Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.

Does Le Fort I Osteotomy Influence Nasal Septum Deviation?

BACKGROUND

Le Fort I osteotomy is a technique for surgically correcting the maxillary position. Le Fort I osteotomy may affect the nasolabial structures since a very close relationship exists between the maxilla and the nose.

PURPOSE

This study aimed to investigate the effect of different maxillary movements on the nasal septum after Le Fort I osteotomies with cone beam computed tomography (CBCT) images. We hypothesized that nasal septal angle changes after maxillary impaction and advancement movements.

STUDY DESIGN, SETTING, AND SAMPLE

This retrospective cohort study involved patients who underwent Le Fort I osteotomy to correct the maxillary position at Erciyes University, Oral and Maxillofacial Surgery Hospital. This study included patients who had CBCT images before (T0) and ≥12 months after (T1) surgery. Patients with a history of septoplasty or rhinoplasty before orthognathic surgery, congenital deformities, or posttraumatic deformities were excluded.

PREDICTOR VARIABLES

Its predictor variable was the direction and magnitude of the maxilla's vertical and horizontal movements.

MAIN OUTCOME VARIABLE

Change in septal deviation (in degrees) was the main outcome of the study.

COVARIATES

Age, sex, operation (Le Fort I alone or double jaw surgery), cartilage reduction, and anterior nasal spine reduction during surgery were covariates.

DATA ANALYSIS

Angle values were compared with independent samples t test or the Mann-Whitney U test in two-category variables. The Kruskal Wallis test was used to compare the angle values according to the movement. A P value of < .05 was considered statistically significant.

RESULTS

This study evaluated 154 CBCT images of 77 patients (44 [57.1%] females and 33 [42.9%] males), of which 68 (88.3%) had double jaw surgery and nine (11.7%) had single Le Fort I surgery. The average nasal septum angle was significantly smaller preoperatively (166.2° [157.1° to 172.15°]) than postoperatively (168.7° [131.5° to 180.0°]) across subjects (P = .031). The septal angle decreased in 28 patients, and the rate of postoperative angular change was higher in patients with both advancement and impaction during the surgery (P = .014).

CONCLUSION AND RELEVANCE

Septum deviation can occur in 37% of cases after Le Fort I surgery. Therefore, Le Fort osteotomies are associated with changes in nasal appearance.

Unusual systemic and nondental effects of maxillary expansion therapy: A comprehensive and updated review of literature

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.

Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: An umbrella review

OBJECTIVE

To identify, qualify, and summarize the evidence from different systematic reviews about the outcomes of Rapid Maxillary Expansion (RME) on upper airway dimensions and breathing function in young patients.

METHODS

A literature search (from 2000 to December 2022) was conducted through PubMed (MEDLINE), the Cochrane Library, EMBASE, and Dentistry & Oral Science Source. The authors conducted the following umbrella review phases: research question, study selection criteria (systematic reviews involving randomized clinical trials and longitudinal observational designs), data extraction, and critical appraisal (bias risk assessment) of selected articles through the ROBIS tool.

RESULTS

The initial search yielded 65 potential references. After screening titles and summaries, and the elimination of duplicated publications, 15 articles were eligible for the evaluation of the full-text document. Finally, 11 systematic reviews (5 combined with meta-analysis) were selected, reporting 132 single studies; 38 of them were unrepeatable. Risk-of-bias assessment showed an average global moderate/high quality among the included studies. There was high heterogeneity between the systematic reviews' (and meta-analyses') methodologies used.

CONCLUSIONS

The present umbrella review concludes that significant and stable increases in the nasal and oropharyngeal space volumes and a decrease in airway resistance of growing children and adolescents, occur immediately after RME and at 3, 6- and 12-months follow-up.

Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion

Background and Aim

Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique.

Patients and Methods

This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate.

Results

A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05).

Conclusion

A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.

Is maxillary expansion effective in treatment of obstructive sleep apnoea syndrome? A systematic review of systematic reviews

Background Maxillary expansion (ME) might be beneficial in improving airway dimensions and obstructive sleep apnoea syndrome (OSAS) in patients with constricted maxillae. The aim of this overview is to present clinicians with a summary of the evidence. Data from systematic reviews and meta-analyses were evaluated to investigate the effect of ME on OSAS.Methods An electronic search was commenced in five databases, in addition to a manual search until July 2021. Screening of articles started with title and abstract followed by full-text assessment. Systematic reviews with/without meta-analyses were included. Critical appraisal was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Level of Research Design scoring and criteria of body of evidence scores. The search, study selection and critical appraisal were completed by three reviewers.Results In total, 14 systematic reviews with/without meta-analyses were included. The quality of available evidence ranged between low to high, based on the overall quality evaluation.Conclusions Based on the available evidence, maxillary expansion might be able to improve the nasal airway volume and OSAS in both growing and adult patients in the short term. ME can be considered as one of the treatment options in cases with OSAS.

Comparing dimensions of upper airway in patients with nasal septal deviation and healthy people in CBCT

Nasal septal deviation causes the obstruction of the nasal lateral wall and sinus cavities as well as bringing some respiratory problems. Furthermore, the obstruction of the upper airway tract can cause changes in normal breathing process, which itself has an important effect on the normal development of both the mandibular and facial areas. This study aimed to assess the dimensions of airway in patients suffering from nasal septal deviation as well as comparing them with healthy individuals through CBCT images. This descriptive analytical study was performed on 127 patients (classified into two groups: with septal deviation (n=93) and without this deviation (n=34). In each patient, the presence and severity of nasal septal deviation as well as upper airway dimensions were examined from sagittal and coronal views. The obtained data were then analyzed using independent t-test and Mann-Whitney test.no significant difference was observed between the mean age of the two study groups (P=0.208). Among those subjects with and without nasal septal deviation, no significant difference was observed in the lateral view in nasopharynx (P=0.653), oropharynx (P=0.828), and hypopharynx (P=0.693) areas in terms of the anteroposterior airway dimensions. As well, no significant difference was observed in the transversal dimensions in coronal view in nasopharynx (P=0.098), oropharynx (P=0.438), and hypopharynx (P=0.676) areas. There was no significant difference in terms of anteroposterior airway dimensions in the lateral view as well as regarding transverse dimensions in coronal view in nasopharynx, oropharynx, and hypopharynx areas.

Long-term assessment of conventional and mini-screw-assisted rapid palatal expansion on the nasal cavity

OBJECTIVES

To evaluate the long-term effects of mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion-ANS height, ANS-PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated.

RESULTS

The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls.

CONCLUSIONS

MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.

The effect of concha bullosa and nasal septal deviation on palatal dimensions: a cone beam computed tomography study

Introduction

Nasal septal deviation (NSD) and concha bullosa (CB) are associated with airway obstruction in mouth breathers. Mouth breathing is associated with alterations in maxillary growth and palatal architecture. The aim of our study was to determine the effect of the presence of CB and NSD on the dimensions of the hard palate using cone-beam computed tomography (CBCT).

Materials and methods

A retrospective study was conducted using CBCT scans of 200 study subjects. The study subjects were divided into four groups based on the presence of CB and NSD. Septal deviation angle (SDA), palatal interalveolar length (PIL), palatal depth (PD) and maxillopalatal arch angle (MPAA) were measured in the study groups.

Results

The presence of NSD and CB was associated with significant (p < 0.001) differences in the palatal dimensions of the study subjects. The PIL and MPA (p < 0.001) were significantly reduced (p < 0.001), whereas the PD was significantly increased (p < 0.001) in study subjects with NSD and CB. There was no significant change in the palatal dimensions between the unilateral and bilateral types of CB. Among the palatal dimensions, the PIL had the most significant association (R² = 0.53) with SDA and CB. There was a significant correlation between the palatal dimensions and SDA when CB was present along with NSD.

Conclusion

Based on the results of this study, it can be concluded that the presence of NSD and CB have a significant effect on the palatal dimensions and, therefore, they may be associated with skeletal malocclusion.

Effect of septal deviation on nasomaxillary shape: A geometric morphometric study

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.

Evaluation of the nasal septum and depth of palatal arch in different facial vertical patterns: A Cone-Beam Computed Tomography Study

OBJECTIVE

The purpose of this study was to evaluate the nasal septum and the depth of posterior palatal arch in the different facial vertical patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 143 CBCTs were analysed (53 normodivergents, 26 hypodivergents, and 64 hyperdivergents) using the software Real Scan 2.2. On the coronal view, the following measurements were taken, palatal interalveolar length (PIL), palatal arch depth (PAD), maxillopalatal arch angle (MPAA), septal vertical length (SVL), deviated septal length (DSL), and deviated septal curve angle (DSCA). Using the program Stata v16.0, we obtained the mean, standard deviation and median values. The identification of significant differences between facial biotypes was performed using the one-way ANOVA test and H of Kruskal-Wallis test, considering a significance level of 0.05.

RESULTS

The hypodivergent group got the highest PIL and MPAA (49.6mm and 118.1° respectively), with statistically significant differences (P<0.05) between this group and the hyperdivergent group. Statistically significant differences were found by gender for the SNMeGo, PFH, AFH, and the relationship between the facial heights, where the males had the highest values. Additionally, PIL and SVL also had the highest values for males (48.8mm and 63.6mm respectively).

CONCLUSIONS

Patients presenting with greater hyperdivergence have shorter interalveolar distances and smaller maxillopalatal arch angles.

Rapid Maxillary Expansion Has a Beneficial Effect on the Ventilation in Children With Nasal Septal Deviation: A Computational Fluid Dynamics Study

Nasal septal deviation (NSD) is one of the most common nasal diseases. Different from common clinical examination methods, computational fluid dynamics (CFD) can provide visual flow information of the nasal cavity. The dimension and volume of the nasal cavity are easily affected by rapid maxillary expansion (RME). The purpose of this study was to use CFD to evaluate the effect of RME on the aerodynamics of the nasal cavity in children with maxillary transverse deficiency and NSD. Computational fluid dynamics was implemented after 3D reconstruction based on the CBCT of 15 children who have completed RME treatment. After treatment, the volume increases in the nasal cavity, nasopharynx, oropharynx, and pharynx were not statistically significant. The wall shear stress of the nasal cavity after RME, 1.749 ± 0.673 Pa, was significantly lower than that before RME, 2.684 ± 0.919 Pa. Meanwhile, the maximal negative pressure in the pharyngeal airway during inspiration was smaller after RME (-31.058 Pa) than before (-48.204 Pa). This study suggests that RME has a beneficial effect on nasal ventilation. The nasal airflow became more symmetrical in the bilateral nasal cavity after RME. Pharyngeal resistance decreased with the reduction in nasal resistance and the increase in the volume of oropharynx after RME.

Evaluation of the Relationship Between Olfactory Fossa Measurements and Nasal Septum Deviation for Endoscopic Sinus Surgery

INTRODUCTION

Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD).

METHODS

A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD.

RESULTS

In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ± 4.69 in women 4.11 ± 4.36, respectively. The mean width of the right OF was 2.50 ± 0.64 mm and 2.58 ± 0.72 mm for the left side and there was no statistically significant association between OF width - NSD and OF width - OF depth (P > 0.05).

CONCLUSION

The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.

Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

INTRODUCTION

Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry.

OBJECTIVE

The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME.

METHODS

This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient.

RESULTS

NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area.

CONCLUSIONS

NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate

OBJECTIVES

To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP).

MATERIALS AND METHODS

A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed.

RESULTS

No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05).

CONCLUSIONS

Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.

Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images

BACKGROUND AND OBJECTIVE

This study aims to assess the effect of Rapid Maxillary Expansion (RME) on Nasal Septal Deviation (NSD) changes from three-dimensional (3D) images.

METHODS

In this study, cone-beam computed tomography (CBCT) images from 15 patients with maxillary constriction (mean age 12 ± 1.6 years) were included. RME treatment with Hyrax appliance was performed in all patients. CBCT scans were taken at three different times; before appliance insertion (T0), after active expansion (T1) and 3 months after appliance insertion (T2). We developed a novel Matlab-based application to quantify NSD based on the tortuosity ratio by dividing the actual length of the septum by the ideal length in the mid-sagittal plane by using this application.

RESULTS

Tortuosity ratio (TR) values were found as 1.03 ± 0.03 (T0), 1.02 ± 0.02 (T1), and 1.02 ± 0.02 (T2). Differences of TR values among these groups were evaluated using the statistical method of ANOVA (ANalysis Of VAriance) for repeated measures with the significance level of p ≤ .05. Results showed significant reductions in TR values between T0-T1 (p ≤ .05) and between T0-T2 (p ≤ .05). Nonetheless, a significant difference between T1-T2 was not determined (p > .05).

CONCLUSIONS

As a result, we can conclude that the NSD degree is affected by the RME treatment. The developed application can be used for both educational and research purposes.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting

INTRODUCTION

This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A).

METHODS

Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores.

RESULTS

Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting.

CONCLUSIONS

The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation

OBJECTIVE

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

METHODS

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

RESULTS

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

CONCLUSION

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Displacement and force distribution of splinted and tilted mandibular anterior teeth under occlusal loads: an in silico 3D finite element analysis

Background

Fixed orthodontic retainers have numerous advantages, but it is not known whether they can exert pathological forces on supporting tissues around the splinted teeth. The purpose of this study was to investigate how the inclination of the lower anterior teeth can affect dental displacement and also change the direction of occlusal loads exerted to dental and its supporting tissues.

Methods

Four three-dimensional finite element models of the anterior part of the mandible were designed. All the models contained the incisors and canines, their periodontal ligament layers (PDLs), the supporting bone (both spongy and cortical), and a pentaflex splinting wire placed in the lingual side of the teeth. Teeth inclination was considered to be 80° (model 1), 90° (model 2), 100° (model 3), and 110° (model 4) to the horizontal plane. The lower incisors were loaded with a 187-N vertical force. Their displacement patterns and the stress in their PDLs were evaluated.

Results

In incisors with 80° of inclination, less than a 0.1-mm lingual displacement was seen on the incisal edge and a similar distance of displacement towards the labial was seen on their root apices. However, in models with 90°–110° of inclination, the incisal edge displaced labially between about 0.01 and 0.45 mm, while root apices displaced lingually instead. By increasing the angle of the teeth, the strain in the periodontal ligament increased from about 37 to 58 mJ. The von Mises stresses around the cervical and apical areas differed for each tooth and each model, without a similar pattern. Increasing the angle of the teeth resulted in much higher cervical stresses in the incisors, but not in the canines. In the lateral incisor, cervical stress increased until 100° of inclination but reduced to about half by increasing the angle to 110°. Apical stress increased rather consistently in the incisor and lateral incisors, by increasing the inclination. However, in the canines, apical stress reduced to about half, from the first to fourth models.

Conclusions

Increasing the labial inclination can mostly harm the central incisors, followed by the lateral incisors. This finding warns against long durations of splinting in patients with higher and/or patients with reduced labial bone thickness.

Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects

INTRODUCTION

Deviated nasal septum may cause a reduction of the nasal airflow, thus, during the craniofacial development, a reduced nasal airflow could originate a chronic mouth-breathing pattern, related with moderate to severe maxillary constriction. The aim of this retrospective study is to analyze the correlation between maxillary transverse deficiency and nasal septum deviation.

METHODS

Frontal cephalograms were performed on 66 posterior-anterior radiographs of subjects (34M, 32F; mean age 9.95±2.50 years) with maxillary transverse deficiency and on a control group of 31 posterior-anterior radiographs of subjects (13M, 18F; 9.29±2.08 years). Angular parameters of the nasal cavities were recorded and compared between the two groups using a Student's t-test.

RESULTS

Generally all the parameters are very similar between the two groups except for the ASY angle that differs for about the 27%; anyway the Student's t-test showed no statistically significant differences between the two groups (mostly p>0.20).

CONCLUSIONS

This study failed to show an association between transverse maxillary deficiencies and nasal septum deviations. Moreover, no significant differences were found between the mean nasal cavities dimensions in subjects with transverse maxillary deficiency and the control group.