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Rajkumar K, Walia BS, Viswambaran M, Ganesh V, Padmavati. Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite. J Maxillofac Oral Surg 2023; 22:900-907. [PMID: 38105837 PMCID: PMC10719231 DOI: 10.1007/s12663-022-01756-9] [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: 05/24/2021] [Accepted: 06/12/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.
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Affiliation(s)
- K. Rajkumar
- Oral and Maxillofacial Surgery, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - B. S. Walia
- Orthodontics & Dentofacial Orthopaedics, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - M. Viswambaran
- Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - V. Ganesh
- Fracktal Works Pvt Ltd, Bangalore, India
| | - Padmavati
- Sree Balaji Dental College and Hospital, Chennai, India
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2
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Tepedino M, Esposito R, Montaruli G, Monaco A, Chimenti C, Ciavarella D. Changes in hyoid bone and tongue position in Class I subjects after orthodontic treatment with rapid palatal expander. Cranio 2022:1-10. [PMID: 36101967 DOI: 10.1080/08869634.2022.2121015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate the effects of the rapid palatal expander (RPE) on the hyoid bone and tongue position in skeletal Class I patients, compared to control groups. METHODS Eighty-four Class I subjects, aged 6-14, were selected. Among these, 28 patients were treated with RPE, 28 with function-generating bite (FGB) appliance, and 28 were untreated. Lateral cephalograms taken before (T0) and after (T1) treatment were retrieved. Changes in the hyoid bone and tongue position were evaluated, and the area above the tongue was measured. RESULTS No significant difference in the hyoid and tongue posture was observed across the groups. However, there were significant differences for HC3 (distance from H-point to the third cervical vertebrae), H2H (distance from H-point to SN plane), and TT-Eb (tongue length) between T0 and T1 in all groups. CONCLUSION The results suggest that hyoid bone and tongue position changes were related to growth rather than treatment.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Annalisa Monaco
- Department of Health, Science and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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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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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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Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear. J Craniofac Surg 2020; 31:172-177. [DOI: 10.1097/scs.0000000000006197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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Stark TR, Pozo-Alonso M, Daniels R, Camacho M. Pediatric Considerations for Dental Sleep Medicine. Sleep Med Clin 2018; 13:531-548. [DOI: 10.1016/j.jsmc.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Benefits of Maxillary Expansion for a Patient With Spinal Muscular Atrophy Type 2. Am J Phys Med Rehabil 2018; 98:e32-e34. [PMID: 30138129 DOI: 10.1097/phm.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case report involves a 10-yr-old boy diagnosed with spinal muscular atrophy type 2 who underwent nighttime mechanical ventilation with bilevel positive airway pressure. The oral examination revealed restricted mouth opening, lip interposition, dental crowding, and maxillary compression. After maxillary expansion, the upper airway volume increased 18.6%; 13 episodes of airway infections (20 days of hospitalization) were recorded in the 2 yrs before the maxillary expansion and only 4 episodes (no hospital admissions) in the 2 subsequent years. In conclusion, maxillary expansion in children with systemic disease that involves respiratory impairment may, in some cases, provide functional and clinical improvements, increase upper airway airflows, and possibly decrease the number of respiratory infections.
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Giuliani A, Mazzoni S, Mangano C, Zecca PA, Caprioglio A, Vercellini N, Raspanti M, Mangano F, Piattelli A, Iezzi G, Fastuca R. Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography. BMC Oral Health 2018; 18:125. [PMID: 30045728 PMCID: PMC6060467 DOI: 10.1186/s12903-018-0590-7] [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: 03/22/2018] [Accepted: 07/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. Methods Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. Results In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. Conclusions The microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME. Electronic supplementary material The online version of this article (10.1186/s12903-018-0590-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra Giuliani
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy.
| | - Serena Mazzoni
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy
| | | | - Piero Antonio Zecca
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Nicolò Vercellini
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | | | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
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10
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Chardey EK, Fastuca R, Beretta M, Di Blasio A, Vercellini N, Caprioglio A, Zecca PA, Macchi A. Digital Dynamic 3D Monitoring of Lower Incisors Intrusion in Lingual Orthodontics. Open Dent J 2018; 12:104-117. [PMID: 29492176 PMCID: PMC5815052 DOI: 10.2174/1874210601812010104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots. Methods 9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch. Results The root displacement of the incisors during their intrusion in the early stage was totally "bone-safe" in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured. Conclusion This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.
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Affiliation(s)
- Elia Kodjo Chardey
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Di Blasio
- Department of Biotechnological, Biomedical and Translational Sciences, Section of Orthodontics, University of Parma, Parma, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Singh GD, Kraver M, Chernyshev O. Restoration of sleep using a novel biomimetic protocol for adult OSA: Clinical case report. Cranio 2018; 37:136-139. [PMID: 29448905 DOI: 10.1080/08869634.2018.1425235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A sleep study of a 56-year old male with excessive daytime sleepiness demonstrated an AHI of 16.4hr-1 with 13% of total sleep time in REM sleep and a mean oxygen desaturation (SpO2) of 86%. CLINICAL PRESENTATION On intra-oral examination, it was found that the patient had maxillary hypoplasia and bilateral torus mandibularis. A 3D cone-beam CT (CBCT) scan was taken, and 28 craniofacial parameters were measured. Surgical reduction of the mandibular tori followed by biomimetic oral appliance therapy (BOAT) was initiated. After 14 months, a post-treatment CBCT scan revealed that 70% of parameters measured had improved. Therefore, another sleep study was performed with no device in the mouth. This follow-up home sleep test demonstrated that the AHI fell to 5.3hr-1hr; with 27% REM sleep, and a mean SpO2 of 93% without any device in the mouth. CONCLUSION These findings suggest that BOAT might be able to restore sleep in certain adult cases.
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Affiliation(s)
- G Dave Singh
- a Vivos BioTechnologies, Inc. , Cedar Crest , NM , USA
| | | | - Oleg Chernyshev
- c Neurology and Sleep Medicine , Louisiana State University , Shreveport , LA , USA
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Lione R, Brunelli V, Franchi L, Pavoni C, Quiroga Souki B, Cozza P. Mandibular response after rapid maxillary expansion in class II growing patients: a pilot randomized controlled trial. Prog Orthod 2017; 18:36. [PMID: 29105023 PMCID: PMC5673058 DOI: 10.1186/s40510-017-0189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this pilot randomized controlled trial (RCT) was to evaluate the sagittal mandibular response induced by rapid maxillary expansion (RME) therapy in mixed dentition patients with class II malocclusion, comparing the effects of bonded RME and banded RME with a matched untreated class II control group. Methods This RCT was designed in parallel with an allocation ratio of 1:1:1. The sample consisted of 30 children with a mean age of 8.1 ± 0.6 years who were randomly assigned to three groups: group 1 treated with bonded RME, group 2 treated with banded RME, and group 3 the untreated control group. All patients met the following inclusion criteria: early mixed dentition, class II molar relationship, transverse discrepancy ≥ 4 mm, overjet ≥ 5 mm, and prepubertal skeletal maturity stage (CS1–CS2). The expansion screw was activated one quarter of a turn per day (0.25 mm) until overcorrection was reached. For each subject, lateral cephalograms and plaster casts were obtained before treatment (T1) and after 1 year (T2). A randomization list was created for the group assignment, with an allocation ratio of 1:1:1. The observer who performed all the measurements was blinded to group assignment. The study was single-blinded in regard to statistical analysis. Results RME was effective in the correction of maxillary deficiency. Class II patients treated with both types of RME showed no significant improvement of the anteroposterior relationship of the maxilla and the mandible at both skeletal and occlusal levels. The acrylic splint RME had significant effects on reducing the skeletal vertical dimension and the gonial angle. Conclusions The orthopedic expansion did not affect the sagittal relationship of class II patients treated in the early mixed dentition when compared with the untreated control group. Additional studies with a larger sample are warranted to elucidate individual variations in dento-skeletal mandibular response to the maxillary expansion protocol in class-II-growing patients. Trial registration ClinicalTrials.govNCT03159962.
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Affiliation(s)
- Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy. .,Department of Dentistry UNSBC, Tirana, Albania.
| | - Valerio Brunelli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.,Department of Dentistry UNSBC, Tirana, Albania
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.,Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - Chiara Pavoni
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.,Department of Dentistry UNSBC, Tirana, Albania
| | - Bernardo Quiroga Souki
- School of Dentistry, Orthodontics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.,Department of Dentistry UNSBC, Tirana, Albania
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Fastuca R, Lorusso P, Lagravère MO, Michelotti A, Portelli M, Zecca PA, D’ Antò V, Militi A, Nucera R, Caprioglio A. Digital evaluation of nasal changes induced by rapid maxillary expansion with different anchorage and appliance design. BMC Oral Health 2017; 17:113. [PMID: 28705206 PMCID: PMC5513127 DOI: 10.1186/s12903-017-0404-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/04/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Scientific evidence showed that rapid maxillary expansion (RME) affects naso-maxillary complex, increasing nasal width and volume. This study aimed to evaluate nasal changes induced by rapid maxillary expansion with different anchorage and appliance design by using low dose and cone beam computed tomography. METHODS A total of 44 patients (20 males, mean age 8y 8 m ± 1y 2 m; 24 females mean age 8y 2 m ± 1y 4 m) were included in the investigation and divided into three groups according to the appliance: Hyrax-type expander anchored to permanent teeth, modified Hyrax-type expander anchored to deciduous teeth, modified Haas-type expander anchored to deciduous teeth. Maxillary expansion was performed until overcorrection and the expander was passively kept in situ for 7 months at least. All patients had three-dimensional imaging before expansion (T0) and after the retention period (T1). Nasal floor width, nasal wall width, maxillary inter-molar width were measured by means of Mimics software. The paired sample t-test was employed to assess the significance of the differences between the time points; the analysis of variance test (ANOVA) was used to compare differences between groups. RESULTS The statistical analysis revealed significant differences between T0 and T1 for each recorded measurement in each group; no significant differences were found by comparing groups. CONCLUSIONS Rapid maxillary expansion produces a significant skeletal transverse expansion of nasal region in growing patients. No significant differences in nasal effects are expected when the appliance is anchored onto deciduous teeth, with or without the palatal acrylic coverage.
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Affiliation(s)
- Rosamaria Fastuca
- Department of Surgical and Morphological Sciences, University of Messina, Via Consolare Valeria 1, Messina, Italy
- C/O Dental School, Via G. Piatti, 10, 21100 Velate, VA Italy
| | - Paola Lorusso
- Private Practice in Orthodontics, Bari, Italy
- Research Fellow, University of insubria, Via G. Piatti, 10 Varese, Italy
| | - Manuel O Lagravère
- Department of Dentistry, University of Alberta, 11400 University Avenue, Edmonton, AB Canada
| | - Ambra Michelotti
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, Naples, Italy
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Via G. Piatti, 10 Varese, Italy
| | | | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, Via G. Piatti, 10 Varese, Italy
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Asymmetric Expansion with a Modified Quad Helix for Treatment of Isolated Crossbite. Case Rep Dent 2017; 2017:7275846. [PMID: 28589044 PMCID: PMC5446872 DOI: 10.1155/2017/7275846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/24/2017] [Indexed: 12/05/2022] Open
Abstract
Unilateral posterior crossbite often involves only one tooth, especially upper first molar; in these cases it is never easy to obtain an asymmetrical movement of a molar and a proper planning of the orthodontic device with its anchorage is necessary to avoid arch overexpansion. Thanks to its simplicity and efficacy, the modified Quad Helix here described represents a valid therapeutic tool in cases of isolated posterior crossbite.
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Cephalometric changes in growing patients with increased vertical dimension treated with cervical headgear. J Orofac Orthop 2017; 78:312-320. [DOI: 10.1007/s00056-017-0087-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/04/2017] [Indexed: 10/19/2022]
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Caprioglio A, Bergamini C, Franchi L, Vercellini N, Zecca PA, Nucera R, Fastuca R. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition. Prog Orthod 2017; 18:9. [PMID: 28367605 PMCID: PMC5376539 DOI: 10.1186/s40510-017-0163-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to identify cephalometric pretreatment parameters for prediction of Class II improvement induced by rapid maxillary expansion. METHODS Lateral cephalograms of 30 patients (mean age 8.3 ± 1.6 years old) showing Class II molar relationship and undergone to rapid maxillary expansion on the upper deciduous molars were traced before treatment, and molar relation changes were evaluated on dental casts before and after treatment. Overall treatment time lasted 10.2 ± 2 months. Good responders (18 subjects, 10 females and 8 males) showed improvement of at least 2.50 mm, and bad responders (12 subjects, 7 females and 5 males) showed no improvement, improvement less than 2.50 mm, or worsening of molar relationship after treatment. Student's t test was used to assess significance of differences between groups, and discriminant analysis allowed identification of predictive pretreatment variables. RESULTS Articular angle, superior gonial angle, and mandibular dimensions (Co-Gn, S-Ar, Ar-Go, Go-Me) showed significant differences in the comparison between groups. Mandibular length Co-Gn and superior gonial angle were selected as significant predictive variable for discrimination. CONCLUSIONS Patients with smaller mandibular length and more acute superior gonial angle are expected to have more chances to improve molar Class II after rapid maxillary expansion.
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Affiliation(s)
- Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Chiara Bergamini
- Division of Orthodontics, Department of Surgical and Morphological Sciences, Orthodontic Programme, School of Medicine, University of Insubria, Varese, Italy
| | - Lorenzo Franchi
- Division of Dentistry, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Riccardo Nucera
- Division of Orthodontics, Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy. .,C/O Dental School, Via G. Piatti, 10, Velate, 21100, Varese, Italy.
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Alsufyani NA, Noga ML, Witmans M, Major PW. Upper airway imaging in sleep-disordered breathing: role of cone-beam computed tomography. Oral Radiol 2017. [DOI: 10.1007/s11282-017-0280-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Caprioglio A, Fastuca R, Zecca PA, Beretta M, Mangano C, Piattelli A, Macchi A, Iezzi G. Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report. Int J Mol Sci 2017; 18:ijms18030615. [PMID: 28287481 PMCID: PMC5372631 DOI: 10.3390/ijms18030615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022] Open
Abstract
The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 ± 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing.
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Affiliation(s)
- Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, 98100 Messina, Italy.
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Carlo Mangano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
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Fastuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod 2017; 85:955-61. [PMID: 26516709 DOI: 10.2319/072014-504.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate changes in airway volumes and respiratory performance in patients undergoing rapid maxillary expansion and determine whether any correlations exist between the morphological and respiratory functional modifications induced by rapid maxillary expansion and pretreatment airway stenosis. MATERIALS AND METHODS Fifteen patients (11 females and 4 males; mean age, 7.5 ± 0.3 years) were enrolled in the study. Each patient underwent cone beam computed tomography and polysomnography examination before rapid maxillary expansion and after the removal of the maxillary expander 12 months later. The airway regions were segmented and the volumes were computed. RESULTS The upper, middle, and lower airway volumes were significantly increased 2305 mm(3), 1144 mm(3), and 1915 mm(3), respectively. Similarly, oxygen saturation was increased (+5.3%) and the apnea/hypopnea index was improved (-4.2 events). All the observed modifications were statistically significant (P < .05). Baseline middle and lower airway volume showed a significant negative correlation with the oxygen saturation modification. CONCLUSIONS The results of this study showed that when rapid maxillary expansion is performed in subjects having posterior crossbite, oxygen saturation is improved. The improvement is greater in subjects having more reduced middle and lower airway volumes.
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Affiliation(s)
- Rosamaria Fastuca
- a Resident, Postgraduate Orthodontic Program, University of Insubria, Varese, Italy
| | - Giuseppe Perinetti
- b Research Fellow, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Piero Antonio Zecca
- c Research Fellow, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Riccardo Nucera
- d Assistant Professor, Department of Surgical and Dental Sciences, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Alberto Caprioglio
- e Associate Professor and Chairperson, Orthodontic Program, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Caprioglio A, Fastuca R. [Etiology and treatment options of anterior open bite in growing patients: a narrative review]. Orthod Fr 2016; 87:467-477. [PMID: 27938658 DOI: 10.1051/orthodfr/2016038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Anterior open bite represents a malocclusion that is still under study because of the still lacking evidence about etiology and best treatment options in growing subjects according to success rate and stability. Etiology involves the interaction of environmental factors such as prolonged sucking habits, mouth breathing, tongue or lip thrusting, tongue dimension, eruption disturbances with a genetically determined vertical facial growth pattern. The treatment options for the early treatment of anterior open bite are still controversial. OBJECTIVES The aim of this study was to evaluate the actual available evidence on treatments of anterior open bite in the mixed dentition in order to assess the effectiveness of the early treatment in reducing open bite, the most efficacious treatment strategy and the stability of the results.
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Affiliation(s)
- Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
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Manni A, Pasini M, Giuca MR, Morganti R, Cozzani M. A retrospective cephalometric study on pharyngeal airway space changes after rapid palatal expansion and Herbst appliance with or without skeletal anchorage. Prog Orthod 2016; 17:29. [PMID: 27641421 PMCID: PMC5035718 DOI: 10.1186/s40510-016-0141-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study is to investigate the pharyngeal airway space changes in patients treated with rapid palatal expansion (RPE) and Herbst appliance with or without skeletal anchorage. Methods A 40-patient study group treated with the Herbst RME combination was included; moreover, a comparison between two subgroups based on whether miniscrews were used was evaluated. A subgroup 1 included 20 patients who were treated with RPE and an acrylic splint Herbst with miniscrews, and subgroup 2 included 20 patients who were treated with RPE and an acrylic splint Herbst. A cephalometric analysis was performed before (T1) and after (T2) treatment. The skeletal parameters of the sagittal occlusion analysis of Pancherz were utilized together with some extra measurements to evaluate the airways. Results An increased nasopharyngeal airway space was observed in group 1 (p < 0.05) from T1 to T2. Furthermore, the increase in nasopharyngeal airway space was significantly higher in subgroup 1 (p < 0.05) in comparison to the subgroup 2. Oropharyngeal (OA) and laryngopharyngeal (LA) dimensions were significantly increased in the subgroup 1 at the end of the treatment. In the subgroup 1, a significant decrease in SNA, a significant increase in SNB, and a significant decrease in ANB were observed from T1 to T2. In the subgroup 2, the treatment resulted in a significant decrease in ANB. In both groups, Pogonion increased significantly from T1 to T2. Conclusions The results suggest that the RPE and the Herbst appliance allow a slight improvement of the sagittal dimensions of the airways. The oropharyngeal dimension increased significantly more in the skeletal anchorage group.
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Affiliation(s)
| | - Marco Pasini
- Department of Surgical, Medical and Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy. .,, Viale Roma 213, Massa, Massa-Carrara, 54100, Italy.
| | - Maria Rita Giuca
- Department of Surgical, Medical and Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Oncology, Transplants and New Technologies, University of Pisa, Pisa, Italy
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Pisani L, Bonaccorso L, Fastuca R, Spena R, Lombardo L, Caprioglio A. Systematic review for orthodontic and orthopedic treatments for anterior open bite in the mixed dentition. Prog Orthod 2016; 17:28. [PMID: 27615261 PMCID: PMC5027197 DOI: 10.1186/s40510-016-0142-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/24/2016] [Indexed: 02/07/2023] Open
Abstract
Background The treatment options for the early treatment of anterior open bite are still controversial. The aim of this study was to evaluate the actual available evidence on treatments of anterior open bite in the mixed dentition in order to assess the effectiveness of the early treatment in reducing open bite, the most efficacious treatment strategy and the stability of the results. Materials and methods A literature survey was done on November 15, 2015, by means of appropriate Medical Subject Headings (MeSH) using the following databases: PubMed, EMBASE, Cochrane Library, LILACS, VHL, and WEB OF SCIENCE. Randomized clinical trials and studies with a control group (treated or untreated) were then selected by two authors. Trials including patients with syndromes or in the permanent dentition and studies concerning treatment with extractions, full-fixed appliances, or surgery were not considered. Full articles were retrieved for abstracts or titles that met the initial inclusion criteria or lacked sufficient detail for immediate exclusion. Results Two thousand five hundred sixty-nine studies about open bite were available; the search strategy selected 240 of them. Twenty-four articles have been judged suitably for the final review, and their relevant data were analyzed. Discussion Although this review confirms the effectiveness of early treatment of open bite, particularly when no-compliance strategies are employed, meta-analysis was unfeasible due to lack of standardization, important methodological limitations, and shortcomings of the studies. Conclusions A more robust approach to trial design in terms of methodology and error analysis is needed. Besides, more studies with longer periods of follow-up are required.
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Affiliation(s)
- Lucia Pisani
- Division of Orthodontics, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
| | - Laura Bonaccorso
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Rosamaria Fastuca
- Division of Orthodontics, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Raffaele Spena
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Upper Airway Changes after Orthodontic Extraction Treatment in Adults: A Preliminary Study using Cone Beam Computed Tomography. PLoS One 2015; 10:e0143233. [PMID: 26588714 PMCID: PMC4654558 DOI: 10.1371/journal.pone.0143233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Whether the orthodontic treatment with premolar extraction and maximum anchorage in adults will lead to a narrowed upper airway remains under debated. The study aims to investigate the airway changes after orthodontic extraction treatment in adult patients with Class II and hyperdivergent skeletal malocclusion. MATERIALS AND METHODS This retrospective study enrolled 18 adults with Class II and hyperdivergent skeletal malocclusion (5 males and 13 females, 24.1 ± 3.8 years of age, BMI 20.33 ± 1.77 kg/m2). And 18 untreated controls were matched 1:1 with the treated patients for age, sex, BMI, and skeletal pattern. CBCT images before and after treatment were obtained. DOLPHIN 11.7 software was used to reconstruct and measure the airway size, hyoid position, and craniofacial structures. Changes in the airway and craniofacial parameters from pre to post treatment were assessed by Wilcoxon signed rank test. Mann-Whitney U test was used in comparisons of the airway parameters between the treated patients and the untreated controls. Significant level was set at 0.05. RESULTS The upper and lower incisors retracted 7.87 mm and 6.10 mm based on the measurement of U1-VRL and L1-VRL (P < 0.01), while the positions of the upper and lower molars (U6-VRL, and L6-VRL) remained stable. Volume, height, and cross-sectional area of the airway were not significantly changed after treatment, while the sagittal dimensions of SPP-SPPW, U-MPW, PAS, and V-LPW were significantly decreased (P < 0.05), and the morphology of the cross sections passing through SPP-SPPW, U-MPW, PAS, and V-LPW became anteroposteriorly compressed (P <0.001). No significant differences in the airway volume, height, and cross-sectional area were found between the treated patients and untreated controls. CONCLUSIONS The airway changes after orthodontic treatment with premolar extraction and maximum anchorage in adults are mainly morphological changes with anteroposterior dimension compressed in airway cross sections, rather than a decrease in size.
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McNamara JA, Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA, Cozza P. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 2015; 16:33. [PMID: 26446931 PMCID: PMC4596248 DOI: 10.1186/s40510-015-0105-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Abstract
Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life.
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Affiliation(s)
- James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Cell and Developmental Biology, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, The University of Michigan, Ann Arbor, MI, USA
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Lorenzo Franchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.
- Department of Surgery and Translational Medicine, University of Florence, Via del Ponte di Mezzo, 46-48, Florence, 50127, Italy.
| | - Fernanda Angelieri
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Department of Orthodontics, São Paulo Methodist University, São Bernardo do Campo, Brazil
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
- Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Dentistry, UNSBC, Tirana, Albania
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Grassia V, d'Apuzzo F, Jamilian A, Femiano F, Favero L, Perillo L. Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts. Prog Orthod 2015; 16:20. [PMID: 26122076 PMCID: PMC4484519 DOI: 10.1186/s40510-015-0089-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022] Open
Abstract
Background Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. Methods Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. Results Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant. Conclusions RME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the “lip bumper effects” observed in the MME protocol.
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Affiliation(s)
- Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Via Luigi De Crecchio 6, 80138, Napoli, Italy,
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Abstract
Paediatric obstructive sleep apnea (OSA) is common and its prevalence is expected to increase due to the rise in childhood obesity. Recent research has shown that many children, both syndromic and non-syndromic, who exhibit mouth breathing as a result of upper airway obstruction, may also exhibit dentofacial anomalies. Although adenotonsillectomy and continuous positive airway pressure have been classically proposed as the primary treatment modalities for paediatric OSA, there are significant limitations to both therapies. Therefore newer treatment modalities are needed. Current research has focused on emerging dental treatment options for paediatric OSA, such as rapid maxillary expansion, oral appliances and distraction osteogenesis. However, there are few randomized trials assessing the effectiveness of these novel dental therapies for paediatric OSA, and hence further research is required to advance the field.
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Ghodke S, Utreja AK, Singh SP, Jena AK. Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects. Prog Orthod 2014; 15:68. [PMID: 25534004 PMCID: PMC4274348 DOI: 10.1186/s40510-014-0068-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/01/2014] [Indexed: 12/24/2022] Open
Abstract
Background The use of functional appliances for the correction of retrognathic mandible is very common in orthodontics. Similar appliances known as oral appliances are also frequently used in adults for the treatment of mild to moderate obstructive sleep apnea (OSA). Many studies have reported improvement of pharyngeal airway passage (PAP) dimensions following functional appliance therapy in children and oral appliance therapy in adults. There is only one study in the literature that discussed the effect of oral appliance therapy on posterior pharyngeal wall thickness (PPWT) among subjects with OSA. The effect of functional appliance therapy on PPWT has never been investigated. Thus the present study was conducted to evaluate the effects of twin-block appliance on pharyngeal airway passage (PAP) dimensions and posterior pharyngeal wall thickness (PPWT) in class II malocclusion subjects with retrognathic mandibles. Methods Thirty-eight class II malocclusion subjects in the age range of 8 to 14 years with mandibular retrusion were divided into a treatment (n = 20) and control (n = 18) group. Mandibular retrusion in the treatment group subjects was corrected by twin-block appliance. The effect of twin-block appliance on PAP and PPWT dimensions were evaluated from lateral cephalograms recorded prior-to and after 6 months of appliance therapy in the treatment group subjects and the changes were compared with the changes in the control group subjects. Student’s t-test was used for statistical analysis; P-value of 0.05 was considered a statistically significant level. Results The depth of the oropharynx was increased significantly in the treatment group subjects (P < 0.001) as compared to the control group subjects (P < 0.05). The depth of the hypopharynx increased significantly in treatment group subjects (P < 0.01). The PPWT at the level of the nasopharynx, oropharynx, and hypopharynx were maintained in the treatment group subjects; whereas in control group subjects, the PPWT was further reduced although the changes were not statistically significant. Conclusions Correction of mandibular retrusion by twin-block appliance in class II malocclusion subjects increased the PAP dimensions and maintained the pre-treatment thickness of posterior pharyngeal wall.
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Affiliation(s)
| | | | | | - Ashok Kumar Jena
- Unit of Orthodontics, Department of Dental Surgery, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, India.
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