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Silvestrini-Biavati F, Oliva G, Ghislanzoni LH, Ottonelli E, Dalessandri D, Lanteri V, Ugolini A. Evaluation of palate morphology in patients treated with leaf expander and hyrax expander: A geometric morphometric analysis. Orthod Craniofac Res 2024. [PMID: 39096030 DOI: 10.1111/ocr.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/25/2024] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate changes in shape of the palatal vault after maxillary expansion with hyrax expander (HE) and leaf expander (LE), using 3D Geometric Morphometric Analysis. SETTING AND SAMPLE POPULATION Overall, 250 patients (110 M, 140 F) with maxillary transverse deficiency were selected for this study. In this study, 127 subjects were treated with HE, 123 with LE. MATERIALS AND METHODS Digital dental models were obtained pre-treatment (T0) and after 12 months from the cementation of the device (T1) and processed by means of a digital scanner. Linear and morphometric analyses were conducted to determine the effects of each appliance on dental measurements and palatal shape, and a multiple linear regression was performed to analyse the influence of anchorage and appliance type on final shape. RESULTS Morphometric analysis showed that there was a lowering of the palatal vault in the HE group, while in the LE group it remained unchanged: the difference in palatal shape at time T0 and T1 was statistically significant in both treatments (HE vs. LE). In the HE group, the change in shape also included the upper part of the palatal vault in the vertical dimension, while in the LE group the change in shape interested mainly palatal shelves and the lower portion of the palate. CONCLUSIONS Both LE and HE produce clinically significant changes in the morphology of the palatal vault.
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Affiliation(s)
| | - Giorgio Oliva
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | | | - Elisa Ottonelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | - Valentina Lanteri
- Surgical, Medical, and Dental Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Ugolini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Rossi A, Lagravère-Vich M, Heo G, Major PW, El-Bialy T. An evaluation of root resorption associated with the use of photobiomodulation during orthodontic treatment with clear aligners: a retrospective cohort pilot study. Angle Orthod 2024; 94:294-302. [PMID: 38412960 PMCID: PMC11050451 DOI: 10.2319/081823-567.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/01/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To evaluate the change in tooth root volume using cone-beam computed tomography (CBCT) in a group of patients treated concurrently with clear aligners and an adjunctive photobiomodulation (PBM) device. MATERIALS AND METHODS This retrospective cohort pilot study included the records of 32 consecutively treated clear aligner patients (23 female, 9 male) from the private practice of one orthodontist. The PBM group (n = 16) used the device once per day for 5 minutes per arch and was compared with a matched control group (n = 16). A semiautomated segmentation technique was used to obtain tooth volume of anterior teeth from CBCT imaging prior to (T0) and during or immediately following (T1) orthodontic treatment with clear aligners. The change in root volume between time points was assessed. RESULTS There was no statistically significant difference between the pre- and posttreatment root volumes of maxillary and mandibular anterior teeth, regardless of which intervention group the patient belonged to (P > .05). There was also no difference in the mean percentage change in root volume between clear aligner patients in this study who were treated with the PBM device compared with a matched control group (P > .05). CONCLUSIONS Clear aligner patients in this study who changed their aligners every 3 to 5 days and used adjunctive photobiomodulation therapy did not experience clinically relevant orthodontically induced external root resorption. Due to the small sample size and measurement error in the root segmentation process, the results should be interpreted with caution.
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Nowak R, Przywitowski S, Golusiński P, Olejnik A, Zawiślak E. Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)-A Retrospective Analysis of 185 Cases Treated at a Single Center. J Clin Med 2024; 13:2053. [PMID: 38610817 PMCID: PMC11012378 DOI: 10.3390/jcm13072053] [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: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.
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Affiliation(s)
- Rafał Nowak
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Szymon Przywitowski
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Anna Olejnik
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Ewa Zawiślak
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
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Ning R, Chen J, Liu S, Lu Y. Treatment effects after maxillary expansion using tooth-borne vs tissue-borne miniscrew-assisted rapid palatal expansion appliance. Am J Orthod Dentofacial Orthop 2023; 164:545-553. [PMID: 37178105 DOI: 10.1016/j.ajodo.2023.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The study investigated the skeletal effects and root resorption in young adults with maxillary transverse deficiency after tissue-borne or tooth-borne mini-implant anchorage maxillary expansion. METHODS Ninety-one young adults with maxillary transverse deficiency, aged 16-25 years, were divided into 3 groups according to the treatment method: group A (n = 29) comprising patients treated with tissue-borne miniscrew-assisted rapid palatal expansion (MARPE), the group B (n = 32) comprising patients treated with tooth-borne MARPE, and the control group (n = 30) comprising patients only treated with fixed orthodontic therapies. Pretreatment and posttreatment cone-beam computed tomography images were used to assess the change of maxillary width, nasal width, first molar torque and root volume by paired t test in the 3 groups, respectively. Analysis of variance and Tukey least significant difference analysis were used to detect the changes of all descriptions among the 3 groups P <0.05. RESULTS In the 2 experimental groups, we observed significant increases in the width of the maxilla, nasal, and arch width, as well as the molar torque. In addition, the height of the alveolar bone and the root volume decreased significantly. There were no significant differences in the maxilla, nasal, and arch width change between the 2 groups. Group B displayed more increases in buccal tipping, alveolar bone loss, and root volume loss than group A (P <0.05). Compared with groups A and B, the control group showed negligible tooth volume loss, with no expansion effect in both skeletal and dental descriptions. CONCLUSIONS Tissue-borne MARPE produced the same expansion efficiency as tooth-borne MARPE. However, tooth-borne MARPE causes more dentoalveolar side effects in buccal tipping, root resorption and alveolar bone loss.
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Affiliation(s)
- Ruoyu Ning
- Department of Orthodontics, Xiangya Stomatological Hospital and Xiangya School of Stomatology, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Central South University, Changsha, Hunan, China; Third Xiangya Hospital and Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Junjie Chen
- Department of Orthodontics, Xiangya Stomatological Hospital and Xiangya School of Stomatology, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Central South University, Changsha, Hunan, China
| | - Siling Liu
- Department of Orthodontics, Xiangya Stomatological Hospital and Xiangya School of Stomatology, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Central South University, Changsha, Hunan, China
| | - Yanqin Lu
- Department of Orthodontics, Xiangya Stomatological Hospital and Xiangya School of Stomatology, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Central South University, Changsha, Hunan, China.
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Abate A, Ugolini A, Maspero C, Silvestrini-Biavati F, Caprioglio A, Lanteri V. Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni-Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation. Clin Oral Investig 2023; 27:5249-5262. [PMID: 37466717 PMCID: PMC10492880 DOI: 10.1007/s00784-023-05144-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars. METHODS Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes. RESULTS The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group. CONCLUSIONS According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.
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Affiliation(s)
- Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, Genoa, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
| | | | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Valentina Lanteri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
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Leonardi R, Ronsivalle V, Isola G, Cicciù M, Lagravère M, Flores-Mir C, Lo Giudice A. External root resorption and rapid maxillary expansion in the short-term: a CBCT comparative study between tooth-borne and bone-borne appliances, using 3D imaging digital technology. BMC Oral Health 2023; 23:558. [PMID: 37573295 PMCID: PMC10422725 DOI: 10.1186/s12903-023-03280-9] [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: 03/10/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The aim of the study was to analyze and compare external root resorption (ERR) in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). METHODS The sample included 40 subjects who received tooth-borne RME (TB group, average age: 13.1 ± 1.08 years) or bone-borne RME (BB group, average age: 14.5 ± 1.11 years) and Cone-beam computed tomography (CBCT) scans before treatment (T0) and after 3-month of retention (T1). A specific 3D Imaging technology was used to generate 3D models of posterior dentition (M1 = maxillary first molars, P2 = second premolars, P1 = first premolar) and calculate volumetric data (mean and percentage values) and shape changes, the latter obtained from deviation analysis between the radicular models at different time points. Evaluation of radicular length changes was performed for each tooth. Data were statistically analysed to perform intra-timing and inter-groups comparisons. RESULTS A significant reduction of radicular volume and length was found in posterior dentition in both groups (p < 0.05), and the M1 (volume) and its palatal root (length) were mostly involved in this response. No differences were found between M1, P1 and P2 (p > 0.05) when volumetric changes were calculated as percentage of the total volume. Deviation analysis revealed that the radicular areas mostly affected by shape change were the apex and bucco-medial side. The amount of ERR was significantly greater in TB group compared to BB group. CONCLUSIONS BB-RME treatment could reduce the amount of ERR at the post-expansion stage.
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Affiliation(s)
- Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Catania, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, University of Catania, Catania, Italy
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, Section of Periodontology, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, University of Catania, Catania, Italy
| | - Manuel Lagravère
- Orthodontic Graduate Program, University of Alberta, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- Orthodontic Graduate Program, University of Alberta, Edmonton, AB, Canada
| | - Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Catania, Italy.
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Wilmes B, Drescher D. CAD-CAM workflows for palatal TAD anchored appliances. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Akyalcin S, Alev Y. Clinical advances in maxillary skeletal expansion and introduction of a new MARPE concept. J ESTHET RESTOR DENT 2023; 35:291-298. [PMID: 36478642 DOI: 10.1111/jerd.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transverse maxillary deficiency, typically characterized by the clinical manifestations of unilateral or bilateral crossbite, is a common orthodontic discrepancy. The primary goal of maxillary expansion should be to obtain a nearly maximum width increase in the basal bone of the constricted maxilla and to avoid the dental expansion of the anchor teeth. The introduction of miniscrew anchorage-supported rapid maxillary expansion (MARPE) devices has helped increase the feasibility of obtaining nonsurgical transverse correction in late adolescents and young adults with optimum orthopedic effects. However, the success rate of MARPE shows a negative correlation with age. Although MARPE offers an effective method for correcting a transverse skeletal deficiency, given the appliance cost and increased risk for complications, it could present challenges for adult patients and practitioners in daily practice. AIMS In this article, current advances in maxillary skeletal expansion are summarized, and a new MARPE concept is introduced. CONCLUSION The new MARPE design offers several advantages to other existing methods: (1) it can be installed directly to the patient in the clinical setting with no additional laboratory waiting times. (2) It is purely a bone-borne appliance. (3) The appliance is designed to be placed in the thickest part of the anterior palate to maximize the cortical and trabecular bone support. (4) Allows for bicortical placement of the miniscrews with no perforations in the nasal floor. Finally, (5) offers an esthetic and minimalistic approach to maxillary skeletal expansion in late adolescent and adult patients.
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Affiliation(s)
- Sercan Akyalcin
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Leonardi R, Ronsivalle V, Barbato E, Lagravère M, Flores-Mir C, Lo Giudice A. External root resorption (ERR) and rapid maxillary expansion (RME) at post-retention stage: a comparison between tooth-borne and bone-borne RME. Prog Orthod 2022; 23:45. [PMID: 36464753 PMCID: PMC9719874 DOI: 10.1186/s40510-022-00439-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/29/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The study aimed to compare external root resorption (ERR) three-dimensionally in subjects treated with tooth-borne (TB) versus bone-borne (BB) rapid maxillary expansion (RME). Forty subjects who received tooth-borne RME (TB group, average age 13.3 years ± 1.10 years) or bone-borne RME (BB group, average age 14.7 ± 1.15 years) were assessed using CBCT imaging before treatment (T0) and after a 6-month retention period (T1). 3D reconstructions of the radicular anatomy of maxillary first molars (M1), first and second premolars (P1 and P2) were generated to calculate volumetric (mean and percentage values) and shape changes (deviation analysis of the radicular models) obtained at each time point. 2D assessment of radicular length changes was also performed for each tooth. Data were statistically analyzed to perform intra-group (different teeth) and inter-group comparisons. RESULTS In both groups, all the investigated teeth showed a significant reduction in radicular volume and length (p < 0.05), with the first molars being the teeth most affected by the resorption process (volume and palatal root length). When volumetric radicular changes were calculated as a percentage of the pre-treatment volumes, no differences were found among the investigated teeth (p > 0.05). Based on the deviation analysis from radicular models superimposition, the areas most affected by shape change were the apex and bucco-medial root surface. Overall, the amount of ERR was significantly greater in the TB group (mm3: M1 = 17.03, P1 = 6.42, P2 = 5.26) compared to the BB group (mm3: M1 = 3.11, P1 = 1.04, P2 = 1.24). CONCLUSIONS Despite the statistical significance, the difference in the amount of ERR of the posterior maxillary dentition between TB-RME and BB-RME remains clinically questionable.
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Affiliation(s)
- Rosalia Leonardi
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Catania, Italy
| | - Vincenzo Ronsivalle
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Catania, Italy
| | - Ersilia Barbato
- grid.7841.aDepartment of Oral and Maxillofacial Sciences, School of Dentistry, “Sapienza” University of Rome, Rome, Italy
| | - Manuel Lagravère
- grid.17089.370000 0001 2190 316XOrthodontic Graduate Program, University of Alberta, Edmonton, AB Canada
| | - Carlos Flores-Mir
- grid.17089.370000 0001 2190 316XOrthodontic Graduate Program, University of Alberta, Edmonton, AB Canada
| | - Antonino Lo Giudice
- grid.8158.40000 0004 1757 1969Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Catania, Italy
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Wilmes B. “Appliance First” or “Bone First” for miniscrew assisted rapid palatal expansion? APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_57_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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OUP accepted manuscript. Eur J Orthod 2022; 44:679-689. [DOI: 10.1093/ejo/cjac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sameshima GT, Iglesias-Linares A. Orthodontic root resorption. J World Fed Orthod 2021; 10:135-143. [PMID: 34785166 DOI: 10.1016/j.ejwf.2021.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
External apical root resorption (EARR) is one of the most frequently reported iatrogenic side effects of orthodontic movement. Nevertheless, no robust and unequivocal scientific evidence is yet available in the literature regarding the clinical and biological factors that trigger EARR. The purpose of the present position paper is to provide clinicians, residents, and investigators a summary of our current understanding about root resorption caused by orthodontic tooth movement, based on up-to-date available scientific evidence. Morphological, structural, biomechanical, and biological differences account for predisposing the apical third to EARR compared to other root surfaces during orthodontic treatment. In addition, a relevant number of patient and treatment-related factors increase risk of EARR. The main patient-related factors are reviewed and discussed: genetic factors, tooth anatomy, demographic factors, malocclusion factors, previous endodontic treatment, medical history, short root anomaly. Similarly, the influence of treatment-related factors are analyzed with regard to the effect of: biomechanical factors, type of orthodontic appliance, adjunctive therapies to accelerate tooth movement, early treatment, maxillary expansion, teeth extractions, the duration of treatment and the amount of apical displacement. Clinical management of EARR from pre-treatment records to the monitoring strategy as well as recommendations for the post orthodontic-treatment period are presented as a guide for the clinician. Despite years of studies, we still do not fully understand EARR, but the future is promising. True three-dimensional imaging with higher resolution and low radiation, and predictive tools towards an earlier detection without radiographs, will mark future developments in the field of EARR in orthodontics.
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Affiliation(s)
- Glenn T Sameshima
- Advanced Orthodontics, Herman Ostrow School of Dentistry of University of Southern California (USC), Los Angeles, California, USA.
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Colak C, Aras B, Cheng LL, Elekdag-Turk S, Turk T, Darendeliler MA. Effects of rapid and slow maxillary expansion on root resorption: a micro-computed tomography study. Eur J Orthod 2021; 43:682-689. [PMID: 34345908 DOI: 10.1093/ejo/cjab024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To compare root resorption (RR) after rapid maxillary expansion (RME) and slow maxillary expansion (SME) through micro-computed tomography (micro-CT). SUBJECTS AND METHODS Twenty-six subjects who required maxillary expansion and bilateral upper first premolar extraction were randomly assigned to RME (n = 13, mean age: 13.25 ± 0.88 years) or SME (n = 13, mean age: 13.53±1.28 years) group. A hyrax-type acrylic bonded expansion appliance was used. The Hyrax screw was activated ¼ turn twice a day for 20 days in the RME group and ¼ turn every second day for 80 days in the SME group. One randomly selected upper first premolar was extracted in each patient after active expansion. The appliance was left in situ for a 24-week retention period then the contralateral upper first premolar was extracted. Extracted teeth were scanned with micro-CT and the volume of the resorption craters was analysed with a specialized software. Transversal skeletal and dental widths were measured on posteroanterior radiographs taken before and after expansion and retention periods. RESULTS The resorption craters were concentrated mostly on the buccal surface and middle level in all samples. The total RR in the RME group was less post-expansion (P ≤ 0.05) and more post-retention (P > 0.05) than the SME group. During retention, there was a significant decrease in the total RR in the SME group (P > 0.05) and an increase in the RME group. Both RME and SME groups displayed a similar increase in skeletal transverse dimensions, but inter-molar width increased significantly more in the SME group during the whole experimental period. CONCLUSION RME does not have an advantage over SME in terms of skeletal expansion and the amount of RR when a retention period of six months is followed.
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Affiliation(s)
- Canan Colak
- Orthodontist, Private Practice, Esentepe Mah. FSM Bulvari Bahar Sitesi A Blok No: 96/5 Nilüfer/Bursa, Turkey
| | - Banu Aras
- Orthodontist, Former Senior Dental Registrar, Sydney Dental Hospital, Sydney, Australia
| | - Lam L Cheng
- Department of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
| | - Selma Elekdag-Turk
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Tamer Turk
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - M Ali Darendeliler
- Department of Orthodontics and Paediatric Dentistry, Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Sydney Dental Hospital, Sydney Local Health District, Sydney, Australia
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Alcin R, Malkoç S. Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study. Korean J Orthod 2021; 51:241-249. [PMID: 34275880 PMCID: PMC8290090 DOI: 10.4041/kjod.2021.51.4.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the volume, amount, and localization of root resorption in the maxillary first premolars using micro-computed tomography (micro-CT) after expansion with four different rapid maxillary expansion (RME) appliances. METHODS In total, 20 patients who required RME and extraction of the maxillary first premolars were recruited for this study. The patients were divided into four groups according to the appliance used: miniimplant- supported hybrid RME appliance, hyrax RME appliance, acrylic-bonded RME appliance, and full-coverage RME appliance. The same activation protocol (one activation daily) was implemented in all groups. For each group, the left and right maxillary first premolars were scanned using micro-CT, and each root were divided into six regions. Resorption craters in the six regions were analyzed using special CTAn software for direct volumetric measurements. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test with Bonferroni adjustment. RESULTS The hybrid expansion appliance resulted in the lowest volume of root resorption and the smallest number of craters (p < 0.001). In terms of overall root resorption, no significant difference was found among the other groups (p > 0.05). Resorption was greater on the buccal surface than on the lingual surface in all groups except the hybrid appliance group (p < 0.05). CONCLUSIONS The findings of this study suggest that all expansion appliances cause root resorption, with resorption craters generally concentrated on the buccal surface. However, the mini-implant-supported hybrid RME appliance causes lesser root resorption than do other conventional appliances.
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Quinzi V, Federici Canova F, Rizzo FA, Marzo G, Rosa M, Primozic J. Factors related to maxillary expander loss due to anchoring deciduous molars exfoliation during treatment in the mixed dentition phase. Eur J Orthod 2021; 43:332-337. [PMID: 33215659 DOI: 10.1093/ejo/cjaa061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim was to identify factors associated with maxillary expander loss due to anchoring deciduous molars exfoliation and assess the diagnostic accuracy of the upper second premolar cusp position as a prognostic factor for the exfoliation of its corresponding deciduous molar. MATERIALS/METHODS Ninety-two subjects aged 8.4 ± 1.1 years, treated with a Haas or hyrax expander, and using the same expansion protocol and deciduous teeth as anchorage were included. The position of the upper second premolar cusp, according to the half pulp chamber (HPC) line of the ipsilateral upper first permanent molar, was assessed on pre-treatment panoramic radiographs. RESULTS A significant association between anchoring deciduous molar exfoliation and the position of the upper second premolar cusp according to the HPC line (P = 0.002; odds ratio = 5.7) was seen, while there was no association with gender, age, treatment duration, and type of expander. The median survival time for an anchoring deciduous molar, when the underlying premolar cusp was touching/crossing the HPC line, was 13.0 (11.7; 14.2) months. The upper second premolar cusp position to the HPC line showed high accuracy (at least 76.11 per cent) and substantial repeatability (at least 0.7) as a prognostic factor for the corresponding second deciduous molar exfoliation. LIMITATIONS Applicability in the mixed dentition phase with fully erupted upper first permanent molars. CONCLUSIONS The probability of a second deciduous molar to be successfully used as maxillary expander anchorage for at least 16 months is above 94 per cent; when at baseline, the corresponding premolar cusp is apical to the HPC line.
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Affiliation(s)
- Vincenzo Quinzi
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, Italy
| | | | - Fiorella Alessandra Rizzo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, Italy
| | - Giuseppe Marzo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, Italy
| | | | - Jasmina Primozic
- Department of Orthodontics and Jaw Orthopaedics, Medical Faculty, University of Ljubljana, Slovenija
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Malkoç S, Alçin R, Uzel A. Does the rhythm and appliance type of rapid maxillary expansion have an effect on root resorption? Angle Orthod 2021; 91:293-300. [PMID: 33492378 PMCID: PMC8084455 DOI: 10.2319/052220-465.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the volume, amount, and localization of root resorption in the upper first premolars by micro-computed tomography (micro-CT) after three different rapid maxillary expansion appliances and two different activation rhythms. MATERIALS AND METHODS The patients were divided into three groups; Hyrax, acrylic cap splint (ACS), and full coverage acrylic bonded (FCAB) appliances. Each group was then divided into the following two subgroups: rapid maxillary expansion (RME) and semirapid maxillary expansion (SRME). After expansion was completed, the appliances were stabilized for 12 weeks during the retention period. For each group, 10 premolars (for a total of 60 premolars) were scanned with the micro-CT (SkyScan). The reconstructed 3D images of each root sample were divided into six regions. The resorption craters on these six different root surfaces were analyzed by special CTAn (SkyScan) software for direct volumetric measurements. Kruskal-Wallis one-way analysis of variance and Mann-Whitney U tests were used for statistical analysis. RESULTS The total volume of root resorption was less with FCAB than with ACS and Hyrax (P < .001). In all groups, a greater volume of resorption was found on the buccal surface than on the lingual surface (P < .001). No significant differences were found between the RME and SRME groups (P > .05). CONCLUSIONS All expansion appliances caused root resorption in the upper first premolar teeth, but FCAB may be safer in terms of root resorption. The resorption craters were generally concentrated on the buccal surface. There was no effect of activation rhythm on root resorption.
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Wilmes B, Tarraf N, Drescher D. Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination. Am J Orthod Dentofacial Orthop 2021; 160:147-154. [PMID: 33906772 DOI: 10.1016/j.ajodo.2020.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
Bone-borne rapid maxillary expansion distraction devices are used to achieve a more skeletal expansion and to avoid dental side effects of conventional expanders such as tipping of anchorage teeth. In this article, we report the use of a prefabricated expander fixed on 2 mini-implants in the anterior palate. This allows for the insertion of the mini-implants and the expander to occur without the need for an impression or any laboratory procedures. Especially when aligners are going to be used, the use of a mini-implant-borne expander seems to be reasonable because the expander can be left in place as a skeletal retainer during the aligner finishing.
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Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany.
| | - Nour Tarraf
- Private practice, Sydney, Australia, and Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Dieter Drescher
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
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Ronsivalle V, Casella F, Fichera G, Bennici O, Conforte C, Lo Giudice A. Root Resorption of Maxillary Posterior Teeth after Rapid Maxillary Expansion: A Comprehensive Review of the Current Evidence from in-vitro and in-vivo Studies. Open Dent J 2021. [DOI: 10.2174/1874210602115010097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background:
The application of heavy forces to the dentition, as those produced during a Rapid Maxillary Expansion (RME), has been associated in the literature with the development of root resorption of maxillary posterior teeth.
Objective:
The aim of the present manuscript was to report the available data from in-vitro and in-vivo studies that can elucidate the biological processes of resorption and repair of radicular cementum after RME.
Methods:
Studies evaluating the occurrence of root resorption after RME by means of histological and radiographic methodology were included. We detailed the changes of the radicular anatomy after RME and provided a synthesis of the most valuable scientific evidence showing the biological processes behind the potential modifications of radicular anatomy. Results. Loss of cementum material and reduction of radicular volumes were seen after rapid maxillary expansion. A small radicular volumetric recovery of anchored teeth occurred after the retention period; this reparative phenomenon was caused by cementum deposition without the reattachment of periodontal fibers, supporting the detrimental effects associated with RR.
Conclusion:Retention period and the timing of radiographic examination could influence the extension of radicular resorption detected after RME since root resorption and cementum repair may occur at the same time at this stage.
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Primozic J, Federici Canova F, Rizzo FA, Marzo G, Quinzi V. Diagnostic ability of the primary second molar crown-to-root length ratio and the corresponding underlying premolar position in estimating future expander anchoring teeth exfoliation. Orthod Craniofac Res 2021; 24:561-567. [PMID: 33606329 DOI: 10.1111/ocr.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/30/2021] [Accepted: 02/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim was to assess the diagnostic ability of the crown-to-root length ratio of the primary second molar and the position of the corresponding underlying premolar in estimating future anchoring teeth exfoliation during maxillary expansion. SETTING AND SAMPLE POPULATION Fifty-four subjects (30 females, 24 males; 108 teeth) aged 8.2 ± 1.0 years that underwent palatal expansion. METHODS The upper second premolar position of the corresponding expander anchoring primary molar was determined in relation to the ipsilateral first permanent molar half-pulp chamber (HPC) line on panoramic radiographs. Subjective and objective (based on measurements) assessments of the crown-to-root length ratio of anchoring primary molars were performed. Exfoliation after the expansion was recorded over a retention period of 12 months. All the assessments were performed individually by three examiners at two 3-week-apart sessions, trained and calibrated before enrolment. The intra-/inter-examiner agreements were evaluated, and the diagnostic accuracy of the methods was calculated. RESULTS All methods exhibited almost perfect intra- and at least substantial inter-examiner agreement (Kappa >0.8 and ≥0.63, respectively). Good diagnostic accuracy was seen for the premolar position to the HPC line (0.7-0.8), while the crown-to-root length ratio methods exhibited hardly sufficient accuracy. The diagnostic agreement of the methods was fair. CONCLUSIONS When primary molars are considered as anchoring teeth for maxillary expansion, the premolar position in relation to the HPC line appears to be the most valid and reliable method for predicting their stability. Despite high repeatability values, the crown-to-root length ratio needs a cut-off point re-definition to increase its predicting ability.
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Affiliation(s)
- Jasmina Primozic
- Department of Orthodontics and Jaw Orthopaedics, Medical Faculty, University of Ljubljana
| | | | - Fiorella Alessandra Rizzo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Marzo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Quinzi
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, L'Aquila, Italy
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Hatrom AA, Howait MS, Zawawi KH, Al-Turki GA, Alansari RA, Almehayawi NF, Alammari SH, Mohammed RA, Hassan AH. Pulp volume changes after piezocision-assisted tooth movement: a randomized clinical trial. BMC Oral Health 2021; 21:28. [PMID: 33435897 PMCID: PMC7805050 DOI: 10.1186/s12903-020-01382-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Orthodontic treatment may result in undesirable side effects, such as root resorption and a decrease in the size of the pulp tissue which could be associated with the duration of the orthodontic treatment. Piezocision-assisted tooth movement was introduced as a minimally invasive surgical procedure to shorten orthodontic treatment time. This prospective randomized clinical trial was aimed to compare the pulp volume changes of maxillary anterior teeth after en-masse retraction with or without piezocision-assisted orthodontics. Methods Patients who required orthodontic treatment with bilateral maxillary first premolar extractions and en-masse retraction were recruited. Patients were randomly divided into extraction with piezocision, or only extraction, serving as controls. Pulp volume and root length changes of the maxillary six anterior teeth were measured and compared between the two groups using a 3-Dimensional analytical software. Paired and independent sample t-tests were used to compare within and between groups. Bivariate correlation was done between the mean change in pulp volume and its corresponding root length. The significance level was set at α = 0.05. Results A total of 23 patients were included, 12 in the piezocision, and 11 in the control group. At the end of the en-masse retraction phase, (mean = 122.74 ± 3.06 days) pulp volume was significantly decreased in all six anterior teeth in both groups (P < 0.01). The decrease in pulp volume was not statistically different between both groups, (P > 0.05). There was a statistically significant but moderate correlation only between the pulp volume change of the right canine and its root length, r = 0.44, P = 0.034. Conclusions The effect of piezocision-assisted orthodontic tooth movement on the pulp volume was comparable to the conventional orthodontic treatment. The degree of change in pulp volume does not appear to be related to the amount of root resorption. Trial registration NCT03180151. Registered December 25, 2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT03180151.
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Affiliation(s)
- Abdulkarim A Hatrom
- Department of Orthodontics, Alnoor Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Mohammed S Howait
- Department of Endodontics, Faculty of Dentistry, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Khalid H Zawawi
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghassan A Al-Turki
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem A Alansari
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nouf F Almehayawi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah H Alammari
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ali H Hassan
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. .,Alfarabi Private College, PO Box 80209, Jeddah, 21589, Saudi Arabia.
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Moon HW, Kim MJ, Ahn HW, Kim SJ, Kim SH, Chung KR, Nelson G. Molar inclination and surrounding alveolar bone change relative to the design of bone-borne maxillary expanders: A CBCT study. Angle Orthod 2019; 90:13-22. [PMID: 31461306 DOI: 10.2319/050619-316.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the molar inclination and skeletal and alveolar bone changes when comparing tooth bone-borne (MSE) and tissue bone-borne type maxillary expanders (C-expander) using cone-beam computed tomography (CBCT) in late adolescence. MATERIALS AND METHODS A sample of 48 late-adolescent patients were divided into two groups according to the type of expander: MSE group (n = 24, age = 19.2 ± 5.9 years) and C-expander group (n = 24, age = 18.1 ± 4.5 years). CBCT scans were taken before treatment and 3 months after expansion. Transverse skeletal and dental expansion, alveolar inclination, tooth axis, buccal alveolar bone height, thickness, dehiscence, and fenestration were evaluated on the maxillary first molar. Paired t-test, independent t-test, Pearson's chi-square test, and Spearman correlation analysis were performed. RESULTS The MSE group produced greater dental expansion (P < .05), whereas skeletal expansion was similar in both groups (P = .859). The C expander group had more alveolar bone inclination change (P < .01), and the MSE group had more buccal tipping of the anchorage teeth (P < .01 or .001). Buccal alveolar bone height loss and thickness changes were greater in the MSE group (P < .01 or <.001). Formation of dehiscences was more frequent in the MSE group (P < .001), whereas for fenestrations, there were no significant differences between the two groups. Buccal bone height loss in the MSE group had a negative correlation with initial buccal bone thickness. CONCLUSIONS The incorporation of teeth into bone-borne expanders resulted in an increase in the severity of side effects. For patients in late adolescence, tissue bone-borne expanders offer comparable skeletal effects to tooth bone-borne expanders, with fewer dentoalveolar side effects.
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Samandara A, Papageorgiou SN, Ioannidou-Marathiotou I, Kavvadia-Tsatala S, Papadopoulos MA. Evaluation of orthodontically induced external root resorption following orthodontic treatment using cone beam computed tomography (CBCT): a systematic review and meta-analysis. Eur J Orthod 2019; 41:67-79. [PMID: 29771300 DOI: 10.1093/ejo/cjy027] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Orthodontically induced external root resorption (OIRR) is a pathologic consequence of orthodontic tooth movement. However, the limitations of two-dimensional radiography suggest that cone beam computed tomography (CBCT) with its three-dimensional capabilities might be more suitable to assess OIRR. Objective The aim of this study was to assess in an evidence-based manner data on linear or volumetric OIRR measurements of permanent teeth by means of CBCT, during and/or after the end of orthodontic treatment. Search methods Unrestricted electronic and hand searches were performed up to January 2017 in 15 databases. Selection criteria methods Randomized clinical trials, prospective, and retrospective non-randomized studies assessing OIRR during and/or after orthodontic treatment using CBCT in human patients were included. Data collection and analysis After duplicate study selection, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses, followed by subgroup, meta-regression, and sensitivity analyses were also performed in order to evaluate factors that affect OIRR. Results A total of 33 studies (30 datasets) were included in the qualitative analysis while data from 27 of them were included in the quantitative analysis. Direct comparisons from randomized trials found little to no influence of appliance-related factors on OIRR. Explorative analyses including non-randomized studies found a pooled OIRR of 0.79 mm based on all included studies and 0.86 mm when OIRR was assessed at the end of orthodontic treatment. Statistically significant differences in OIRR were found according to tooth type or jaw, inclusion of extractions, treatment duration, and diagnostic accuracy of the CBCT. Conclusions Based on the results of this study, CBCT seems to be a reliable tool to examine OIRR during or at the end of orthodontic treatment. Although the average OIRR measured with CBCT seems to lack clinical relevance, there are certain factors that may affect OIRR following orthodontic treatment. Nevertheless, due to data heterogeneity and low quality of the included studies, the corresponding results should be interpreted with some caution. Registration PROSPERO (CRD42016030131).
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Affiliation(s)
- Aikaterini Samandara
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | | | | | - Moschos A Papadopoulos
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
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Lemos Rinaldi MR, Azeredo F, Martinelli de Lima E, Deon Rizzatto SM, Sameshima G, Macedo de Menezes L. Cone-beam computed tomography evaluation of bone plate and root length after maxillary expansion using tooth-borne and tooth-tissue-borne banded expanders. Am J Orthod Dentofacial Orthop 2018; 154:504-516. [PMID: 30268261 DOI: 10.1016/j.ajodo.2017.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The objective of this research was to evaluate the buccal bone plate and root length of maxillary permanent first molars using cone-beam computed tomography after maxillary expansion with different activation protocols. METHODS Cone-beam computed tomography images of growing patients were obtained from the orthodontic department of Pontifical Catholic University of Rio Grande do Sul in Brazil. The groups were Haas-type 2/4 turns, Haas-type 4/4 turns, hyrax-type 2/4 turns, and hyrax-type with alternate rapid maxillary expansions and constrictions (alt-RAMEC) 4/4 turns a day. Tooth length, periodontal insertion, alveolar bone thickness, and intermolar distances were evaluated. The data at the start of treatment and 6 months later were compared using generalized linear models. The intergroup differences were determined by univariate analysis of variance with the Bonferroni adjustment. RESULTS Tooth length was significantly shortened after expansion in all groups (-0.28 to -0.51 mm), except for the alt-RAMEC group. Bone level variables (bone level and bone level at the tooth tip) changed statistically in all groups, except for the Haas 4/4 turns group. There was significant periodontal attachment loss after rapid maxillary expansion with the hyrax/alt-RAMEC (5.09 mm). The hyrax/alt-RAMEC and hyrax groups had more dehiscences, fenestrations, and exposures of the root. CONCLUSIONS The consequence of rapid maxillary expansion using the hyrax was alveolar bone resorption, especially in the hyrax/alt-RAMEC group, whereas the Haas expander caused mild root resorption.
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Affiliation(s)
- Mariana Roennau Lemos Rinaldi
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fabiane Azeredo
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Martinelli de Lima
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Susana Maria Deon Rizzatto
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Glenn Sameshima
- Advanced Dental Education Program in Orthodontics, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, Calif
| | - Luciane Macedo de Menezes
- Department of Orthodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
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Celenk-Koca T, Erdinc AE, Hazar S, Harris L, English JD, Akyalcin S. Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: A prospective randomized clinical trial. Angle Orthod 2018; 88:702-709. [PMID: 30102085 DOI: 10.2319/011518-42.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES: To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents. MATERIALS AND METHODS: Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods. RESULTS: Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups. CONCLUSION: Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.
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Vandenberghe B. The digital patient – Imaging science in dentistry. J Dent 2018; 74 Suppl 1:S21-S26. [DOI: 10.1016/j.jdent.2018.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022] Open
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Puttaravuttiporn P, Wongsuwanlert M, Charoemratrote C, Leethanakul C. Volumetric evaluation of root resorption on the upper incisors using cone beam computed tomography after 1 year of orthodontic treatment in adult patients with marginal bone loss. Angle Orthod 2018; 88:710-718. [PMID: 29911905 DOI: 10.2319/121717-868.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES: To determine upper incisor root resorption, volume loss, and the relationship between root volume loss and tooth movement after 1 year of orthodontic treatment in patients with marginal bone loss. MATERIALS AND METHODS: A total of 30 women (46.3 ± 5.4 years old) with moderate upper incisor bone loss who required intrusion during orthodontic treatment were recruited. Pre- and post-treatment cone beam computed tomography images were reconstructed. Upper incisors at pre- and post-treatment were superimposed; labio- and palato-apical, middle, and coronal third root volumes were assessed. Tooth movement and alveolar bone height were measured from lateral cephalometric radiographs and cone beam computed tomography. Changes in root volume/alveolar bone height were compared using paired-sample t-tests, percentage root volume loss for each tooth/segment was evaluated by one-way analysis of variance, and the relationship between percentage root loss and degree of tooth movement was assessed by linear regression. RESULTS: Mean root volume significantly decreased on the labio- and palato-apical aspects of 12 and labio-apical aspects of 21 and 22 ( P ≤ .024). Palato-apical segment volume loss was greater on lateral than central incisors ( P ≤ .016). Two-dimensional root length and cementoenamel junction-bone crest distance did not change between T0 and T1, with no significant relationship between tooth movement amount and percentage root volume loss. CONCLUSIONS: Delivery of 40 g intrusive force to the four upper incisors using a T-loop and the leveling phase lead to more apical root volume loss on lateral than central incisors. There was no relationship between extent of tooth movement and upper incisor root volume loss.
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Lo Giudice A, Galletti C, Gay-Escoda C, Leonardi R. CBCT assessment of radicular volume loss after rapid maxillary expansion: A systematic review. J Clin Exp Dent 2018; 10:e484-e494. [PMID: 29849974 PMCID: PMC5971075 DOI: 10.4317/jced.54745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/11/2018] [Indexed: 02/03/2023] Open
Abstract
Background The present systematic review analyzed the current literature to investigate whether rapid maxillary expansion (RME) causes radicular resorption, assessed by cone-beam computed tomography (CBCT). Material and Methods Eighteen electronic databases and reference lists of studies were searched up to November 2017. Grey literature was also screened. To be included, articles must be human studies on growing subjects with transversal maxillary deficiency treated with maxillary expansion protocol and with 3-D radiographic assessment of radicular volume by CBCT images. Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, teeth evaluated, CBCT settings), and study outcomes (radicular volume loss) were reported according to the PRISMA statement. Results Only 3 articles were considered eligible and an individual analysis of the selected articles was undertaken. The risk of bias assessment revealed low methodological quality for all the studies included. In all the considered studies, significant radicular volume loss was observed in posterior teeth, following RME. When reported in percentage, the radicular volumetric loss was similar between anchored (first molars and first premolars) and unanchored teeth (second premolars). Conclusions A preliminary evaluation of the patient-related risk factors for RR is warmly advisable when administering RME. Key words:RME, maxillary expansion, root resorption, external root resorption.
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Affiliation(s)
- Antonino Lo Giudice
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging - Section of Orthodontics, School of Dentistry, University of Messina, Policlinico Universitario "G. Martino", Via Consolare Valeria - 98123 Messina, Italy
| | - Cosimo Galletti
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillo-facial Surgery Department. School of Dentistry, University of Barcelona. Campus de Bellvitge UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosalia Leonardi
- Department of Medical-Surgical Specialties - Section of Orthodontics, School of Dentistry, University of Catania, Azienda Ospedaliero - Universitaria "PoliclinicoVittorio Emanuele", Via S. Sofia, 78 - 95123 Catania, Italy
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The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects. Clin Oral Investig 2017; 22:369-376. [DOI: 10.1007/s00784-017-2121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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