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Akbulut S, Yilmaz S, Yagci A. Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol : A retrospective study. J Orofac Orthop 2023; 84:278-286. [PMID: 35257194 DOI: 10.1007/s00056-022-00380-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to compare the short-term effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) with conventional rapid maxillary expansion (RME) followed by facemask (FM) therapy. METHODS A total of 30 patients who had received facemask therapy after RME or Alt-RAMEC protocols were included in the study. The Alt-RAMEC/FM and RME/FM groups were created to be well-matched regarding cervical vertebral maturation stage and sex. In the Alt-RAMEC group (10 males and 5 females, 10.99 ± 1.80 years), expansion screws were activated for a week (two turns/day), then deactivated in the following week (two turns/day). The activation-deactivation protocol continued for 6 or 7 weeks. In the RME/FM group (10 males and 5 females, 11.61 ± 1.20 years), screw activation was performed according to the patients' requirements. Lateral cephalograms which had been taken at the beginning of treatment and at the end of the facemask therapy were analyzed. Intragroup and intergroup differences were statistically analyzed. RESULTS Both groups showed a significant sagittal advancement of the maxilla. However, the Alt-RAMEC/FM group showed statistically greater improvements than the RME/FM group for SNA (3.11 ± 1.79 vs. 1.45 ± 1.34, p = 0.008), ANB (4.29 ± 1.80 vs. 2.95 ± 1.19, p = 0.023), convexity (8.91 ± 4.29 vs. 5.61 ± 2.51, p = 0.016), and overjet (5.86 ± 2.29 vs. 4.61 ± 2.10, p < 0.001). The sagittal mandibular, vertical skeletal, dental, and soft tissue changes were similar between the groups (p > 0.05). CONCLUSION The Alt-RAMEC protocol was found to be more effective in the correction of skeletal class III malocclusion in the short term.
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Affiliation(s)
- Sibel Akbulut
- Faculty of Dentistry, Department of Orthodontics, Tokat Gaziosmanpasa University, Tokat, Turkey.
| | - Sema Yilmaz
- Faculty of Dentistry, Department of Orthodontics, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Ahmet Yagci
- Faculty of Dentistry, Department of Orthodontics, Erciyes University, Kayseri, Turkey
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Singh H, Kapoor P, Sharma P, Maurya RK, Mittal T. Management of skeletal Cl III malocclusion using simultaneous alternate rapid maxillary expansion and constriction (Alt-RAMEC) and facemask protraction in adolescence. J Dent Res Dent Clin Dent Prospects 2022; 16:62-69. [PMID: 35936931 PMCID: PMC9339741 DOI: 10.34172/joddd.2022.010] [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: 11/01/2020] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Cl III malocclusion with a significant skeletal component presents a therapeutic challenge during adolescence. This article presents the encouraging results of an individualized two-stage treatment approach adopted for successful nonsurgical correction of severe skeletal Cl III malocclusion in an adolescent girl after the onset of puberty. An orthopedic approach involving simultaneous alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol and protraction facemask (PFM) therapy was adopted in phase 1 to correct the sagittal skeletal discrepancy. In phase 2, fixed orthodontic therapy aided by the interim use of a modified occlusal settling appliance was undertaken to obtain well-interdigitated occlusion. Meticulously planned and well-executed orthopedic and orthodontic approach, combined with good patient compliance and favorable growth pattern, helped establish well-balanced facial harmony with a proper maxillomandibular relationship and satisfactory overjet and overbite. The results remained stable during the 4-year follow-up. Alt-RAMEC-PFM therapy accompanied by fixed mechanotherapy is a viable option to treat severe skeletal Cl III malocclusion in adolescents.
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Affiliation(s)
- Harpreet Singh
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Delhi, India
| | - Pranav Kapoor
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Delhi, India
| | - Poonam Sharma
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Delhi, India
| | - Raj Kumar Maurya
- Department of Dentistry, Central Government Dental Unit, Dimapur, Nagaland
| | - Tanmay Mittal
- Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, Delhi, India
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The relationship between local alveolar bone housing and size of canine in maxillary canine-lateral incisor transposition: A retrospective cone-beam computed tomography–based study. Am J Orthod Dentofacial Orthop 2022; 162:331-339. [DOI: 10.1016/j.ajodo.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 11/20/2022]
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Özbilen EÖ, Yılmaz HN, Acar YB. Does Alt-RAMEC protocol and facemask treatment affect dentoalveolar structures? Angle Orthod 2021; 91:626-633. [PMID: 33843979 PMCID: PMC8376168 DOI: 10.2319/111620-940.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate dentoalveolar changes immediately after the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol and facemask (FM) treatment using cone-beam computed tomography images. MATERIALS AND METHODS Cone-beam computed tomography images of 20 patients (mean age = 9.64 ± 1.3 years) who received the Alt-RAMEC protocol before FM treatment were retrieved in this retrospective study. Dental and alveolar inclinations, buccal and palatal alveolar bone thickness, and buccal and palatal alveolar bone height changes were measured before treatment (T0), after the Alt-RAMEC protocol (T1), and after FM treatment (T2). Measurements for right and left molars were performed separately. The Shapiro-Wilks test was used to assess the conformity of the parameters to the normal distribution. The paired t-test and repeated measures analysis of variance were used for normally distributed data. The Wilcoxon signed-rank test and Friedman test were used for non-normally distributed data. The Bonferroni correction was used to reduce the chances of obtaining false-positive results. Statistical significance was set at P < .05. RESULTS Buccal alveolar bone thickness and alveolar bone inclinations decreased significantly from T1 to T0 and showed no significant change from T2 to T1. The total reduction T2-T0 was statistically significant. The change in palatal alveolar bone thickness was not significant T1-T0 but increased significantly for T2-T1 and T2-T0. Buccal alveolar bone height, palatal alveolar bone height, and molar inclinations increased significantly T1-T0, but there was no significant change T2-T1. The total reduction at T2-T0 was statistically significant. CONCLUSIONS The results of this study revealed that the effects of the Alt-RAMEC protocol on dentoalveolar tissues were similar to the changes reported in the literature after rapid palatal expansion.
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Çoban Büyükbayraktar Z, Doruk C, Doğan M, Ertaş G. Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial. J Orofac Orthop 2021; 83:395-402. [PMID: 34191034 DOI: 10.1007/s00056-021-00316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients. METHODS This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ 2 test and independent samples t‑test were used to evaluate the data. RESULTS The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05). CONCLUSION This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.
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Affiliation(s)
| | - Cenk Doruk
- Department of Orthodontics, Sivas Cumhuriyet University School of Dentistry, Sivas, Turkey
| | - Mansur Doğan
- Department of Otorhinolaryngology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| | - Gökcan Ertaş
- Department of Orthodontics, Sivas Cumhuriyet University School of Dentistry, Sivas, Turkey
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Xu D, Xie C, Yu H, Zhang Z, Zheng J, Xu S. Evaluation of factors affecting alveolar ridge height and facial bone thickness in Chinese maxillary central incisors by cone beam CT. J Dent Sci 2020; 16:229-235. [PMID: 33384802 PMCID: PMC7770285 DOI: 10.1016/j.jds.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background/purpose In the immediate implantation of maxillary central incisors, the height of the alveolar bone is lost, and there is often a risk of bone fracture due to the thin buccal bone wall (BBW). The purpose of this study was to assess the effects of smoking, age, and root position in the alveolar bone on the BBW and the distance between the cemento-enamel junction (CEJ) and the facial bone crest (FBC) of Chinese maxillary central incisors. Materials and methods The patients were divided by smoking, gender, age, and root sagittal position in the alveolar bone. BBW thickness was measured at the following sites: the 4 mm apical to the CEJ, the middle of the root, and the apex. The distance from the CEJ to the FBC was also evaluated. Results Cone beam CT (CBCT) data for the maxillary central incisors of 645 patients (323 males and 322 females) were selected and analyzed. The CEJ-FBC distance in patients who smoked (2.79 ± 0.78 mm) was significantly greater than that of non-smokers (2.54 ± 0.69 mm). The BBW in subtype III (0.74 ± 0.43 mm, 0.81 ± 0.36 mm) was thinner than that in subtypes I and II at 4 mm apical to the CEJ and in the middle of the root, with a statistically significant difference (p < 0.05). Conclusion In most Chinese people, smoking, gender, age, and the position of the root in alveolar bone are all important factors that must be considered before immediate implantation is undertaken.
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Affiliation(s)
- Duoling Xu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Chengjie Xie
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Huimin Yu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Zhiyong Zhang
- Department of Radiology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Junfa Zheng
- Department of Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Shulan Xu
- Department of Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China
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Almuzian M, Almukhtar A, Ulhaq A, Alharbi F, Darendeliler MA. 3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study. Prog Orthod 2019; 20:37. [PMID: 31531735 PMCID: PMC6749004 DOI: 10.1186/s40510-019-0290-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients. MATERIALS AND METHODS Fourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map. RESULTS All participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB - 2.03° ± 0.85°, Vert.T-B - 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed. CONCLUSION Class III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required.
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Affiliation(s)
- Mohammed Almuzian
- Faculty of Dentistry, University of Sydney, Sydney, Australia.,Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Anas Almukhtar
- College of Dentistry, University of Mosul, Mosul, Iraq.,University of Glasgow, Glasgow, UK
| | - Aman Ulhaq
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Fahad Alharbi
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz, AL-Kharj, 11942, Saudi Arabia.
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Abdelkarim A. Cone-Beam Computed Tomography in Orthodontics. Dent J (Basel) 2019; 7:E89. [PMID: 31480667 PMCID: PMC6784482 DOI: 10.3390/dj7030089] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
Abstract
Unlike patients receiving implants or endodontic treatment, most orthodontic patients are children who are particularly sensitive to ionizing radiation. Cone-beam computed tomography (CBCT) carries risks and benefits in orthodontics. The principal risks and limitations include ionizing radiation, the presence of artifacts, higher cost, limited accessibility, and the need for additional training. However, this imaging modality has several recognized indications in orthodontics, such as the assessment of impacted and ectopic teeth, assessment of pharyngeal airway, assessment of mini-implant sites, evaluation of craniofacial abnormalities, evaluation of sinus anatomy or pathology, evaluation of root resorption, evaluation of the cortical bone plate, and orthognathic surgery planning and evaluation. CBCT is particularly justified when it brings a benefit to the patient or changes the outcome of the treatment when compared with conventional imaging techniques. Therefore, CBCT should be considered for clinical orthodontics for selected patients. Prescription of CBCT requires judicious and sound clinical judgment. The central question of this narrative review article is: when does CBCT add value to the practice of orthodontics? To answer this question, this article presents discussion on radiation dosage of CBCT and other imaging techniques used in orthodontics, limitations of CBCT in orthodontics, justifying the use of CBCT in orthodontics, and the benefits and evidence-based indications of CBCT in orthodontics. This review summarizes the central themes and topics in the literature regarding CBCT in orthodontics and presents ten orthodontic cases in which CBCT proved to be valuable.
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Affiliation(s)
- Ahmad Abdelkarim
- Department of Orthodontics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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