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Yang P, Zhu M, Guo Y, Su C, Wang Y, Bai Y, Zhang N. Evaluation of midpalatal suture maturation stage in 5- to 20-year-olds using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2024:S0889-5406(24)00319-6. [PMID: 39254609 DOI: 10.1016/j.ajodo.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/18/2024] [Accepted: 07/28/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION This study aimed to evaluate the midpalatal suture (MPS) maturation stages using the cone-beam computed tomography classification method in Chinese children aged 5-10 years, adolescents aged 11-15 years, and postadolescents aged 16-20 years and identify a correlation between maturation stage and age and sex. METHODS Axial sections of tomographic images from 717 participants (369 female and 348 male participants) aged 5-20 years were used to classify the maturation stage of the MPS (stages A, B, C, D, and E). Kappa statistics were used to evaluate the measurement error. The chi-square test was applied to analyze the differences in the distribution of MPS stages by age group and by sex among all participants, as well as the adolescent group. The Fisher exact test was employed to assess the differences in MPS stage distribution by sex among children aged 5-10 years and among the postadolescent group. The Mann-Whitney U test was used to assess the potential variance in age distribution between stages C and D. RESULTS The most prevalent maturation stage was stage C (40.3%). Of the total population, 69.4% had MPS in stages A, B, or C. A significant difference in age distribution was observed between stage C and stage D (P <0.001). The distribution of the MPS maturation stage significantly varied by age group (P <0.001) and sex (P <0.001). CONCLUSIONS The distribution of participants in advanced maturation stages increases with age. Female patients generally experience earlier MPS maturation than male patients, particularly between the ages of 11-20 years.
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Affiliation(s)
- Pan Yang
- Department of Oral and Maxillofacial Radiology, School of Stomatology, Capital Medical University, Beijing, China
| | - Mengyao Zhu
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yiman Guo
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Chengjun Su
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yajie Wang
- Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China.
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Al-Gazzawi AMQ, Knode V, Ludwig B, Othman A, Salamini A, Pandis N, Fleming PS. Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement. Am J Orthod Dentofacial Orthop 2024; 166:69-75. [PMID: 38647514 DOI: 10.1016/j.ajodo.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The objective of this study was to investigate the accuracy of palatal miniscrew insertion, evaluating the effect of guide fabrication and surgical placement. METHODS Guided insertion of bilateral paramedian palatal miniscrews was undertaken using Appliance Designer software (3Shape, Copenhagen, Denmark). A resin surgical guide (P Pro Surgical Guide; Straumann AG, Basel, Switzerland) was used. Superimposition of the miniscrew position relative to the digital design was undertaken using bespoke software (Inspect 3D module, OnyxCeph; Image Instruments GmbH, Chemnitz, Germany) to assess surgical inaccuracy. Miniscrew position relative to the surgical guide was also assessed to isolate the effect of planning inaccuracies. Both horizontal and vertical discrepancies were evaluated at both implant locations. RESULTS Twenty-seven patients having bilateral palatal insertions were examined. Mean discrepancies were <0.5 mm, both in the horizontal and vertical planes. The mean overall horizontal and vertical discrepancy between the digital design and final miniscrew position on the left side was 0.32 ± 0.15 mm and 0.34 ± 0.17 mm, respectively. The maximum horizontal discrepancy observed was 0.72 mm. No significant differences were observed in relation to the accuracy of mini-implant positioning on the basis of sidedness, either for horizontal (P = 0.29) or vertical (P = 0.86) discrepancy. CONCLUSIONS High levels of accuracy associated with guided insertion of paramedian palatal implants were recorded with mean discrepancies of less than 0.5 mm both in the horizontal and vertical planes. No difference in accuracy was noted between the left and right sides. Very minor levels of inaccuracy associated both with surgical techniques and surgical guide fabrication were recorded.
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Affiliation(s)
| | | | - Bjorn Ludwig
- Private practice, Traben-Trarbach, Germany; Department of Orthodontics, University of Homburg, Saar, Germany
| | | | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Medical Faculty, Dental School, University of Bern, Bern, Switzerland
| | - Padhraig S Fleming
- Division of Public and Child Dental Health, Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland.
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Qi Y, Ding L, Xue L, Xu S, Lin J. Analysis of changes and correlation in condyle-fossa relationship after maxillary skeletal expansion. Orthod Craniofac Res 2024. [PMID: 38566529 DOI: 10.1111/ocr.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate the changes in condyle-glenoid fossa relationship after maxillary skeletal expansion (MSE) and to verify the correlation between the condyle positional changes and expansion effect. METHODS In this study, 20 patients (mean age 21.1 ± 5.7 years, 8 male, 12 female) with maxillary transverse deficiency (MTD) were treated with the MSE appliance, which contained molar bands and a expander with four micro-implants. The CBCT images were taken before expansion (T0), after expansion (T1) and after 6 months of maintenance (T2). The posterior TMJ space (PS), superior TMJ space (SS), anterior TMJ space, coronal lateral TMJ space (CLS), coronal medial TMJ space (CMS), condyle axis angle, maxillary basal bone width (BWM), inter-molars width, nasal bone width, molar inclination and molar palatal cusp height (U6H) were measured using Dolphin Imaging. RESULTS At T1, compared with T0, the PS and SS significantly increased by 0.41 mm (P = .008) and 0.3 mm (P = .007). But only the SS significantly increased by 0.21 mm (P = .025) at T2. There was a significant difference of 0.37 mm (left-right, P = .014) between the left and right SS at T0, but no significant difference at T1 and T2. The increased BMW showed weak positive correlations with the change of PS (P = .015) and CMS (P = .031), and the decreased U6H showed weak negative correlations with the change of PS (P = .015) and CLS (P = .031) at T1. CONCLUSIONS The use of MSE led to an increase in the SS and PS, which were weakly correlated with BWM and U6H. But this effect in the TMJ space gradually diminished after 6 months of maintenance, and the symmetry of the condyle-fossa relationship was preserved.
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Affiliation(s)
- Yezi Qi
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, P.R. China
| | | | - LeiLei Xue
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, P.R. China
| | - SiYi Xu
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, P.R. China
| | - Jun Lin
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, P.R. China
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Leeisaramas C, Chantarapanich N, Inglam S, Insee K. Analysis of Stress Distribution and Displacement Based on the Miniscrew Positions of the Palatal Slope Bone-borne Expander: A Finite Element Study. Eur J Dent 2024. [PMID: 38555643 DOI: 10.1055/s-0043-1777823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the stress distribution pattern of the palatal slope bone-borne expander on the maxillary area according to a different anteroposterior position of anchored miniscrews using finite element analysis. MATERIALS AND METHODS Nasomaxillary stereolithography files with three different anteroposterior anchored miniscrew positions of the palatal slope bone-borne expander were determined as model A, B, and C. Each model consists of four supported miniscrews. Model A: two anterior miniscrews were located between the maxillary canine and the first premolar, and two posteriors between the second premolar and the first molar. Model B: two anteriors were between the lateral incisor and the canine, and two posteriors were the same as in model A. Model C: two anteriors were the same as in model A, and two posteriors were distal to the first molar. One turn of expander screws was applied. Maximum principal stress, equivalent elastic strain, equivalent von Mises stress, and transverse displacement were evaluated. RESULTS The maximum principal stress was mostly found at the bone-miniscrew interface. Model A exhibited an intersecting area of stress between the supported miniscrews. The highest value of principal stress was in model B, while model C showed a uniform distribution pattern. The elastic strain pattern was similar to the principal stress in all models. The highest value of equivalent von Mises stress was located on the expander screw. The largest amount of transverse displacement of teeth was in model A, while model C exhibited a more consistent transverse displacement than other models. Vertical displacement of posterior teeth was also noticed. CONCLUSION Based on the result, it revealed that the various anteroposterior miniscrew placements of the palatal slope bone-borne expander had various patterns of stress distribution and resulted in various outcomes. It may be inferred that model A's miniscrew location was advantageous for obtaining expansion quantities, but model C's miniscrew position was advantageous for maintaining consistent biomechanics.
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Affiliation(s)
- Chakree Leeisaramas
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Nattapon Chantarapanich
- Digital Industrial Design and Manufacturing Research Unit and Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
| | - Samroeng Inglam
- Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
| | - Kanlaya Insee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
- Thammasat University Research Unit in Dental Biomechanics, Thammasat University, Pathum Thani, Thailand
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Bocklet M, Ahmadi F, Tremont T, Ross L, Yao H, Andrade I. Comparison of 3D-printed and laboratory-fabricated Hyrax on stress distribution and displacement of the maxillary complex: a 3D finite element study. Prog Orthod 2024; 25:11. [PMID: 38494544 PMCID: PMC10944817 DOI: 10.1186/s40510-024-00510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/05/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To analyze and compare the effects of a traditional laboratory-fabricated Hyrax expander (T-Hyrax) and two different 3D-printed Hyrax expander models relative to tension points, force distribution, and areas of concentration in the craniofacial complex during maxillary expansion using finite element analysis. MATERIALS AND METHODS Three maxillary expanders with similar designs, but various alloys were modeled: a T-Hyrax, a fully printed Hyrax (F-Hyrax), and a hybrid printed Hyrax (H-Hyrax). The stress distributions and magnitude of displacements were assessed with a 5 mm expansion in a symmetrical finite element model. The areas of interest included the teeth, alveolar processes, midpalatal suture, nasal complex, circummaxillary sutures (CS), and the expanders themselves. RESULTS The highest stress value (29.2 MPa) was found at the midpalatal suture of the F-Hyrax, while the lowest stress (0.90 MPa) was found at the temporozygomatic suture in the T-Hyrax. On average, the F-Hyrax increased stress at the CS by 24.76% compared with the T-Hyrax and H-Hyrax. The largest displacements were found at the upper incisor (U1) and anterior nasal spine (ANS). The findings indicated an average increase of 12.80% displacement at the CS using the F-Hyrax compared to the T-Hyrax. CONCLUSION The F-Hyrax exerts more stress and displacement on the maxilla than both the T-Hyrax and H-Hyrax, where the weak link appears to be the solder joint.
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Affiliation(s)
- Michael Bocklet
- Department of Orthodontics, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Ave, MSC 507, Charleston, SC, 29425, USA
| | - Farhad Ahmadi
- Department of Oral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Clemson-MUSC Joint Bioengineering Program, Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Timothy Tremont
- Department of Orthodontics, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Ave, MSC 507, Charleston, SC, 29425, USA
| | - Loring Ross
- Department of Orthodontics, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Ave, MSC 507, Charleston, SC, 29425, USA
| | - Hai Yao
- Department of Oral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Clemson-MUSC Joint Bioengineering Program, Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Ildeu Andrade
- Department of Orthodontics, College of Dental Medicine, Medical University of South Carolina, 173 Ashley Ave, MSC 507, Charleston, SC, 29425, USA.
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Zhu M, Yang P, Bian C, Zuo F, Guo Z, Wang Y, Wang Y, Bai Y, Zhang N. Convolutional neural network-assisted diagnosis of midpalatal suture maturation stage in cone-beam computed tomography. J Dent 2024; 141:104808. [PMID: 38101505 DOI: 10.1016/j.jdent.2023.104808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES The selection of treatment for maxillary expansion is closely related to the calcification degree of the midpalatal suture. A classification method for individual assessment of the morphology of midpalatal suture in cone-beam computed tomography (CBCT) is useful for evaluating the calcification degree. Currently, convolutional neural networks (CNNs) have been introduced into the field of oral and maxillofacial imaging diagnosis. This study validated the ability of CNN models in assessing the maturation stage of the midpalatal suture. METHODS The existing CNN model ResNet50 was trained to locate the CBCT transverse plane which contained a complete midpalatal suture. ResNet18, ResNet50, RessNet101, Inception-v3, and Efficientnetv2-s models were trained to evaluate the midpalatal suture maturation stage. Multi-class classification metrics, accuracy, recall, precision, F1-score, and area under the curve values from the receiver operating characteristic curve were used to evaluate the performance of the models, and gradient-weighted class activation map technology was utilised to visualise five midpalatal suture maturation stages for each model. RESULTS Resnet50 demonstrated an accuracy of 99.74 % in identifying the transverse plane that contained the complete midpalatal suture. The highest accuracies achieved on the two-stage, three-stage, and five-stage maturation classification tests were 95.15, 88.06, and 75.37 %, all of which exceeded the average accuracy of three experienced orthodontists. CONCLUSIONS The CNN model can locate the plane of the midpalatal suture in CBCT images and can assist clinicians in assessing the maturation stage of the midpalatal suture to select the means of maxillary expansion. CLINICAL SIGNIFICANCE The application of artificial intelligence on CBCT midpalatal suture plane localisation and maturation stage evaluation enhances diagnostic and treatment efficiency and accuracy of individual assessment of midpalatal suture calcification degree. Additionally, it assists the clinical palatal expansion technique in achieving ideal results.
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Affiliation(s)
- Mengyao Zhu
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing 100050, China
| | - Pan Yang
- Department of Oral and Maxillofacial Radiology, School of Stomatology, Capital Medical University, Beijing 100050, China
| | - Ce Bian
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing 100050, China
| | - Feifei Zuo
- LargeV Instrument Corp., Ltd., Beijing 100084, China
| | - Zhongmin Guo
- LargeV Instrument Corp., Ltd., Beijing 100084, China
| | - Yufeng Wang
- LargeV Instrument Corp., Ltd., Beijing 100084, China
| | - Yajie Wang
- Department of Engineering Physics, Tsinghua University, Beijing 100084, China; LargeV Instrument Corp., Ltd., Beijing 100084, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing 100050, China
| | - Ning Zhang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing 100050, China.
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Alhasyimi AA, Ayub A, Farmasyanti CA. Effectiveness of the Attachment Design and Thickness of Clear Aligners during Orthodontic Anterior Retraction: Finite Element Analysis. Eur J Dent 2024; 18:174-181. [PMID: 36963425 PMCID: PMC10959602 DOI: 10.1055/s-0043-1761452] [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: 03/26/2023] Open
Abstract
OBJECTIVE Clear aligner treatment (CAT) provides orthodontic patients with a comfortable treatment alternative; however, this device has limited capacity to facilitate tooth movements. Although composite attachment has been proposed to facilitate tooth displacement, some of its aspects, such as aligner thickness, can influence CAT's precision. This work aimed to compare the stress distribution patterns produced by clear aligners with different thicknesses and composite attachment shapes during anterior retraction. MATERIALS AND METHODS Maxillary models consisting of clear aligners, maxillary teeth, and various attachments to the upper central incisor's labial surface were generated. Three models were built to mimic the retraction of the upper central incisors. Each had a distinct attachment design (rectangular attachment, ellipsoid attachment, and pyramidal attachment) and various aligner thicknesses (0.75, 0.85, 0.95, 1.05, and 1.15 mm). Upper central incisor retraction was accomplished using clear aligners. Finite element analysis was used to examine the built models. Stress distribution pattern was examined. RESULTS The greater the thickness of the aligner, the higher the stress experienced by the teeth. The 0.75 mm-thick aligner induces the lightest stress with a minimum of 0.0037623 MPa and a maximum of 0.32859 MPa. Meanwhile, the 1.5 mm-thick aligner has the highest stress with a minimum of 0.004679 MPa and a maximum of 0.43858 MPa. The force distribution on rectangular attachments appears evenly distributed. The maximum pressure force on rectangular attachments has a minimum of 0.38828 MPa, which is smaller than the maximum on ellipsoid and pyramidal attachments at 0.40933 and 0.45099 MPa, respectively. CONCLUSION The best aligner thickness is 0.75 to 0.85 mm for anterior retraction. An aligner with 0.95 mm thickness can still be used when a remarkable amount of tooth movement force is needed; however, this exception is only applicable to a limited number of clear aligner trays. The ellipsoid attachment is the best type of attachment because the resulting force is substantial and evenly distributed.
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Affiliation(s)
- Ananto Ali Alhasyimi
- Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Aulia Ayub
- Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Koç O, Bolat Gumus E. Effects of different distractor positions on the formation of expansion, stress and displacement patterns in surgically assisted rapid maxillary expansion without pterygomaxillary disjunction: a finite element analysis study. Comput Methods Biomech Biomed Engin 2024; 27:56-66. [PMID: 36724781 DOI: 10.1080/10255842.2023.2170712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient's anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.
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Affiliation(s)
- Osman Koç
- Department of Mechanical Engineering, Yildiz Technical University, Yildiz, Istanbul, Turkey
| | - Esra Bolat Gumus
- Faculty of Dentistry, Department of Orthodontics, Akdeniz University, Antalya, Turkey
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Walter A, de la Iglesia F, Winsauer H, Ploder O, Wendl B, Puigdollers Perez A. Evaluation of expansion forces of five pure bone-borne maxillary expander designs anchored with orthodontic mini-implants: An in vitro study. J Orthod 2023; 50:335-343. [PMID: 36786416 DOI: 10.1177/14653125231152502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
AIM This in vitro study investigates the limit of expansion forces and torque wrench forces developed by five skeletal bone expander designs (MICRO 2/4 expanders™) for clinical application. MATERIAL AND METHODS A total of 30 skeletal expanders were placed in artificial bone blocks and mechanically tested, simulating maxillary expansion. Differences in jackscrew (Dentaurum™ [D], Superscrew™ [S] and Powerscrew™ [P]), number of orthodontic mini-implants (OMIs; two or four) and their placement inclinations (parallel 0° or 10° inclination) form five designs (D4/10°, S4/0°, S4/10°, P4/10° and P2/10°). Expansion forces and torque wrench values were registered, and radiographs were made initially and after 4 mm of expansion. Stress-strain curves were obtained after successive activations and the statistical analysis was performed as appropriate. RESULTS Plastic deformations in the OMIs and jackscrew occurred around the activation numbers 11-13, with torque wrench values in the range of 500-700 cN. The maximum expansion forces in expanders with four OMIs varied from 93.0 (D4/10°) to 166.6 N (P4/10°) whereas two OMI expanders (P2/10°) registered forces of 79.4 N. Radiographs revealed during loads bending forces (S4/00°, S4/10°) with jackscrew and OMIs deformation in a convex shape, and shear forces (P4/10°, P2/10°) demonstrated only OMIs deformation in a concave shape, providing 15% more expansive force. The jackscrew D4/10° did not have any deformation, but its wire key did not allow reliable activations from activation number 10 and compared to S4/10° and P4/10°, these expanders provided greater expansion forces (P = 0.000 and P = 0.032, respectively). CONCLUSION The different results obtained in stability and expansion forces indicate that if the activations are carried out under extreme conditions, they may have clinical importance with deformations and non-working expansion mechanics. Jackscrew designs play an important role in expansive forces and expander stability. Torque wrench values can be used clinically as a tool to asses the expansion forces and to avoid deformations.
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Affiliation(s)
- Andre Walter
- Orthodontics, Universitat Internacionat de Catalunya, Barcelona, Spain
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Bahammam M, El-Bialy T. Comparison of Alveolar Bone Thickness and Height after Slow Expansion using Quad-Helix or Clear Aligners. Saudi Dent J 2023; 35:255-262. [PMID: 37091281 PMCID: PMC10114590 DOI: 10.1016/j.sdentj.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The study was conducted to investigate the thickness and height of the alveolar bone of individual teeth after slow maxillary expansion (SME) with quad helix or clear aligner appliances and hypothesized that there is no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. Material and Methods This is a retrospective study; the records of 22 patients treated between December 2019 to April 2020 by dental arch expansion using either clear aligners or quad helix appliances were retrieved and studied. The results obtained through cone beam computed tomography (CBCTs) before and immediately after maxillary expansion (2 + 1 mm per side) were analyzed (11 in the Quad Helix group and 11 in the clear aligner). The data collected was analyzed using linear and angular measurements obtained through On-demand 3D App software. Furthermore, Statistical Package for Social Sciences (SPSS) version 25.0 was used to present the findings by mean and standard deviations, and Scheffe's test was applied for comparing forces. Results The results showed that the mean age of patients in the clear aligner group and Quad Helix was 16.27 ± 0.56 years and 15.5 ± 1.53 years, respectively. There was no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. This is due to the findings that suggest that there was a decrease in bone height and bone width when treated with a quad helix as compared to clear alignment. Conclusion It can be concluded that the quad helix SME treatment affects alveolar bone integrity; therefore, clear aligners might be better for treating patients than the quad helix.
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Affiliation(s)
- Maha Bahammam
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia
- Corresponding author.
| | - Tarek El-Bialy
- Orthodontics and Biomedical Engineering, Division of Orthodontics, Katz Group Centre for Pharmacy and Health Research, School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Koç O, Pamukçu H, Kocabalkan AA. Comparison of 3 different bone-borne type expansion appliances used in surgically-assisted rapid palatal expansion: A finite element analysis. Am J Orthod Dentofacial Orthop 2023; 163:e23-e33. [PMID: 36572581 DOI: 10.1016/j.ajodo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aimed to compare the effects of 3 different bone-borne type expansion appliances used in the surgically-assisted rapid palatal expansion (SARPE) by finite element analysis. METHODS Three different miniscrew-supported palatal expansion appliances were modeled. Median and lateral osteotomies were performed without pterygomaxillary suture separation. Model I consisted of a palatal expander with 2 miniscrews placed 4 mm far from the midpalatal suture. In model II, 2 miniscrews were located at the alveolar ridge between the first molar and the second premolar. In model III, 4 miniscrews were placed as a combination of the first and second models. Stress distributions and amount of displacements were evaluated with Ansys software (version 19.2; Ansys, Canonsburg, Pa) for 5-mm expansion in a symmetrical finite element analysis model to reflect the clinical situation. RESULTS SARPE simulation using miniscrew-assisted maxillary expanders for all models showed a rotation and tipping of the maxilla. The largest displacement was found for the anterior part of the palate in model II and the posterior part in model III. Although a wedge-shaped expansion pattern was observed in all models, this form was more prominent in model II. The highest stress value (0.91 MPa) was measured in model I, and the lowest value (0.004 MPa) was measured in model II for the anterior nasal spine region. The highest stress value (0.51 MPa) was measured in model III, and the lowest value (0.12 MPa) was measured in model II for the posterior nasal spine region. The lowest stress values were measured in model II for all the craniofacial and maxillofacial structures. CONCLUSIONS Among the models, the lowest stress distribution conditions for craniofacial and maxillofacial structures were found in model II. The largest displacement was found at the incisors and anterior part of the maxilla for model II. The greatest displacement was found at the posterior region for model III.
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Affiliation(s)
- Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Hande Pamukçu
- Department of Orthodontics, School of Dentistry, Başkent University, Ankara, Turkey
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Rodríguez Torres P, Riad Deglow E, Zubizarreta-Macho Á, Tzironi G, González Menéndez H, Lorrio Castro J, Lobo Galindo AB, Hernández Montero S. Effect of the computer-aided static navigation technique on the accuracy of bicortical mini-implants placement site for maxillary skeletal expansion appliances: an in vitro study. BMC Oral Health 2023; 23:86. [PMID: 36774459 PMCID: PMC9921661 DOI: 10.1186/s12903-023-02785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/01/2023] [Indexed: 02/13/2023] Open
Abstract
The objective of the present study was to evaluate and compare the effect of the computer-aided static navigation technique on the accuracy of the maxillary skeletal expansion (MSE) appliances. MATERIAL AND METHODS Forty orthodontic self-drilling mini-implants were placed in ten anatomically based standardized polyurethane models of a completely edentulous upper maxilla, manufactured using a 3D impression procedure. The four orthodontic self-drilling mini-implants for anchoring the MSE appliance were digitally planned on 3D planning software, based on preoperative cone-beam computed tomography (CBCT) scan and a 3D extraoral surface scan. Afterwards, the surgical templates were virtually planned and manufactured using stereolithography. Subsequently, the orthodontic self-drilling mini-implants were placed an postoperative CBCT scans were performed. Finally, coronal entry-point, apical end-point and angular deviations were calculated using a t-test for independent samples or a non-parametric Signed Rank test. RESULTS Statistically significant differences were not shown at coronal entry-point (p = 0.13), apical end-point (p = 0.41) and angular deviations (p = 0.27) between the planned and performed orthodontic self-drilling mini-implants. CONCLUSIONS Computer-aided static navigation technique enables accurate orthodontic mini-implant placement for the MSE appliances.
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Affiliation(s)
- Paulina Rodríguez Torres
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691 Madrid, Spain
| | - Elena Riad Deglow
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691 Madrid, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691, Madrid, Spain. .,Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain.
| | - Georgia Tzironi
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
| | - Héctor González Menéndez
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691 Madrid, Spain
| | - Juan Lorrio Castro
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691 Madrid, Spain
| | - Ana Belén Lobo Galindo
- grid.464699.00000 0001 2323 8386Department of Dental Therapeutics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain
| | - Sofía Hernández Montero
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de La Cañada, 28691 Madrid, Spain
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Ritchie C, McGregor S, Bearn DR. Temporary anchorage devices and the forces and effects on the dentition and surrounding structures during orthodontic treatment: a scoping review. Eur J Orthod 2023; 45:324-337. [PMID: 36763546 DOI: 10.1093/ejo/cjac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Temporary anchorage devices (TADs) offer the clinician an immediate temporary source of skeletal anchorage for a range of orthodontic interventions. It is important to understand forces involved in using TADs and the effects on the dentition and surrounding structures, to improve clinical outcomes. OBJECTIVE To examine and qualitatively synthesize literature on the forces involved with the use of TADs and the effects on the dentition and surrounding structures in orthodontic tooth movement, to provide better understanding of the complex interactions and the clinical implications. SEARCH METHODS Electronic databases searched included: Cochrane Library [including Central Register of Controlled Trials (CENTRAL)], Embase via OVID, Pubmed, and Scopus. Study screening and selection were conducted in duplicate. SELECTION CRITERIA Studies selected were clinical studies, simulation studies (computer or laboratory-based), or animal studies with no restriction over gender, age, study type (excluding case reports), or setting. Studies focusing on the forces involved with the use of TADs in orthodontic treatment and their effects on the dentition and surrounding structures were included. DATA COLLECTION AND ANALYSIS A data charting form was piloted and refined. Data charting was performed independently and in duplicate. This consisted of key fields with predetermined options and free text. The extracted data were collated, and a narrative synthesis conducted. RESULTS The results from 203 included studies were grouped into seven TAD based interventions combining the clinical, simulation, and animal studies. They were: En masse retraction of anterior teeth, intrusion, movement of a single tooth, orthopaedic interventions, distalisation, maxillary expansion and other types. The forces involved with the use of TADs, and their effects on the dentition and surrounding structures, were presented in descriptive and tabular formats. LIMITATIONS This review restricted study language to English. Formal appraisal of the quality of evidence is not a required feature of scoping reviews, as per the PRISMA-ScR guidelines, however it was evident that a proportion of clinical studies were of high risk of bias and low quality and therefore any proposed changes the reader may consider to their clinical practice should be contextualized in light of this. CONCLUSIONS Across the seven types of TAD based interventions the effects on the dentition and surrounding structures are described providing a better understanding of the complex interactions. A guide to the level and direction of forces in each type of intervention is provided to aid clinicians in achieving high quality outcomes. IMPLICATIONS There is a need to validate future FEA simulation studies by comparing to clinical data. It is also recommended that future scoping reviews incorporate a formal critical appraisal of studies to facilitate the translation of the results into clinical practice. Development of a standard set of terms for TADs is recommended to facilitate future research. REGISTRATION Registration of a scoping review is not possible with PROSPERO. FUNDING None to declare.
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Affiliation(s)
- Colin Ritchie
- Orthodontic Department, Dundee Dental Hospital and Research School, University of Dundee, Scotland
| | - Scott McGregor
- Library & Learning Centre, University of Dundee, Scotland
| | - David R Bearn
- Orthodontic Department, University of Dundee, Scotland
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Meng WY, Ma YQ, Shi B, Liu RK, Wang XM. The comparison of biomechanical effects of the conventional and bone-borne palatal expanders on late adolescence with unilateral cleft palate: a 3-dimensional finite element analysis. BMC Oral Health 2022; 22:600. [PMID: 36514035 PMCID: PMC9745990 DOI: 10.1186/s12903-022-02640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with unilateral cleft lip and palate were associated with different nasomaxillary complex from the normal population. Although the biomechanical effects of conventional rapid palatal expansion (Hyrax expansion) and bone-borne rapid palatal expansion (micro-implant-assisted expansion) in non-cleft patients have been identified by multiple studies, little is known in patients with unilateral cleft lip and palate. The purpose of this study was to investigate and compare the biomechanical effects of the conventional and bone-borne palatal expanders in a late adolescence with unilateral cleft lip and palate. METHODS A cone beam CT scan of a late adolescence with unilateral cleft lip and palate was selected to construct the three-dimensional finite element models of teeth and craniofacial structures. The models of conventional and born-borne palatal expanders were established to simulate the clinical maxillary expansion. The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacements in craniofacial structures and teeth. RESULTS Bone-borne palatal expander achieved more transverse movement than conventional palatal expander in the whole mount of craniofacial regions, and the maximum amount of expansion was occurred anteriorly along the alveolar ridge on cleft-side. The expanding force from born-borne palatal expander resulted in more advancement in nasomaxillary complex than it in conventional palatal expander, especially in the anterior area of the minor segment of maxilla. Stresses from the both expanders distributed in similar patterns, but larger magnitudes and ranges were generated using the bone-borne expander around the maxillary buttresses and pterygoid plates of sphenoid bone. The maximum expanding stresses from born-borne palatal expander were concentrated on palatal slope supporting minscrews, whereas those from conventional palatal expander were concentrated on the anchoring molars. In addition, the buccal tipping effect of teeth generated using the bone-borne expander was less than it using the conventional palatal expander. CONCLUSION Bone-borne expander generated enhanced skeletal expansion at the levels of alveolar and palate in transversal direction, where the miniscrews contributed increased expanding forces to maxillary buttresses and decreased forces to buccal alveolar. Bone-borne expanders presented a superiority in correcting the asymmetric maxilla without surgical assistant in late adolescence with unilateral cleft lip and palate.
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Affiliation(s)
- Wen-yu Meng
- grid.412643.60000 0004 1757 2902Department of Ultrasound Imaging, The First Hospital of Lanzhou University, 730000 Lanzhou, The People’s Republic of China
| | - Yan-qing Ma
- grid.32566.340000 0000 8571 0482Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing (NO: 20JR10RA653 - ZDKF20210401), School of Stomatology, Lanzhou University, No. 199, Donggang West Road, Gansu Province 730000 Lanzhou, People’s Republic of China ,grid.32566.340000 0000 8571 0482Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000 Gansu Province People’s Republic of China
| | - Bing Shi
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 The People’s Republic of China
| | - Ren-kai Liu
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 The People’s Republic of China ,grid.413200.40000 0001 1276 6562Department of Orthodontics and Pediatric Dentistry, West China Stomatological Hospital, West China College of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041 People’s Republic of China
| | - Xiao-ming Wang
- grid.32566.340000 0000 8571 0482Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing (NO: 20JR10RA653 - ZDKF20210401), School of Stomatology, Lanzhou University, No. 199, Donggang West Road, Gansu Province 730000 Lanzhou, People’s Republic of China ,grid.32566.340000 0000 8571 0482Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000 Gansu Province People’s Republic of China
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Lu TY, Ahmad MA, Hassan WNW, Hariri F. The Stress and Deformation Effect of Novel Rapid Maxillary Expanders by Finite Element Analysis. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Age, Sex, and Maxillary Position Are Associated with Successful Microimplant-Assisted Rapid Palatal Expansion in Adults. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate the possible predictors of success of microimplant-assisted rapid palatal expansion (MARPE) in skeletally mature patients. Additionally, factors associated with the amount of maxillary expansion were analyzed. Factors associated with MARPE success were analyzed in 53 adult patients (27 males, 26 females, mean age 25.8 ± 8.9 years, and range 18.0 to 56.6 years) who had a maxillary transverse deficiency greater than 2 mm and a cervical vertebral maturation stage of 6. Age at pretreatment (T1), sex, sutural bone density at T1, type of appliance, mode of microimplant fixation, and lateral cephalometric variables at T1 were considered for inclusion as predictors for MARPE success. In patients who showed successful maxillary skeletal expansion, the linear distances of maxillary widths were measured on cone-beam-computed-tomography images at T1 and after MARPE (T2), and factors associated with the amount of expansion were analyzed. In total, 41 of the 53 patients showed successful maxillary expansion. Age (p = 0.019), sex (p = 0.002), and A-N perp (p = 0.015) were significantly associated with the success of MARPE. The factors associated with the amount of maxillary skeletal expansion were SN-MP and midpalatal-suture density at T1. In conclusion, there is a greater chance of failure in male patients who are older and have maxillary retrusion. A greater amount of maxillary expansion can be expected in patients with a higher mandibular-plane angle and with lower midpalatal-suture density.
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McMullen C, Al Turkestani NN, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Angelieri F, Franchi L, Ngan P, He H, Cevidanes LHS. Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2022; 161:666-678. [PMID: 34980520 PMCID: PMC9050833 DOI: 10.1016/j.ajodo.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. METHODS The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P <0.05). RESULTS Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P = 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P = 0.004). CONCLUSIONS Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.
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Affiliation(s)
- Craig McMullen
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, W Va
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Sarraj M, Akyalcin S, He H, Xiang J, AlSaty G, Celenk-Koca T, DeBiase C, Martin C, AlSharif K, Ngan P. Comparison of skeletal and dentoalveolar changes between pure bone-borne and hybrid tooth-borne and bone-borne maxillary rapid palatal expanders using cone-beam computed tomography. APOS TRENDS IN ORTHODONTICS 2021. [DOI: 10.25259/apos_160_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The objectives of the study were to compare the skeletal, dentoalveolar, and periodontal changes between two types of microimplant-assisted rapid maxillary expansion appliances: The bone-anchored maxillary expanders (BAME) and the tooth-bone-anchored maxillary skeletal expander (MSE).
Materials and Methods:
Thirty-four patients with a transverse maxillary deficiency were divided into two groups; the first group (16 patients, average age 14.9 years) was treated with the MSE appliance, and the second group (18 patients, average age 13.8 years) was treated with the BAME appliance. Cone-beam computed tomography scans were taken at pre-treatment (T1) and immediately post-expansion (T2) to measure the changes in midpalatal suture opening, total expansion (TE), alveolar bone bending, dental tipping (DT), and buccal bone thickness. Data were analyzed using paired t-test and two-sample t-test.
Results:
Midpalatal suture separation was found in 100% of the patients in both groups. The TE at the first molar was 5.9 mm in the MSE group and 4.7 mm in the BAME group. The skeletal contributions were 56% and 83% of TE for the MSE and BAME groups, respectively. Significantly less dental buccal tipping and buccal bone loss were found with the BAME group. The midpalatal suture in both groups exhibited a parallel opening pattern in the axial plane.
Conclusion:
The use of BAME appliance resulted in greater skeletal effects, less dental tipping, and less buccal bone reduction compared to MSE appliance (immediately after maxillary expansion).
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Affiliation(s)
- Mohamad Sarraj
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Sercan Akyalcin
- Department of Orthodontics, Tufts University, Boston, Massachusetts, United States,
| | - Hong He
- Department of Orthodontics, Wuhan University School of Stomatology, Wuhan, China,
| | - Jun Xiang
- Department of Family Medicine, West Virginia University, Morgantown, United States,
| | - Ghaddy AlSaty
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Tugce Celenk-Koca
- Department of Orthodontics, Tufts University, Boston, Massachusetts, United States,
| | - Christina DeBiase
- School of Dentistry Academic Affairs, West Virginia University, Morgantown, West Virginia, United States,
| | - Chris Martin
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Khaled AlSharif
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
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Bud ES, Bică CI, Păcurar M, Vaida P, Vlasa A, Martha K, Bud A. Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy. BIOLOGY 2021; 10:biology10030187. [PMID: 33802266 PMCID: PMC8001817 DOI: 10.3390/biology10030187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/20/2022]
Abstract
Simple Summary In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances. Abstract The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.
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Affiliation(s)
- Eugen Silviu Bud
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
| | - Cristina Ioana Bică
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
| | - Mariana Păcurar
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
| | - Petru Vaida
- Dudley Group of Hospitals NHS Foundation Trust, Birmingham B18 7QH, UK;
| | - Alexandru Vlasa
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
- Correspondence:
| | - Krisztina Martha
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
| | - Anamaria Bud
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania; (E.S.B.); (C.I.B.); (M.P.); (K.M.); (A.B.)
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Yu SK, Cho Y, Seo YS, Kim JS, Kim DK, Kim HJ. Radiological evaluation of the bone and soft tissue thicknesses of the palate for using a miniscrew-supported maxillary skeletal expander. Surg Radiol Anat 2021; 43:1001-1008. [PMID: 33386930 DOI: 10.1007/s00276-020-02634-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion. METHODS The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3 mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2 mm and 4 mm lateral to the anteroposterior reference line (AP line). RESULTS The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2 mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2 mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4 mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6 mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased. CONCLUSIONS These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.
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Affiliation(s)
- Sun-Kyoung Yu
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Yonghwa Cho
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Yo-Seob Seo
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jae-Sung Kim
- The Institute of Dental Science, College of Dentistry, Chosun University, Gwangju, Korea
| | - Do Kyung Kim
- The Institute of Dental Science, College of Dentistry, Chosun University, Gwangju, Korea
| | - Heung-Joong Kim
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea.
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Lam R, Goonewardene MS, Naoum S. Pulp blood flow and sensibility in patients with a history of dental trauma undergoing maxillary expansion. Angle Orthod 2020; 90:695-701. [PMID: 33378486 DOI: 10.2319/022520-129.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess changes in pulp blood flow (PBF) and pulp sensibility (PS) in teeth of patients with a history of dental trauma undergoing maxillary expansion. MATERIALS AND METHODS Twenty-five patients requiring rapid maxillary expansion (RME) had the pulp status of their maxillary anterior teeth assessed using laser Doppler flowmetry, electric pulp testing, and thermal testing (CO2 snow). Each patient was tested at T1 (prior to expansion), T2 (2 weeks after rapid expansion), and T3 (3 months after expansion). Relationships between PBF, time interval, and history of trauma were evaluated using linear mixed modelling. RESULTS Within the Trauma group, PBF was significantly lower (P ≤ .05) at T2 and T3 in comparison to T1 and significantly lower (P ≤ .05) at T2 in comparison to T3. In the Non-trauma group, PBF at T2 was significantly lower (P ≤ .05) than PBF at T1 and T3; however, no significant difference (P > .05) in PBF was observed when comparing PBF at T1 and T3. In both groups, PS was maintained in almost all teeth (>90%). CONCLUSIONS RME in healthy teeth causes reduction of PBF before reestablishment of pretreatment values. RME in traumatized teeth causes reduction of PBF without PBF being reestablished to pretreatment levels. Teeth with a history of compromise may have reduced adaptive capacity under insults such as RME, which should be appreciated during the informed consent process.
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Lena Sezici Y, Gediz M, Akış AA, Sarı G, Duran GS, Dindaroğlu F. Displacement and stress distribution of Kilroy spring and nickel-titanium closed-coil spring during traction of palatally impacted canine: A 3-dimensional finite element analysis. Orthod Craniofac Res 2020; 23:471-478. [PMID: 32492259 DOI: 10.1111/ocr.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the stress distribution and initial displacements during traction of palatally impacted canine between Kilroy and nickel-titanium (NiTi) closed-coil springs by means of the finite element analysis. SETTING AND SAMPLE POPULATION A finite element method analysis of two traction methods for a maxillary impacted canine. MATERIALS AND METHODS The corresponding periodontal ligaments (PDLs), brackets, molar tubes and a 0.019 × 0.025-in base stainless-steel (SS) wire were modelled and imported to ANSYS SpaceClaim version 2020 R1. Traction was simulated under two different set-ups with equal force magnitude (60 g); (1) the Kilroy spring, which is made of 0.016-inch SS, and (2) the NiTi closed -coil spring. Von Mises stress distributions and initial displacements of the maxillary teeth were analysed. RESULTS In both mechanics, while the highest stress was seen on the impacted canine (Kilroy, 10.41 kPa; NiTi closed-coil, 5.27 kPa), the stress distribution decreased as the distance from the impacted canine increased. The Kilroy spring showed a greater total displacement (465.60 μm) on the impacted canine. The higher stresses on the adjacent lateral (5.29 kPa) and premolar (6.41 kPa) occurred with the Kilroy spring. CONCLUSIONS The Kilroy spring yielded higher stresses than the NiTi closed-coil spring on the impacted canine and the adjacent teeth. The difference between distribution of the stresses over the impacted canine induced greater displacement with the Kilroy spring, particularly in the vertical direction.
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Affiliation(s)
| | - Meltem Gediz
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | | | - Gözde Sarı
- Department of Mechanical Engineering, Faculty of Engineering, University of Celal Bayar, Manisa, Turkey
| | - Gökhan Serhat Duran
- Department of Orthodontics, Gülhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey
| | - Furkan Dindaroğlu
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
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23
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Galli M, Federici FR, Di Nardo D, Yusef M, Morese A, Manenti RJ, Testarelli L. Surgical and orthodontic rapid palatal expansion in adults using a modified palatal partial osteotomy technique (ppot): Technique description and clinical experience. J Clin Exp Dent 2020; 12:e610-e614. [PMID: 32665823 PMCID: PMC7335607 DOI: 10.4317/jced.56313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/26/2020] [Indexed: 11/20/2022] Open
Abstract
Transversal hypoplasia of the upper maxilla is a frequent condition between malocclusions. The rapid maxillary expansion (RME) is an already consolidated technique for these types of defects. This case report analyzes the outcome of a novel surgical technique that we named TOPP (Partial Palatal osteotomy technique) aiming to provide scientifically proven data over the percentage of relapse and the long-term stability of this type of surgical assisted palatal expansion. A 24 year old male patient with a hyperdivergent class III, presenting the absence of 1.1 due to a teenage trauma and a transversal contraction of the upper arch was selected for the surgery. The mucoperiosteal flap was performed at a palatal level with a paramarginal arch shape (from region 1.4 to 2.4) due to preserve the nasal-incisal vascular bundle and the mucoperiosteum was detached from the floor of the nose. A horizontal osteotomy was performed at 4-5 mm above the roots apexes; a sagittal osteotomy in a posterior direction was done at the level of the midline to divide the mesiopalatine suture and separate the maxilla in two halves. The only bony attachment that remained was represented by the perpendicular lamina of the palatal bone. The TOPP technique showed that it is possible to have a better control of both the intercanine and intermolar expansion, that is more difficult in the case of a conventional SARME. Other goals were a greater view and access to the site and the reduction of the risk of damaging the palatine fibromucosa. The incision of the archform paramarginal flap improves certainly the conditions of the palatal fibromucosa in the post operative and allows the reduction of the soft tissues’ elastic return. Key words:Rapid maxillary expansion, orthognatic surgery, maxillary osteotomy.
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Affiliation(s)
- Massimo Galli
- MD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | | | - Dario Di Nardo
- DDS, PhD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Marco Yusef
- MD, DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Antonio Morese
- DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Rebecca-Jewel Manenti
- DDS. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Luca Testarelli
- DDS, PhD. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
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Fox GC, Jones TA, Wilson JM, Claro WI, Williams RA, Trojan TM, Al Dayeh A. Sutural loading in bone‐ versus dental‐borne rapid palatal expansion: An ex vivo study. Orthod Craniofac Res 2020; 23:419-426. [DOI: 10.1111/ocr.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Gavin C. Fox
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Thomas A. Jones
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - John M. Wilson
- College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Wanda I. Claro
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Richard A. Williams
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Terry M. Trojan
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Ayman Al Dayeh
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
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25
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ALKAN Ö, AKKAYA S. An investigation of the biomechanical effects of vertical chin cup on mandibular condyle and ramus in those with and without anterior openbite: a finite element method. ACTA ODONTOLOGICA TURCICA 2020. [DOI: 10.17214/gaziaot.657363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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