (MTD) in young adults. However, the effect of MCRME on respiratory function still needs to be determined. In this study, we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics (CFD). Twenty patients with MTD (8 males, 12 females; mean age 20.55 years) had cone-beam computed tomography (CBCT) images taken before and after MCRME. The CBCT data were used to construct a three-dimensional (3D) upper airway model. The upper airway flow characteristics were simulated using CFD, and measurements were made based on the CBCT images and CFD. The results showed that the widths of the palatal bone and nasal cavity, and the intermolar width were increased significantly after MCRME. The volume of the nasal cavity and nasopharynx increased significantly, while there were no obvious changes in the volumes of the oropharynx and hypopharynx. CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment. Our results suggest that in these young adults with MTD, increasing the maxillary width, upper airway volume, and quantity of airflow by MCRME substantially improved upper airway ventilation.
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Affiliation(s)
- Juan Li
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lingfang Shi
- Department of Stomatology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China
| | - Xiayao Zhang
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luxi Weng
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong Chen
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Jun Lin
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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Jesus AS, Oliveira CB, Murata WH, Gonçales ES, Pereira-Filho VA, Santos-Pinto A. Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches. Int J Oral Maxillofac Surg 2021; 50:1059-1068. [PMID: 33478814 DOI: 10.1016/j.ijom.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/18/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
This retrospective study was performed to evaluate nasomaxillary changes in 36 patients at an advanced stage of skeletal maturity who underwent miniscrew-assisted rapid palatal expansion (MARPE) or surgically assisted rapid palatal expansion (SARPE) with/without an alar base cinch. Cone beam computed tomography images taken before and after expansion were analysed. Changes in the width of the dental arch (D66S, D66I), maxillary base (MxMol), and nasal floor and nasal cavity in the molar and canine regions (NaFMol, NaFCan, NaCMol, NaCCan) were compared, as well as changes in the choanal aperture (CA) and nasal soft tissue (NW). The MARPE technique produced smaller dental changes (D66S; P=0.025) and greater nasomaxillary expansion (MxMol, P=0.010; NaCMol, P=0.016; NaCCan, P=0.017; NaFMol, P=0.001; CA, P=0.002) than both SARPE techniques. Changes in NW did not differ significantly between the groups (P=0.200). MARPE uniformly increased the anterior and posterior widths of the nasal cavity. SARPE expanded the nasal cavity in a 'V-shape' pattern. Changes in the nasal cavity and choanal aperture related to the amount of dental arch expansion were greater for MARPE than for SARPE. All three approaches increased the width of the nasal soft tissue, although the cinch in SARPE limited this increase.
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Affiliation(s)
- A S Jesus
- Department of Orthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil.
| | - C B Oliveira
- Department of Orthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
| | - W H Murata
- Department of Orthodontics, São Leopoldo Mandic School and Dental Institute, Campinas, SP, Brazil
| | - E S Gonçales
- Department of Stomatology, Bauru School of Dentistry, São Paulo University, Bauru, Brazil
| | - V A Pereira-Filho
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
| | - A Santos-Pinto
- Department of Orthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
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Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion? J Craniofac Surg 2020; 31:829-831. [PMID: 32068729 DOI: 10.1097/scs.0000000000006245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes. MATERIAL AND METHODS Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate. RESULTS Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively. CONCLUSION SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.
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TÜKEL HC, BENLİDAYI ME, TATLI U, UZEL A, UZUN SB, KÜRKÇÜ M. Transpalatal distraksiyonun faringeal havayolu boyutları üzerindeki etkilerinin araştırılması. ACTA ODONTOLOGICA TURCICA 2020. [DOI: 10.17214/gaziaot.573426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Lee SR, Lee JW, Chung DH, Lee SM. Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: A three-dimensional stereophotogrammetry study. Korean J Orthod 2020; 50:75-85. [PMID: 32257933 PMCID: PMC7093666 DOI: 10.4041/kjod.2020.50.2.75] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study was to evaluate changes in the nasal soft tissues, including movements of landmarks, changes in linear distances, and volumetric changes, using three-dimensional (3D) stereophotogrammetry after microimplant-assisted rapid palatal expansion (MARPE) in adult patients. Methods Facial data were scanned using a white light scanner before and after MARPE in 30 patients. In total, 7 mm of expansion was achieved over a 4-week expansion period. We determined 10 soft tissue landmarks using reverse engineering software and measured 3D vector changes at those points. In addition, we calculated the distances between points to determine changes in the width of the nasal soft tissues. The volumetric change in the nose was also measured. Results All landmarks except pronasale and subnasale showed statistically significant movement on the x-axis. Pronasale, subnasale, alar right, and alar left showed significant movement on the y-axis, while all landmarks except subnasale showed significant movement on the z-axis. The alar base width, alar width, and alar curvature width increased by 1.214, 0.932, and 0.987 mm, respectively. The average volumetric change was 993.33 mm3, and the amount of increase relative to the average initial volume was 2.96%. Conclusions The majority of soft tissue landmarks around the nasal region show significant positional changes after MARPE in adults. The nose tends to widen and move forward and downward. The post-treatment nasal volume may also exhibit a significant increase relative to the initial volume. Clinicians should thoroughly explain the anticipated changes to patients before MARPE initiation.
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Affiliation(s)
- Seung-Ryeol Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Jin-Woo Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Dong-Hwa Chung
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Sang-Min Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
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Dental and Skeletal Changes after Transpalatal Distraction. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5814103. [PMID: 32090098 PMCID: PMC6998753 DOI: 10.1155/2020/5814103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Maxillary constriction is a common skeletal craniofacial abnormality, and transverse maxillary deficiency affects 30% of patients receiving orthodontic and surgical treatment. The aim of the study was to analyse craniofacial skeletal changes in adults with maxillary constriction after transpalatal distraction. The study group consisted of 36 patients (16 women) aged 17 to 42 years (M = 27.1; SD = 7.8) with a known complete skeletal crossbite and who underwent transpalatal distraction procedure. The measurements were obtained on diagnostic models, and cephalometric PA radiograms were obtained at time points, i.e., before treatment (T1) and after the completion of active distraction (T2). The analysis of diagnostic models involving the arch width measurement at different levels demonstrated a significant increase in L1, L2, L3, L4, L5, and L6 dimensions after transpalatal distraction. The largest width increase (9.5 mm) was observed for the L3 dimension (the intercanine distance). The analysis of frontal cephalograms displayed a significant increase in W1, W2, and W3 dimensions after transpalatal distraction. The largest width increase (4.9 mm) was observed for the W1 dimension at the level of the alveolar process of the maxilla. Transpalatal distraction is an effective treatment for transverse maxillary deficiency after the end of bone growth. The expansion observed on diagnostic models is close to a parallel segment shift mechanism, with a mild tendency towards a larger opening anteriorly. The maxillary segment rotation pattern analysed based on the frontal cephalograms is close to a hand fan unfolding with the rotation point at the frontonasal suture.
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Faur CI, Roman RA, Bran S, Dinu C, Coclici A, Rotaru H, Hedesiu M. The Changes in Upper Airway Volume after Orthognathic Surgery Evaluated by Individual Segmentation on CBCT Images. MÆDICA 2019; 14:213-219. [PMID: 31798735 DOI: 10.26574/maedica.2019.14.3.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:The aim of this CBCT study was to evaluate the postoperative volume changes of the rhinosinusal airway space, maxillary sinuses and nasal fossa, that occur after Le Fort I osteotomy, using individual segmentation of 3D virtual models. Material and methods:A number of 16 patients (with Class II and Class III malocclusions) who underwent a CBCT examination for orthognathic surgery at six month-interval between preoperative and postoperative evaluations were included. Patients with thickening of the sinus mucosa, craniofacial syndromes, maxillofacial trauma, rhinoplasty or other maxillofacial pathological conditions were excluded from the study. Individual segmentation of airway volumes was performed by the ITK-SNAP 2.0 software. Paired student t-test was used for the statistical examination of volume changes and Pearson's test for the assessment of intra-rate correlation. Outcomes:A statistically significant decrease in the rhinosinusal volume in Class II (9.36±3.43 cm3) and Class III malocclusions (3.65±2.96 cm3) was found after Le Fort I osteotomy. A decrease in volume was also found for maxillary sinuses (5.63±1.52 cm3 for Class II and 6.72±4.5 cm3 for Class III malocclusion). Nasal fossa decreased in volume (3.79±3.8 cm3) in Class II malocclusion patients and increased (3.07±2.39 cm3) in Class III malocclusion patients. The Pearson correlation revealed a high intra-rate agreement of measurements. Conclusion:Le Fort I osteotomy modifies the postoperative volume of rhinosinusal aerial spaces and individual segmentation on CBCT images is a useful tool to analyze the changes.
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Affiliation(s)
- Cosmin Ioan Faur
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Raluca Ancuta Roman
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Simion Bran
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Cristian Dinu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Alina Coclici
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Horatiu Rotaru
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
| | - Mihaela Hedesiu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, Cluj-Napoca, Romania
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Klazen YP, Caron CJ, Schaal SC, Borghi A, Van der Schroeff MP, Dunaway DJ, Padwa BL, Koudstaal MJ. What Are the Characteristics of the Upper Airway in Patients With Craniofacial Microsomia? J Oral Maxillofac Surg 2019; 77:1869-1881. [DOI: 10.1016/j.joms.2019.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
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Carlino F, Claudio PP, Tomeo M, Cortese A. Mandibular bi-directional distraction osteogenesis: A technique to manage both transverse and sagittal mandibular diameters via a lingual tooth-borne acrylic plate and double-hinge bone anchorage. J Craniomaxillofac Surg 2019; 47:1521-1529. [PMID: 31377072 DOI: 10.1016/j.jcms.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/27/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Mandibular hypoplasia can develop transversely, sagittally, or in both diameters simultaneously. Current techniques achieve either sagittal or transverse expansion with different surgeries. Here, we present a novel method to obtain transverse and sagittal mandibular distraction in one stage. MATERIALS AND METHODS The technique consists of a double osteotomy: a dento-alveolar osteotomy comprising four or six anterior teeth and a vertical symphysiotomy underneath. The mandibular basal bone is immediately expanded transversely and fixed to the lower symphysis via a miniplate carrying only one screw on each side that functions as a hinge during active distraction. The plate is connected to the anterior dento-alveolar block with a metal wire ligature. A teeth-anchored lingual distraction system can expand transversely at the alveolar bone level and then sagittally with the anterior dento-alveolar segment wired to the lower plate. RESULTS Satisfying and stable results were achieved, confirmed by measurements on serial plaster casts. CONCLUSION To the best of our knowledge, this is the first proposal for ortho-surgical correction of both transversal and sagittal mandibular hypoplasia via a bi-directional distraction procedure. A combination of bone-hardware anchorage and dental-anchored distraction systems is suggested. Transmucosal hardware emergence and need for a second surgery to remove bone-borne appliances are avoided.
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Affiliation(s)
- F Carlino
- Hospital Villa dei Pini, Department of Surgery, Section of Maxillofacial Surgery, Civitanova Marche, MC, Italy.
| | - P P Claudio
- Department of Oral and Maxillofacial Surgery & Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Tomeo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - A Cortese
- Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy
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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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Liu P, Jiao D, Wang X, Liu J, Martin D, Guo J. Changes in maxillary width and upper airway spaces in young adults after surgically assisted rapid palatal expansion with surgically facilitated orthodontic therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:381-386. [PMID: 30879916 DOI: 10.1016/j.oooo.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the changes in maxillary width and upper airway spaces in young adults with maxillary transverse deficiency (MTD) after surgically assisted rapid palatal expansion combined with surgically facilitated orthodontic therapy. STUDY DESIGN Twenty patients (11 males, 9 females; mean age 25.1 ± 6.3 years) with maxillary transverse deficiency were recruited. An expander was placed on the premolars and first molars. Cone beam computed tomography was performed before treatment and after a 3-month retention period. Measurements were done on the basis of the cone beam computed tomography images by using Dolphin Imaging 3-D software. The paired sample t test was used for statistical analysis. RESULTS The intermolar width and the buccal tipping of the upper first molars exhibited significant increase (P < .001). The volume and the minimum cross-sectional area (MCA) increased significantly (P < .05). The right-left diameter of MCA increased from 21.15 to 25.48mm (P < .001), whereas the anterior-posterior diameter of MCA did not change significantly (P > .05). CONCLUSIONS Widening of transverse maxillary deficiency after surgically assisted rapid palatal expansion with surgically facilitated orthodontic therapy improves upper airway spaces in young adults.
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Affiliation(s)
- Panpan Liu
- Lecturer, Department of Orthodontics and Pediatric Dentistry, School & Hospital of Stomatology, Key Laboratory of Oral Biomedicine of Shandong, Shandong University, Shandong, China
| | - Delong Jiao
- Lecturer, Department of Orthodontics, School & Hospital of Stomatology, Laboratory of Oral Biomedicine of Shandong, Shandong University, Shandong, China
| | - Xiaoya Wang
- Lecturer, Department of Orthodontics, School & Hospital of Stomatology, Laboratory of Oral Biomedicine of Shandong, Shandong University, Shandong, China
| | - Jing Liu
- Lecturer, Department of Orthodontics, School & Hospital of Stomatology, Laboratory of Oral Biomedicine of Shandong, Shandong University, Shandong, China
| | - Domingo Martin
- Professor, Private Practice; Visiting Professor Universidad Internacional de Cataluña, Barcelona, Spain
| | - Jing Guo
- Professor, Department of Orthodontics, School & Hospital of Stomatology, Laboratory of Oral Biomedicine of Shandong, Shandong University, Shandong, China.
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Gül A, de Jong MA, de Gijt JP, Wolvius EB, Kayser M, Böhringer S, Koudstaal MJ. Three-dimensional soft tissue effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: an automatic stereophotogrammetry landmarking analysis. Int J Oral Maxillofac Surg 2018; 48:629-634. [PMID: 30459065 DOI: 10.1016/j.ijom.2018.10.016] [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: 04/28/2018] [Revised: 07/14/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
Studies on mandibular midline distraction (MMD) are mostly performed using conventional research methods. Concerning surgically assisted rapid maxillary expansion (SARME), more research is conducted using three-dimensional (3D) techniques. Research on bimaxillary expansion, the combination of MMD and SARME, is reported sparsely. The main objective of this study was to provide a 3D evaluation of soft tissue effects following SARME and/or MMD. Patients who underwent SARME and/or MMD between 2008 and 2013 were included. Stereophotogrammetry was undertaken at the following time points: preoperative (T1), immediately post-distraction (T2), 1year postoperative (T3). An automatic 3D facial landmarking algorithm using two-dimensional Gabor wavelets was applied for the analysis. Twenty patients who had undergone SARME were included, 12 of whom had undergone bimaxillary expansion. Age at the time of surgery ranged from 16 to 47 years. There was a significant downward displacement of soft tissue pogonion. Furthermore, there was a significant mean increase of 2.20mm in inter-alar width and a non-significant mean increase of 1.77mm in inter-alar curvature point width. In conclusion, automatic stereophotogrammetry landmarking analysis of soft tissue effects showed downward displacement of soft tissue pogonion following bimaxillary expansion and transverse widening of the inter-alar width and a tendency towards an increase in inter-alar curvature point width after SARME.
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Affiliation(s)
- A Gül
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - M A de Jong
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Genetic Identification, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - J P de Gijt
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Kayser
- Department of Genetic Identification, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S Böhringer
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Li K, Quo S, Guilleminault C. Endoscopically-assisted surgical expansion (EASE) for the treatment of obstructive sleep apnea. Sleep Med 2018; 60:53-59. [PMID: 30393018 DOI: 10.1016/j.sleep.2018.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to evaluate the results of an outpatient surgical procedure known as endoscopically-assisted surgical expansion (EASE) in expanding the maxilla to treat obstructive sleep apnea (OSA) in adolescent and adults. METHODS Thirty-three patients (18 males), aged 15-61 years, underwent EASE of the maxilla. All patients completed pre- and post-operative clinical evaluations, polysomnography, questionnaires (Epworth Sleepiness Scale [ESS] and Nasal Obstruction Septoplasty Questionnaire [NOSE]) as well as cone beam computed tomography (CBCT). RESULTS With EASE, the overall apnea hypopnea index (AHI) improved from 31.6 ± 11.3 to 10.1 ± 6.3. The oxygen desaturation index (ODI) improved from 11.8 ± 9.6 to 1.8 ± 3.7, with reduction of ESS scores from 13.4 ± 4.0 to 6.7 ± 3.1. Nasal breathing improved as demonstrated by reduction of the NOSE scores from 57.8 ± 12.9 to 15.6 ± 5.7. Expansion of the airway from widening of the nasal floor was consistently evident on all postoperative CBCT; the anterior nasal floor expanded 4.9 ± 1.2 mm, posterior nasal floor expanded 5.6 ± 1.2 mm, and the dental diastema created was 2.3 ± 0.8 mm. Mean operative time was 54.0 ± 6.0 min. All patients with mild to moderate OSA were discharged the same day; patients with severe OSA were observed overnight. All patients returned to school or work and regular activities within three days. CONCLUSIONS EASE is an outpatient procedure that improves nasal breathing and OSA by widening the nasal floor in adolescents and adults. Compared to current surgical approaches for maxillary expansion, EASE is considerably less invasive and consistently achieves enlargement of the airway with minimal complications.
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Affiliation(s)
- Kasey Li
- Sleep Apnea Surgery Center, East Palo Alto, CA, USA.
| | - Stacey Quo
- School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
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Kim SY, Park YC, Lee KJ, Lintermann A, Han SS, Yu HS, Choi YJ. Assessment of changes in the nasal airway after nonsurgical miniscrew-assisted rapid maxillary expansion in young adults. Angle Orthod 2018; 88:435-441. [PMID: 29561652 DOI: 10.2319/092917-656.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate changes in the volume and cross-sectional area of the nasal airway before and 1 year after nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults. MATERIALS AND METHODS Fourteen patients (mean age, 22.7 years; 10 women, four men) with a transverse discrepancy who underwent cone beam computed tomography before (T0), immediately after (T1), and 1 year after (T2) expansion were retrospectively included in this study. The volume of the nasal cavity and nasopharynx and the cross-sectional area of the anterior, middle, and posterior segments of the nasal airway were measured and compared among the three timepoints using paired t-tests. RESULTS The volume of the nasal cavity showed a significant increase at T1 and T2 ( P < .05), while that of the nasopharynx increased only at T2 ( P < .05). The anterior and middle cross-sectional areas significantly increased at T1 and T2 ( P < .05), while the posterior cross-sectional area showed no significant change throughout the observation period ( P > .05). CONCLUSIONS The results demonstrate that the volume and cross-sectional area of the nasal cavity increased after MARME and were maintained at 1 year after expansion. Therefore, MARME may be helpful in expanding the nasal airway.
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New Technique for Mandibular Symphyseal Distraction by a Double-Level Anchorage and Fixation System: Advantages and Results. J Craniofac Surg 2018; 27:1469-75. [PMID: 27607116 DOI: 10.1097/scs.0000000000002831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A surgical technique to widen the mandible is the mandibular midline distraction: the most common indications for mandibular midline distraction are severe mandibular anterior crowding, severe mandibular transverse deficiency, uni- or bilateral crossbite, impacted anterior teeth with inadequate space, and tipped teeth. Commonly used distraction devices can be divided into 2 systems: bone-borne distraction system appliance, dental-borne distraction systems. Each system has peculiar advantages, disadvantages, and different indications. To combine advantages of both systems we developed a new technique adopting an immediate basal bone widening with fixation after osteotomy and a dental borne rigid lingual system for distraction. AIM The aim of this work is to show a new technique for symphysis mandibular distraction based on a double-level anchorage and fixation system on clinical patients showing final results and advantages. METHODS Two patients affected by dento-alveolar and basal bone maxillary and mandibular transversal collapse even in association with other skeletal malocclusion were selected. Patients were clinically and radiographically studied and analyzed at different times before and after surgery. Dental and basal bone measurements were performed clinically and radiographically. RESULTS The results were optimal with perfect dental arches alignment followed by closing of the open bites with multiple-segmented surgery in a second surgical time. No misalignment of the 2 mandibular halves was noticed during the distraction procedure. DISCUSSION Dental-bone discrepancies correction is mandatory before orthodontic treatment alignment. Transversal jaw expansion can be achieved safely and stably by distraction of both maxillae for the combination of osteogenesis and histogenesis with augmentation of both bone and soft tissue. Bone-borne distraction will result in more stable results; dental-borne devices will result in more simple and aesthetically rewarding procedures. Hybrid techniques usually show mixed results depending on the characteristics of the device. For this reason we developed a combination of both the aforementioned systems which is not a hybrid system but the combination of an immediate expansion of the symphysis and fixation by 1 miniplate with only 2 screws acting like hinges during distraction, combined with a lingual distraction system at the alveolar bone level. CONCLUSIONS Bone-borne distraction systems result in more efficient basal bone mandibular widening with increased stability for dental results. For dental-borne appliance the advantages consist in no second surgery need for their removal, no transmucosal hardware emergence and better aesthetic, especially when lingual devices were used. Our technique combines advantages of both procedures.
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Rômulo de Medeiros J, Ferraro Bezerra M, Gurgel Costa FW, Pinheiro Bezerra T, de Araújo Alencar CR, Studart Soares EC. Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D. Int J Oral Maxillofac Surg 2017; 46:1094-1101. [PMID: 28521967 DOI: 10.1016/j.ijom.2017.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/21/2016] [Accepted: 04/14/2017] [Indexed: 11/30/2022]
Abstract
Surgically assisted rapid maxillary expansion has been used for the treatment of transverse maxillary deficiency. This prospective study aimed to evaluate the effect of this surgery (with or without pterygomaxillary disjunction) on the upper airway volume. The patients were randomly divided into two groups: without pterygomaxillary disjunction (-PD) and with pterygomaxillary disjunction (+PD). Eleven patients per group were estimated to obtain a representative sample (90% of power and 95% of confidence level). Volumetric images of cone beam computed tomography scans were obtained preoperatively, immediately after Hyrax screw stabilization and 6 months after Hyrax screw stabilization. Volumetric measurements of the nasal cavity, maxillary sinuses, nasopharynx, and oropharynx, and of the minimum oropharynx cross-sectional area were obtained using Dolphin 3D Imaging Software. The final sample consisted of 25 adult individuals (+PD group, n=12; -PD group, n=13). In the +PD group, we observed a statistically significant increase immediately after Hyrax screw stabilization for the nasopharynx volume (P=0.003), oropharynx volume (P=0.007) and oropharynx cross-sectional area (P=0.001). Pterygomaxillary disjunction resulted in a significant (P <0.05) increase in volumetric measurements of the nasopharynx and minimum oropharynx cross-sectional area 6 months after the expander device stabilization.
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Affiliation(s)
- J Rômulo de Medeiros
- Division of Oral and Maxillofacial Surgery, Federal University of Ceará, University of Fortaleza, Fortaleza, Brazil.
| | - M Ferraro Bezerra
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
| | - F W Gurgel Costa
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
| | - T Pinheiro Bezerra
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Unichristus University Center, Fortaleza, Brazil
| | | | - E C Studart Soares
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
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Camps-Perepérez I, Guijarro-Martínez R, Peiró-Guijarro MA, Hernández-Alfaro F. The value of cone beam computed tomography imaging in surgically assisted rapid palatal expansion: a systematic review of the literature. Int J Oral Maxillofac Surg 2017; 46:827-838. [PMID: 28279603 DOI: 10.1016/j.ijom.2017.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 01/23/2017] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate the reliability of cone-beam computed tomography (CBCT) imaging of the maxillary structures and the postoperative dentoskeletal, nasal airway, periodontal, and facial soft tissue changes after surgically assisted rapid palatal expansion (SARPE). A systematic review of the literature on CBCT analysis of SARPE was performed. The PubMed, Embase, and Cochrane Library databases were searched. Nine articles were included, involving a total of 228 patients. The general trend was tooth-borne distraction with pterygomaxillary dysjunction. A systematic increase in all transverse dimensions at the dentoalveolar and dental levels, as well as a certain degree of tipping and extrusion of the anchorage teeth and tipping of the skeletal segments, was detected. Soft tissue findings reflected the underlying dentoalveolar changes. A decrease in the buccal alveolar bone thickness and alveolar crest level occurred. Results confirm that CBCT is an accurate and reliable method to assess anatomical changes after SARPE. Although this systematic review provides valuable preliminary information about the effects of SARPE, results should be interpreted with caution due to the low level of evidence of the publications, great heterogeneity among study groups regarding outcome variables and surgical-orthodontic protocols, and lack of long-term data.
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Affiliation(s)
- I Camps-Perepérez
- Department of Oral and Maxillofacial Surgery, International University of Catalonia (UIC), Sant Cugat del Vallés, Barcelona, Spain
| | - R Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, International University of Catalonia (UIC), Sant Cugat del Vallés, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain.
| | - M A Peiró-Guijarro
- Department of Oral and Maxillofacial Surgery, International University of Catalonia (UIC), Sant Cugat del Vallés, Barcelona, Spain
| | - F Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, International University of Catalonia (UIC), Sant Cugat del Vallés, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spain
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Stepanko LS, Lagravère MO. Sphenoid bone changes in rapid maxillary expansion assessed with cone-beam computed tomography. Korean J Orthod 2016; 46:269-79. [PMID: 27668190 PMCID: PMC5033766 DOI: 10.4041/kjod.2016.46.5.269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Rapid maxillary expansion (RME) is used to expand the maxilla and increase arch perimeter; yet, there are few reports on its effects on the sphenoid bone. With cone-beam computed topography (CBCT), it is possible to visualize sphenoid bone changes. The purpose of this study was to investigate sphenoid bone changes observed in conjunction with RME treatments, using CBCT. METHODS Sixty patients (34 women and 26 men, aged 11-17 years) underwent RME as part of their orthodontic treatment. Patients were randomly assigned to one of three groups: a tooth-anchored group, a bone-anchored group, or a control group. Initial CBCT scans were performed preceding the RME treatment (T1) and again directly after the completion of expansion (T2). Statistical analysis included ANOVA, descriptive statistics, and the intraclass correlation coefficient (ICC). RESULTS The reliability of the landmark location was at least 0.783, and the largest ICC mean measurement error was 2.32 mm. With regard to distances, the largest change was 0.78 mm, which was not statistically significant (p > 0.05). Statistical significance was established in patient groups of the same sex and treatment type for the following distance measurements: right anterior lateral pterygoid plate to the right edge of the hypophyseal fossa (d2), anterior distance between the medial pterygoid plates (d4), and anterior distance between the left medial and lateral plates (d8). CONCLUSIONS In this study, there were no clinically significant changes in the sphenoid bone due to RME treatments regardless of sex or treatment type.
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Affiliation(s)
- Lucas S Stepanko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Manuel O Lagravère
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2016; 74:338-48. [DOI: 10.1016/j.joms.2015.06.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 01/23/2023]
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Buck LM, Dalci O, Darendeliler MA, Papadopoulou AK. Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review. J Oral Maxillofac Surg 2015; 74:1025-43. [PMID: 26778518 DOI: 10.1016/j.joms.2015.11.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/15/2015] [Accepted: 11/30/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Surgically assisted rapid maxillary expansion (SARME) is required in non-growing patients when maturity or resistance precludes desired sutural separation by noninvasive techniques. The aim of this review was to determine what volumetric changes occur in the upper airway spaces after SARME in adults. MATERIALS AND METHODS A systematic review was performed with data assessed for suitability of meta-analysis. The primary outcome measurement of volumetric changes in an upper airway space was sought in non-growing patients undergoing SARME. Electronic database searches were performed for published literature in Medline (by Ovid), Pre-Medline, Old Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) spanning all available years to August 1, 2015. Unpublished literature was searched electronically through ClinicalTrials.gov and the National Research Register. Additional hand searching of reference lists of relevant articles, grey searching, and expert correspondence was conducted for any additional studies. Two authors independently screened search results, extracted data, and assessed the risk of bias of included studies. RESULTS Twenty-one studies were located by initial screening; 10 were excluded after full-text review, leaving 11 studies eligible that met all inclusion criteria for this systematic review. In total, 204 treated patients (mean age, 18 to 31 yr) were included in the qualitative synthesis. Ten studies evaluated nasal cavity volume, 2 evaluated palatal volume, and 1 evaluated oropharyngeal volume. Appliances used included tooth-borne hyrax and transpalatal distractor devices. CONCLUSIONS SARME was found to produce substantial short-term volume increases in the nasal cavity in non-growing patients that were maintained for at least 63 months. Evidence weakly suggested no effect on oropharyngeal volume. However, most studies were evaluated as having a high risk of bias. The effect of such volume changes on respiratory function still needs to be determined; thus, SARME cannot be recommended for respiratory purposes.
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Affiliation(s)
- Lloyd M Buck
- Postgraduate Student, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Oyku Dalci
- Senior Lecturer, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - M Ali Darendeliler
- Professor and Chair, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Alexandra K Papadopoulou
- Senior Lecturer, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia; Research Associate, Department of Oral Surgery and Implantology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Singh GD, Heit T, Preble D, Chandrashekhar R. Changes in 3D nasal cavity volume after biomimetic oral appliance therapy in adults. Cranio 2015; 34:6-12. [PMID: 25622854 DOI: 10.1179/2151090315y.0000000001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- G Dave Singh
- 1 BioModeling Solutions, Inc. , Beaverton, OR, USA
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