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Nucera R, Militi A, Caputo A, Bellocchio AM, Minervini G, Cervino G, Portelli M. Indirect orthodontic bonding using an original 3D method compared with conventional technique: A narrative review. Saudi Dent J 2024; 36:72-76. [PMID: 38375395 PMCID: PMC10874802 DOI: 10.1016/j.sdentj.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 02/21/2024] Open
Abstract
As well known success in orthodontics is related to a correct diagnosis and to a carefull treatment planning. Our study aims to provide clinician with a reproducible and precise method, for orthodontic indirect bonding, thanks to CBCT images and due to a CAD-CAM process. METHODS A case of an orthodontic treatment plan, of a female patient, 37 years old, was selected. Plaster models were digitally acquired using the Extra-Oral scanner Maestro 3D and processed within the Studio Maestro 3D software. CBCT images in DICOM format were imported into the MIMICS software, in order to perform the segmentation of the dental elements, and to obtain a three-dimensional coronal-root dental arches model. The DICOM file thus processed was exported in an STL file, reworked with Meshmixer software to improve image quality, and imported into the 3D Maestro software to be superimposed on the digital model. In this way a three-dimensional real model of the dental arches was developed. After an accurate orthodontic virtual set-up, we proceeded to brackets positioning on the 3D model of the dental arches. Subsequently, a virtual transfer template was created, in order to carry out the digital printing of a thermo-printed mask necessary to perform an indirect bonding of the orthodontic appliance. RESULTS The original digital workflow proposed in this study allows the development of a real and non-ideal three-dimensional coronal-root model of the dental arches; this model can be used for indirect orthodontic bonding eliminating any errors in the expression of 1st, 2nd and 3rd order information of the pre-informed orthodontic appliance. CONCLUSIONS Technological advancements in oral scanning and 3D printing will allow the achievement of an easy and reproducible ideal positioning of the orthodontic brackets.
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Affiliation(s)
- Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Andrea Caputo
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Angela Mirea Bellocchio
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80100 Napoli, Italy
| | - Gabriele Cervino
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
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Colino-Gallardo P, Del Fresno-Aguilar I, Castillo-Montaño L, Colino-Paniagua C, Baptista-Sánchez H, Criado-Pérez L, Alvarado-Lorenzo A. Skeletal and Dentoalveolar Changes in Growing Patients Treated with Rapid Maxillary Expansion Measured in 3D Cone-Beam Computed Tomography. Biomedicines 2023; 11:3305. [PMID: 38137526 PMCID: PMC10740967 DOI: 10.3390/biomedicines11123305] [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: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The skeletal and dental effects of rapid maxillary expansion (RME) have been extensively studied, but high-quality research is still needed to determine the three-dimensional (3D) effects of RME. The aim of this study was to compare skeletal and dentoalveolar parameters through cone-beam computed tomography (CBCT) pre- (T1) and post-treatment (T2) with respect to RME. Twenty growing patients (mean age 10.7 years) were treated with a Hyrax-type expander. A 3D CBCT was performed at T1 and T2, measuring nasal width, maxillary width, palatal height, maxillary arch perimeter, angulation of the upper first molar, and intermolar width. The mean palatal suture opening was 2.85 ± 0.62 mm (p < 0.0001). Nasal width increased 1.28 ± 0.64 mm and maxillary width 2.79 ± 1.48 mm (p < 0.0001). In contrast, palatal height was reduced 0.65 ± 0.64 mm (p < 0.0001). Regarding arch perimeter, the radicular perimeter increased 2.89 ± 1.80 mm, while the coronal perimeter increased 3.42 ± 2.09 mm (p < 0.0001). Molar angulation increased 5.62 ± 3.20° for the right molar and 4.74 ± 2.22° for the left molar (p < 0.0001). Intermolar width increased 5.21 ± 1.55 mm (p < 0.0001). Treatment with Hyrax produced a significant opening in the mean palatal suture. Also, a significant increase in nasal width, maxillary width, arch perimeter, molar angulation, and intermolar width, and a decrease in palatal height, were observed.
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Affiliation(s)
- Peri Colino-Gallardo
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Irene Del Fresno-Aguilar
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Laura Castillo-Montaño
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Carlos Colino-Paniagua
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Hugo Baptista-Sánchez
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
| | - Laura Criado-Pérez
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
| | - Alfonso Alvarado-Lorenzo
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
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Khan MK, Sharma DS, Jindal MK. Unusual systemic and nondental effects of maxillary expansion therapy: A comprehensive and updated review of literature. J Orthod Sci 2023; 12:38. [PMID: 37881659 PMCID: PMC10597365 DOI: 10.4103/jos.jos_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 10/27/2023] Open
Abstract
In dental practice, pediatric patients with a wide range of manifestations of malocclusion viz. crossbite, dental crowding, and skeletal Class III due to transverse discrepancy of the abnormally constricted maxilla or palate are found. However, the dental management of such kind of malocclusion with narrow palate needs a meticulous dental evaluation. Appliances used for treating such malocclusion conditions may include Slow-Maxillary Expansion (SME) or Rapid Maxillary Expansion (RME) orthodontic or orthopedic appliances. Considerable success has been described in the literature using the maxillary/palatal expansion modality. Unusual systemic and nondental effects of expansion appliances therapy have been described in some scientific studies. However, no comprehensive review article has been published describing the nondental and systemic effects of RME/SME therapy in Pediatric Dentistry. Considering the above scenarios, the updated and comprehensive review of the relevant literature is necessary for health professionals. Dental professionals including pediatric dentists and orthodontists need to consider such untoward or unexpected effects of RME/SME treatment modality. Hence, the current comprehensive review article has been written with the aim to meticulously describe the relevant scientific literature about nondental/extraoral and systemic effects of RME/SME appliances.
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Affiliation(s)
- Mohammad Kamran Khan
- Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India
| | - Divya Sanjay Sharma
- Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India
| | - Mahendra Kumar Jindal
- Department of Pediatric and Preventive Dentistry, Faculty of Medicine, Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India
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Georgiadis T, Angelopoulos C, Papadopoulos MA, Kolokitha OE. Three-Dimensional Cone-Beam Computed Tomography Evaluation of Changes in Naso-Maxillary Complex Associated with Rapid Palatal Expansion. Diagnostics (Basel) 2023; 13:diagnostics13071322. [PMID: 37046539 PMCID: PMC10093383 DOI: 10.3390/diagnostics13071322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
The introduction of Cone-Beam Computed Tomography (CBCT) in orthodontics has added a new tool to diagnosis and treatment planning. The aim of this prospective clinical trial was to investigate the changes in the dimensions of the naso-maxillary complex in growing patients after RPE using CBCT. A total of 16 growing children (8 females, 6 males) with a mean age of 11, 12 ± 1 and 86 years underwent RPE as part of their comprehensive orthodontic treatment. CBCT scans were obtained before RPE (T1), immediately after RPE (T2) and 6 months after RPE (T3). The dimensions of the nasal width, nasal floor and the aperture of the midpalatal suture were calculated in different coronal slices of CBCT. Evaluation of the mean value variance per measurement at the three time intervals were performed using the paired Wilcoxon signed-rank test. Differences between the three time intervals were assessed by performing Multiple Pairwise Comparisons. A statistically significant increase in all measurements was seen immediately after RPE expansion (T2–T1) and six months after expansion (T3–T1). Between the end of expansion and 6 months in retention (T3–T2), a decrease was observed for all measurements. RPE can cause expansion of the nasal cavity in growing patients. The expansion of the midpalatal suture follows a triangular pattern of opening.
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Affiliation(s)
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Moschos A. Papadopoulos
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olga-Elpis Kolokitha
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Akbulut N, Akbulut S, Bayrak S, Şen E, Altan A, Kaymaz G, Çolak S. Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study. Clin Oral Investig 2023; 27:807-815. [PMID: 36648584 DOI: 10.1007/s00784-023-04860-3] [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: 02/07/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated. MATERIALS AND METHODS This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods. RESULTS For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05). CONCLUSION Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV. CLINICAL RELEVANCE Step Le Fort I advancement surgery technique usually affects nasal structures positively regarding the nasal airway.
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Affiliation(s)
- Nihat Akbulut
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Sibel Akbulut
- Orthodontics Department, Dentistry Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Seval Bayrak
- Oral and Maxillofacial Radiology Department, Dentistry Faculty, Bolu Abant Izzet Baysal University, Golkoy, Bolu, Turkey.
| | - Esengül Şen
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ahmet Altan
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Gizemnur Kaymaz
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Sefa Çolak
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
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Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective. J Clin Med 2022; 11:jcm11175243. [PMID: 36079172 PMCID: PMC9457357 DOI: 10.3390/jcm11175243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.
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Prévé S, García Alcázar B. Interest of miniscrew-assisted rapid palatal expansion on the upper airway in growing patients: A systematic review. Int Orthod 2022; 20:100657. [DOI: 10.1016/j.ortho.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 10/17/2022]
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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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Wen H, Wu W, Fan F, Liao P, Chen H, Zhang Y, Deng Z, Lv W. Human identification performed with skull's sphenoid sinus based on deep learning. Int J Legal Med 2022; 136:1067-1074. [PMID: 35022840 DOI: 10.1007/s00414-021-02761-2] [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: 06/07/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Human identification plays a significant role in the investigations of disasters and criminal cases. Human identification could be achieved quickly and efficiently via 3D sphenoid sinus models by customized convolutional neural networks. In this retrospective study, a deep learning neural network was proposed to achieve human identification of 1475 noncontrast thin-slice CT scans. A total of 732 patients were retrieved and studied (82% for model training and 18% for testing). By establishing an individual recognition framework, the anonymous sphenoid sinus model was matched and cross-tested, and the performance of the framework also was evaluated on the test set using the recognition rate, ROC curve and identification speed. Finally, manual matching was performed based on the framework results in the test set. Out of a total of 732 subjects (mean age 46.45 years ± 14.92 (SD); 349 women), 600 subjects were trained, and 132 subjects were tested. The present automatic human identification has achieved Rank 1 and Rank 5 accuracy values of 93.94% and 99.24%, respectively, in the test set. In addition, all the identifications were completed within 55 s, which manifested the inference speed of the test set. We used the comparison results of the MVSS-Net to exclude sphenoid sinus models with low similarity and carried out traditional visual comparisons of the CT anatomical aspects of the sphenoid sinus of 132 individuals with an accuracy of 100%. The customized deep learning framework achieves reliable and fast human identification based on a 3D sphenoid sinus and can assist forensic radiologists in human identification accuracy.
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Affiliation(s)
- Hanjie Wen
- College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Wei Wu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Peixi Liao
- Department of Scientific Research and Education, The Sixth People's 3. Hospital of Chengdu, Chengdu, 610065, People's Republic of China
| | - Hu Chen
- College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China.
| | - Yi Zhang
- College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
| | - Zhenhua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Weiqiang Lv
- College of Computer Science, Sichuan University, Chengdu, 610065, People's Republic of China
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Xu M, Li Y, Feng X, Zheng W, Zhao Z, Li Y. Parathyroid hormone promotes maxillary expansion and reduces relapse in the repeated activation maxillary expansion rat model by regulating Wnt/β-catenin pathway. Prog Orthod 2022; 23:1. [PMID: 34978631 PMCID: PMC8724514 DOI: 10.1186/s40510-021-00394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background Constricted maxillary bone is a common skeletal deformity, which may lead to crowding and posterior crossbite. Mid-palatal suture expansion is often used to increase the maxillary width, but its skeletal effects are limited and tend to relapse, even with prolonged retention. We hypothesized that parathyroid hormone (PTH) may reduce the relapse of maxillary expansion. Methods We established a novel rat maxillary expansion model using palatal tubes with an insertable “W”-shaped spring which can be repeatedly activated. A total of 32 male healthy Wistar rats were randomly divided into six groups: the control group, the PTH group, the expansion group, the expansion + PTH group, the expansion + relapse group and the expansion + PTH + relapse group. All animals in the first 4 groups were killed after 10 days and the 2 relapse groups were killed after 15 days. The maxillary arch widths and histological staining were used to assess the expansion and relapse effects. The immunohistochemical staining, micro-CT, RT-qPCR and Western blot were used to evaluate the bone remodeling during expansion. Results The suture width was increased by the expansion device, and the repeated activation maxillary expansion rat model showed better expansion effects than the conventional model. PTH significantly promoted the expansion width and reduced the relapse ratio. Meanwhile, in the expansion + PTH group, histological and immunohistochemical staining showed that osteoblasts, osteoclasts, new cartilage and osteoid were significantly increased, micro-CT showed increased bone mass, and PCR and Western blot results confirmed up-regulation of RANKL, β-catenin, type II collagen and OCN. Conclusion The novel repeated activation maxillary expansion rat model has better effects than the conventional model. PTH enhances the maxillary expansion and reduces its relapse by regulating Wnt/β-catenin and RANKL pathways. PTH administration may serve as an adjunctive therapy in addition to mechanical expansion for treatment of maxillary constriction.
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Affiliation(s)
- Mengting Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Yuan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Xiaoxia Feng
- The Affiliated Stomatology Hospital, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wei Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China.
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China.
| | - Yu Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
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Ugolini A, Agostino P, Silvestrini-Biavati A, Harrison JE, Batista KB. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev 2021; 12:CD000979. [PMID: 34951927 PMCID: PMC8709729 DOI: 10.1002/14651858.cd000979.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively. Several treatments have been recommended to correct this problem, which is related to such dental issues as tooth attrition, abnormal development of the jaws, joint problems, and imbalanced facial appearance. Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate). This is the third update of a Cochrane review first published in 2001. OBJECTIVES To assess the effects of different orthodontic treatments for posterior crossbites. SEARCH METHODS Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 8 April 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults. DATA COLLECTION AND ANALYSIS Two review authors, independently and in duplicate, screened the results of the electronic searches, extracted data, and assessed the risk of bias of the included studies. A third review author participated to resolve disagreements. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous data (event), unless there were zero values in trial arms, in which case we used odds ratios (ORs). We used mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models. We used the GRADE approach to assess the certainty of the evidence for the main outcomes. MAIN RESULTS We included 31 studies that randomised approximately 1410 participants. Eight studies were at low risk of bias, 15 were at high risk of bias, and eight were unclear. Intervention versus observation For children (age 7 to 11 years), quad-helix was beneficial for posterior crossbite correction compared to observation (OR 50.59, 95% CI 26.77 to 95.60; 3 studies, 149 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 4.71 mm, 95% CI 4.31 to 5.10; 3 studies, 146 participants; moderate-certainty evidence). For children, expansion plates were also beneficial for posterior crossbite correction compared to observation (OR 25.26, 95% CI 13.08 to 48.77; 3 studies, 148 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 3.30 mm, 95% CI 2.88 to 3.73; 3 studies, 145 participants, 3 studies; moderate-certainty evidence). In addition, expansion plates resulted in higher inter-canine distances (MD 2.59 mm, 95% CI 2.18 to 3.01; 3 studies, 145 participants; moderate-certainty evidence). The use of Hyrax is probably effective for correcting posterior crossbite compared to observation (OR 48.02, 95% CI 21.58 to 106.87; 93 participants, 3 studies; moderate-certainty evidence). Two of the studies focused on adolescents (age 12 to 16 years) and found that Hyrax increased the inter-molar distance compared with observation (MD 5.80, 95% CI 5.15 to 6.45; 2 studies, 72 participants; moderate-certainty evidence). Intervention A versus intervention B When comparing quad-helix with expansion plates in children, quad-helix was more effective for posterior crossbite correction (RR 1.29, 95% CI 1.13 to 1.46; 3 studies, 151 participants; moderate-certainty evidence), final inter-molar distance (MD 1.48 mm, 95% CI 0.91 mm to 2.04 mm; 3 studies, 151 participants; high-certainty evidence), inter-canine distance (0.59 mm higher (95% CI 0.09 mm to 1.08 mm; 3 studies, 151 participants; low-certainty evidence) and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and Haas for posterior crossbite correction (RR 1.05, 95% CI 0.94 to 1.18; 3 studies, 83 participants; moderate-certainty evidence) or inter-molar distance (MD -0.15 mm, 95% CI -0.86 mm to 0.56 mm; 2 studies of adolescents, 46 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and tooth-bone-borne expansion for crossbite correction (RR 1.02, 95% CI 0.92 to 1.12; I² = 0%; 3 studies, 120 participants; low-certainty evidence) or inter-molar distance (MD -0.66 mm, 95% CI -1.36 mm to 0.04 mm; I² = 0%; 2 studies, 65 participants; low-certainty evidence). There was no evidence of a difference between Hyrax with bone-borne expansion for posterior crossbite correction (RR 1.00, 95% CI 0.94 to 1.07; I² = 0%; 2 studies of adolescents, 81 participants; low-certainty evidence) or inter-molar distance (MD -0.14 mm, 95% CI -0.85 mm to 0.57 mm; I² = 0%; 2 studies, 81 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: For children in the early mixed dentition stage (age 7 to 11 years old), quad-helix and expansion plates are more beneficial than no treatment for correcting posterior crossbites. Expansion plates also increase the inter-canine distance. Quad-helix is more effective than expansion plates for correcting posterior crossbite and increasing inter-molar distance. Treatment duration is shorter with quad-helix than expansion plates. For adolescents in permanent dentition (age 12 to 16 years old), Hyrax and Haas are similar for posterior crossbite correction and increasing the inter-molar distance. The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.
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Affiliation(s)
- Alessandro Ugolini
- Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Paola Agostino
- Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
| | | | - Jayne E Harrison
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Klaus Bsl Batista
- Department of Preventive and Public Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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CBCT Comparison of Dentoskeletal Effects of Haas-Type and Hyrax-Type Expanders Using Deciduous Teeth as Anchorage: A Randomized Clinical Trial. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11157110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to compare the three-dimensional dentoskeletal effects of Haas-type and Hyrax-type expanders using primary teeth as anchorage for rapid palatal expansion (RPE). Thirty-four subjects in mixed dentition were divided according to their expander’s type: Hyrax (n = 16; 6F, 10M; mean age 8 ± 3 years) or Haas (n = 18; 14F, 4M; mean age 8 ± 2 years). Each patient underwent CBCTs before (T0) and after RPE (T1). Dentoskeletal changes were collected. A paired sample t-test and independent t-test were used to compare each variable within the same group and between groups, respectively, with a 5% significance. The Hyrax group showed an increase in all dentoskeletal parameters; skeletal expansion was significantly increased anteriorly (1.76 mm) and posteriorly (1.93 mm). The greatest dental expansion was observed in the anchorage unit (6.47 mm), about twice as much as permanent molars (3.42 mm). The same statistical significance of Haas group measurements was observed; anteriorly skeletal expansion (2.97 mm) was greater than posteriorly (1.93 mm) and dental expansion was greater on anchored teeth (6.80 mm) than non-anchored teeth (4.57 mm). No statistical significance was observed between Hyrax and Hass groups. CBCT analysis showed that, in RPE, the dental expansion was greater than skeletal expansion. No significant or clinical changes were observed between Hyrax and Haas appliances anchored to primary teeth.
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Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. Eur J Orthod 2021; 43:283-292. [PMID: 33564835 DOI: 10.1093/ejo/cjab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six growing subjects (10-16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. RESULTS Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: -45.8%, HH: -75.5%, K: -63.2%) and velocity (H: -30%, HH: -58.5%, K: -35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. CONCLUSIONS RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. LIMITATION Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. HARMS Replacement of blocked Keles expanders for finalizing treatment. PROTOCOL The protocol was not published before the trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
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14
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Fastuca R, Beccarini T, Rossi O, Zecca PA, Caprioglio A. Influence of facial components in class III malocclusion esthetic perception of orthodontists, patients, and laypersons. J Orofac Orthop 2021; 83:48-58. [PMID: 33929556 DOI: 10.1007/s00056-021-00287-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the present study was to investigate the influence of different facial components (face length, lip volume, nose size, and cheekbone contour) on the perception of facial attractiveness of patients with Angle class III malocclusion in different categories of responders (orthodontists, laypersons, patients) with two-dimensional (2D) and three-dimensional (3D) simulations. METHODS An ideal standard 3D face was manipulated to create a class III facial malocclusion. Four facial components were modified (face length, lip volume, nose size and cheekbone contour) and the resulting simulations were used to obtain 2D figures and 3D videos, which were evaluated in a survey by orthodontists, patients, and laypersons. RESULTS No significant differences were detected between the 2D figures and 3D video simulations. Good correspondence was shown between the three categories of responders for the most and the least attractive faces. Smaller lips and bigger nose, regardless to the vertical dimension (short or long face), were found to be the least attractive features with agreement of all respondents. CONCLUSION Regarding class III facial attractiveness perception, the sum of all facial features and not the alteration of a single component alone seems to play a key role in the perception of facial attractiveness. The 2D or 3D perspective did not play a significant role in perception and the analyzed categories of responders did not show significant differences when perceiving facial attractiveness of the utilized simulations.
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Affiliation(s)
- Rosamaria Fastuca
- Research Fellow, Department of Medicine and Surgery, University of Insubria, Varese, Italy. .,C/O Dental School, Via G. Piatti, 10, 21100, Velate (Va), Italy.
| | | | - Ornella Rossi
- Resident, Orthodontic Program, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Condylar Changes in Children with Posterior Crossbite after Maxillary Expansion: Tridimensional Evaluation. CHILDREN-BASEL 2021; 8:children8010038. [PMID: 33440762 PMCID: PMC7827353 DOI: 10.3390/children8010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: To investigate condylar position in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through 3D analysis; (2) Methods: Thirty-two Caucasian patients (14 males, mean age 8 y 8 m ± 1 y 2 m; 18 females mean age 8 y 2 m ± 1 y 4 m) with functional posterior crossbite (FPXB) diagnosis underwent rapid palatal expansion with a Haas appliance banded on second deciduous upper molars. Patients’ underwent CBCT scans before rapid palatal expansion (T0) and after 12 months (T1). The images were processed through 3D slicer software; (3) Results: The condylar position changes between T1 and T0 among the crossbite and non-crossbite sides were not statistically significant, except for the transversal axis. At T1, the condyles moved forward (y axis) and laterally (x axis), they also moved downward (z axis) but not significantly; (4) Conclusions: Condilar position in growing patients with functional posterior crossbite did not change significantly after rapid maxillary expansion.
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Yu TT, Li J, Liu DW. Seven-year follow-up of the nonsurgical expansion of maxillary and mandibular arches in a young adult: A case report. World J Clin Cases 2020; 8:5371-5379. [PMID: 33269272 PMCID: PMC7674729 DOI: 10.12998/wjcc.v8.i21.5371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/28/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Palatal expansion treatment has been used to expand the constricted maxillary arch and has become a routine procedure in orthodontic practice over the past decades. However, the long-term stability of expansion in the permanent dentition without a surgical approach is uncertain.
CASE SUMMARY We present the case of a 15-year-old boy with Class II malocclusion and constricted arches. The patient was treated with rapid palatal expansion (RPE) followed by a fixed orthodontic appliance. A 7-year follow-up evaluation was performed by analyzing cephalometric radiographs, plaster models, and photographs. The patient’s constricted maxillary and mandibular arches were relived after the expansion treatment. A Class I occlusion and normal arch form were established and maintained in the long-term.
CONCLUSION RPE treatment is successful in solving constricted dental arch in the permanent dentition without a surgical approach. Permanent retention and even occlusal contact help prevent long-term relapse.
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Affiliation(s)
- Ting-Ting Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jing Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Da-Wei Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Lo Giudice A, Ronsivalle V, Grippaudo C, Lucchese A, Muraglie S, Lagravère MO, Isola G. One Step before 3D Printing-Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandible: A Comparative Study Using a Surface-to-Surface Matching Technique. MATERIALS 2020; 13:ma13122798. [PMID: 32575875 PMCID: PMC7345160 DOI: 10.3390/ma13122798] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/10/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four different types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate differences in mandibular volumetric recordings and for a deviation analysis among the different software types used. Linear regression was also performed between manual and semi-automatic methods. No significant differences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm3, ITK-Snap = 40.81 cm3, Invesalius = 40.04 cm3, Dolphin 3D = 42.03 cm3, Slicer 3D = 40.58 cm3). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coefficients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p < 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing).
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Policlinico Universitario “Vittorio Emanuele—G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (S.M.)
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Policlinico Universitario “Vittorio Emanuele—G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (S.M.)
| | - Cristina Grippaudo
- Department of Orthodontics, University of Sacred Heart of Rome, 00168 Rome, Italy;
| | - Alessandra Lucchese
- Department of Orthodontics, Vita-Salute San Raffaele University, 10,090 Milan, Italy;
| | - Simone Muraglie
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Policlinico Universitario “Vittorio Emanuele—G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (S.M.)
| | - Manuel O. Lagravère
- Orthodontic Graduate Program, ECHA 5-524, Faculty of Medicine and Dentistry, University of Alberta, 11405-87 Ave, Edmonton, AB T6G1Z1, Canada;
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Policlinico Universitario “Vittorio Emanuele—G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy; (A.L.G.); (V.R.); (S.M.)
- Correspondence: ; Tel.: +39-0953-782-453
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Portelli M, Militi A, Lo Giudice A, Lo Giudice R, Rustico L, Fastuca R, Nucera R. 3D Assessment of Endodontic Lesions with a Low-Dose CBCT Protocol. Dent J (Basel) 2020; 8:dj8020051. [PMID: 32414199 PMCID: PMC7345315 DOI: 10.3390/dj8020051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Cone beam computed tomography (CBCT) is often used in different fields of dental science, especially in complex anatomical districts like the endodontic one. The aim of this study is to propose a low-dose CBCT protocol useful in cases of endodontic lesions. Methods: The device used was a MyRay Hyperion X9-11x5; the low dose setting of the machine was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. The absorbed organ doses have been evaluated with an anthropomorphic phantom loaded with thermoluminescent dosimeters positioned at the level of sensitive organs like brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, and lymph nodes. Equivalent and effective doses have been calculated; the last one has been calculated using the recommendations approved by the Main Commission of ICRP (International Commission Radiological Protection) in March 2007. For the assessment of image quality, five senior clinicians, independent and experienced clinicians, were asked to state if CBCT scans were accurate enough to assess endodontic lesions. Results: The use of a low-dose CBCT acquisition produced the lowest organ dose (5.01 microSv) at the level of the esophagus. Image quality has been considered accurate enough for endodontic diagnostic needs. Conclusions: CBCT low-dose protocol can be used over the standard one in endodontic special cases because it provides a significantly lower radiation dose to the patients while ensuring good image quality. However, further studies are necessary to evaluate the opportunity of low-dose CBCT exams in endodontic clinical practice.
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Affiliation(s)
- Marco Portelli
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
- Correspondence: ; Tel.: +0039090/2216910; Fax: +0039090/2216911
| | - Angela Militi
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Antonino Lo Giudice
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Roberto Lo Giudice
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Lorenzo Rustico
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Rosamaria Fastuca
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy;
| | - Riccardo Nucera
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
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Niu X, Di Carlo G, Cornelis MA, Cattaneo PM. Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res 2020; 23:250-276. [PMID: 32248642 DOI: 10.1111/ocr.12378] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The purpose of this systematic review was to evaluate the three-dimensional (3D) changes occurring at short- and long-term follow-up after rapid maxillary expansion (RME) in nasal cavity (NC) and upper airway (UA) in growing patients. METHODS A literature search up to 1 July 2019 was performed. Randomized and non-randomized clinical trials and cohort studies comparing the effects of RME in a paediatric population using 3D analyses based on computed tomography (CT), cone-beam CT and MRI were included. The risks of bias of the included studies were assessed using the Cochrane Collaboration's risk of bias tool, the GRADE approach and a customized tool. The random-effects meta-analyses of the mean differences and 95% confidence intervals of NC and UA volume changes were carried out, followed by subgroup analyses. RESULTS Twenty-seven studies were included, with 18 selected for quantitative synthesis. Immediately after expansion, the nasopharynx and oropharynx increased significantly. After 3 months of retention, only the NC and nasopharynx showed a significant volume increase. Two studies mentioned the use of a sleep-disordered breathing questionnaire, and one study reported the difference before and after RME. None of the 27 articles included assessed the correlation between the skeletal widening and NC or UA volume changes after RME. CONCLUSIONS The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.
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Affiliation(s)
- Xiaowen Niu
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Gabriele Di Carlo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Department of Oral and Maxillofacial Sciences, Unit of Pediatric Dentistry, Sapienza University of Rome, Rome, Italy
| | - Marie A Cornelis
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Paolo M Cattaneo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
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Correlation between Caries, Body Mass Index and Occlusion in an Italian Pediatric Patients Sample: A Transverse Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17092994. [PMID: 32357403 PMCID: PMC7246709 DOI: 10.3390/ijerph17092994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between caries, body mass index (BMI) and occlusion in a sample of pediatric patients. METHODS The study group included 127 patients (72 female, 55 male) aged between 6 and 16 years (mean age 10.2) and selected between January and June 2019 at the Department of Pediatric Dentistry, University of Messina. Caries incidence was evaluated using the decayed, missing and filled teeth (DMFT) index. On the basis of BMI values, using a table adjusted for age and gender, patients were grouped into four categories (underweight, normal weight, risk of overweight, overweight). RESULTS There was no significant correlation between BMI and DMFT in the whole sample. The study of the correlation between BMI and DMFT in patients with different types of malocclusion showed a significant inverse correlation for patients affected by II class and deepbite malocclusion. CONCLUSIONS The incidence of caries does not seem to be significantly related to BMI and occlusal patterns, but it decreases with increasing age.
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Caprioglio A, Castiglioni F, Sambataro S, Giuntini V, Comaglio I, Lorvetti F, Fastuca R. Changes in canine inclination after rapid and slow maxillary expansion compared to untreated controls. Orthod Craniofac Res 2020; 23:351-356. [PMID: 32248634 DOI: 10.1111/ocr.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 12/14/2022]
Abstract
OBJECTS Palatally displaced canines (PDC) might represent condition causing several clinical problems, such as roots resorption and malocclusion, and can develop palatal canine impaction. Some interceptive treatments such as rapid maxillary expansion were suggested in order to foster maxillary canine eruption. Among expansion protocols, no data are available about differences between rapid and slow maxillary expansion on maxillary canine eruption. The aim of this study was therefore to evaluate α-angle changes in palatally displaced canines using rapid and slow maxillary expansion compared to untreated control patients. SETTING AND SAMPLE POPULATION The final sample comprised 19 patients treated with rapid maxillary expansion (RME group), 17 treated with slow maxillary expansion (SME group) and 22 control patients (Control group). MATERIALS AND METHODS α-angle was measured on panoramic films to detect canine inclination at the beginning, and at the end of maxillary expansion treatment or observation, time and changes over time were compared. RESULTS In the comparisons among groups, RME group was the only group showing a decrease in α-angle measurements that was statistically significant also when compared to the other groups, except for the left side when compared to SME group. CONCLUSION RME treatment significantly and positively affected canine position when compared to SME treatment and control group.
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Affiliation(s)
- Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ilaria Comaglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Rosamaria Fastuca
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Fastuca R, Michelotti A, Nucera R, D’Antò V, Militi A, Logiudice A, Caprioglio A, Portelli M. Midpalatal Suture Density Evaluation after Rapid and Slow Maxillary Expansion with a Low-Dose CT Protocol: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E112. [PMID: 32150850 PMCID: PMC7143279 DOI: 10.3390/medicina56030112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 ± 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.
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Affiliation(s)
- Rosamaria Fastuca
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy; (R.F.); (A.C.)
| | - Ambra Michelotti
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy;
| | - Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Vincenzo D’Antò
- School of Orthodontics, University of Naples, 80131 Naples, Italy;
| | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Antonino Logiudice
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Alberto Caprioglio
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy; (R.F.); (A.C.)
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
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Sayar G, Kılınç DD. Rapid maxillary expansion outcomes according to midpalatal suture maturation levels. Prog Orthod 2019; 20:27. [PMID: 31304569 PMCID: PMC6626764 DOI: 10.1186/s40510-019-0278-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aims to compare the relationship between skeletal and dental outcomes of rapid maxillary expansion (RME) treatment on cone beam computed tomography (CBCT) images between pre-pubertal peak (pre-peak) and post-pubertal peak (post-peak) patients. The null hypothesis was that there was no difference in the outcomes of RME treatment between the groups. METHODS Thirty-two patients who underwent RME treatment were classified according to midpalatal suture maturation levels and then divided into two groups as pre-peak and post-peak. Skeletal and dental measurements were performed on the CBCT images at T0 (pre-treatment stage) and at T1 (post-treatment stage). Paired sample t test was used to evaluate normally distributed data and P < 0.05 was taken as the significance level. RESULTS There were significant differences between T0 and T1 within the groups, but the changes between the pre-peak and post-peak patient groups were not statistically significant. CONCLUSION Non-significant changes were found between the two groups, and the null hypothesis was excepted.
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Affiliation(s)
- Gülşilay Sayar
- Department of Orthodontics, School of Dentistry, Istanbul Medipol University, Atatürk Bulvarı No: 27, 34083, Unkapanı-Fatih/Istanbul, Turkey.
| | - Delal Dara Kılınç
- Department of Orthodontics, School of Dental Medicine, Bahçeşehir University, Istanbul, Turkey
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Lagravère MO, Zecca PA, Caprioglio A, Fastuca R. Metabolic effects of treatment in patients with obstructive sleep apnea: a systematic review. Minerva Pediatr 2019; 71:380-389. [DOI: 10.23736/s0026-4946.18.05223-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Staderini E, Patini R, De Luca M, Gallenzi P. Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials. ACTA OTORHINOLARYNGOLOGICA ITALICA 2019; 38:399-408. [PMID: 30498268 PMCID: PMC6265666 DOI: 10.14639/0392-100x-2059] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to analyse the quality and clinical evidence in the literature analysing, through 3D stereophotogrammetry, the nasolabial soft tissue modifications that may occur after rapid maxillary expansion (RME). This systematic literature review was based on the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: CRD42017079875. Pubmed, Cochrane, EBSCO, Scopus, Web of Science databases were searched with no restriction of year or publication status. Selection criteria were: randomised clinical trials, controlled clinical trials, cohort studies, cross-sectional studies, case-control studies on patients with unilateral/bilateral crossbite, transverse maxillary deficiency and crowding, treated with RME and monitored by 3D stereophotogrammetry. 652 articles were retrieved in the initial search. After the review process, 11 full-text articles met inclusion criteria. After the evaluation process, 4 publications were included for the present literature review. Due to the heterogeneous methodology meta-analysis was not possible; consequently, a systematic assessment of the studies and summary of the findings from the available evidence were used to answer the research question. The maximum widening of the alar cartilage is 1.41 ± 0.95 mm, whose clinical significance is open to question. The effect of RME on the mouth width remains controversial. In Altindis et al., the difference between pre-treatment and post-treatment mouth width (1.80 mm increment in the banded RME group) was statistically significant, while in Baysal 1.86 mm was considered a non-significant value. Inconsistencies and limitations in the study population and measurement protocols were detected between studies. These data underline the necessity for updated guidelines that allow to standardise, for this type of study, sample selection, measurement methods and collection of results.
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Affiliation(s)
- E Staderini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Institute of Dentistry and Maxillofacial Surgery, Rome, Italy
| | - R Patini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Institute of Dentistry and Maxillofacial Surgery, Rome, Italy
| | - M De Luca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Institute of Dentistry and Maxillofacial Surgery, Rome, Italy
| | - P Gallenzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica del Sacro Cuore, Institute of Dentistry and Maxillofacial Surgery, Rome, Italy
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Caprioglio A, Comaglio I, Siani L, Fastuca R. Effects of impaction severity of treated palatally displaced canines on periodontal outcomes: a retrospective study. Prog Orthod 2019; 20:5. [PMID: 30714076 PMCID: PMC6361313 DOI: 10.1186/s40510-018-0256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/19/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Even though periodontal health was suggested to be not related to the traction technique, some other variables might influence the esthetic outcome of palatally displaced canines (PDC) when aligned, such as the initial position and impaction rate of the canine before treatment. The purpose of the present study was therefore to evaluate the existing correlations between periodontal health outcome of PDC after their exposure and alignment and their initial position identified according to the different rates of impaction severity. MATERIALS AND METHODS The final sample enrolled 293 PDC which satisfied inclusion and exclusion criteria. All the canines were exposed using CT by the same oral surgeon and orthodontic traction was applied using the easy cuspid device followed by fixed appliance treatment. Image analysis and periodontal status evaluation were performed for all PDCs. RESULTS α-Angle and d-distance showed no significant differences in the periodontal outcome of PDCs after treatment. The only tested variable showing significant differences was S, since canines with CEJ visible at the end of the treatment presented sectors with a mean score of 1.67, which was significantly different (P < 0.05) when compared to the S-sector for the canines that showed PD < 2 mm at the end of the treatment. CONCLUSIONS Radiographic variables as α-Angle and d-distance seem to not influence the periodontal outcome of the treated impacted canine regardless of the amount of gravity. On the contrary, S-sector might play a significant role when higher rates of gravity are present suggesting the possibility in few cases for periodontal damage at the end of treatment.
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Affiliation(s)
- Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ilaria Comaglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy. .,C/O Dental School, Via G. Piatti, 10, 21100, Messina, Velate (VA), Italy.
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Digregorio MV, Fastuca R, Zecca PA, Caprioglio A, Lagravère MO. Buccal bone plate thickness after rapid maxillary expansion in mixed and permanent dentitions. Am J Orthod Dentofacial Orthop 2019; 155:198-206. [DOI: 10.1016/j.ajodo.2018.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 01/04/2023]
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Fastuca R, Campobasso A, Zecca PA, Caprioglio A. 3D facial soft tissue changes after rapid maxillary expansion on primary teeth: A randomized clinical trial. Orthod Craniofac Res 2018; 21:140-145. [PMID: 29927048 DOI: 10.1111/ocr.12229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the present randomized controlled trial (RCT) was therefore the tridimensional evaluation of soft tissue changes after rapid maxillary expansion in growing patients. SETTING AND SAMPLE POPULATION Treated group comprised 17 patients (10 males and 7 females) with a mean age of 9.8 ± 1.2 years, and control group comprised 17 patients (13 males and 4 females) with a mean age of 9.1 ± 2.1 years. MATERIAL & METHODS All patients of the treated group underwent maxillary expansion with Haas-type expander while patients of the control group underwent no treatment. 3D facial scans were acquired at T1, at the beginning of treatment or observation period, and at T2, 18 months apart. The mean interval between the timepoints was 18.2 ± 0.4 months. RESULTS The main differences between groups were reported in the nasal area. Nasal width (Alr-All) significantly increased in the treated group compared with the control. The increase in intereye and mouth width in the study group did not show differences with the control group. No significant differences were reported for lips' protrusion, angular measurements and facial heights between groups. The total nose volume difference was significantly higher in the treated group compared with control, and this result was related mainly to the significant increase in the nasal dorsum volume. CONCLUSION Maxillary expansion produced significant increase in the nasal base and nasal volumes, but its clinical relevance is still questionable.
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Affiliation(s)
- R Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
| | - A Campobasso
- Division of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - P A Zecca
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - A Caprioglio
- Departmet of Medicine and Surgery, University of Insubria, Varese, Italy
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Early Orthopaedic Treatment of Hemifacial Microsomia. Case Rep Dent 2018; 2017:7318715. [PMID: 29387494 PMCID: PMC5745710 DOI: 10.1155/2017/7318715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/01/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to report treatment effects of functional therapy in a growing patient affected by hemifacial microsomia (HM). According to Kaban's classification, the patient was classified as grade IIa as she presented all mandibular and temporomandibular joint components and a normal shaped, hypoplastic mandible. The therapeutic approach included the use of an asymmetrical functional activator (AFA) to stimulate the growth of the affected side and consequently to improve symmetry of the mandible and maxillary deficiency. Further effects were the lengthening of the mandibular ramus, restoration of occlusion, and expansion of soft tissues.
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