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Loberto S, Pavoni C, Fanelli S, Lugli L, Cozza P, Lione R. Predictability of expansion movements performed by clear aligners in mixed dentition in both arches: a retrospective study on digital casts. BMC Oral Health 2024; 24:694. [PMID: 38879479 PMCID: PMC11179342 DOI: 10.1186/s12903-024-04435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/03/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND to evaluate the predictability of expansion achieved in patients in early mixed dentition treated with Clear Aligners (CA), analyzing the efficiency of the expansion at the end of the first set of aligners and at the end of the therapy in the upper and lower arch. METHODS 36 patients (20 F, 16 M; mean age 8.3 ± 1.5 years) were selected retrospectively from the Department of Orthodontics of the Hospital of Rome "Tor Vergata". All subjects were treated with CA with no other auxiliaries than attachments. For each patient a standardized sequential expansion protocol was planned for both arches. Digital dental casts were created at three observation periods from an intraoral scanner: prior to treatment (T0), at the end of the first set of aligners (T1), at the end of treatment (T2). The 3D models in planned position determined by the first Clincheck (CC) were obtained for comparison with T1 and T2. Six linear transversal measurements were used to evaluate the dimensional changes and the predictability of expansion movements, comparing T1-CC and T2-CC. RESULTS a statistically significant increase within the pre-treatment and the final outcomes for all the variables examined was found. In the upper arch, the greatest level of predictability was detected at the level of the first (46.44%) and second deciduous molar width (44.95%) at T1. The analysis of T2-CC changes showed a significant increase in the percentage of predictability of expansion at the level of the first permanent molars, at mesial (54.86%) and distal (58.92%) width. In the lower arch, a higher percentage of predictability than the upper arch was reported at T1-CC and T2-CC, with the greatest values at the level of second (T1-CC: 48.70%; T2-CC: 75.32%) and first deciduous molar width (T1-CC: 45.71%; T2-CC: 72.75%). CONCLUSIONS CA can induce significant transversal increments. The predictability of expansion is variable, but it did not exceed the 50% during the first set of aligners. It was necessary to apply refinement set to achieve a good predictability for expansion of about 70%. The expansion in the lower arch was observed to be more predictable than in the upper arch.
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Affiliation(s)
- Saveria Loberto
- Phd graduate, Department of Health Science, Unicamillus-Saint Camillus International Medical University, Rome, Italy
| | - Chiara Pavoni
- Researcher, Department of Health Science, Unicamillus-Saint Camillus International Medical University, Rome, Italy
| | - Silvia Fanelli
- Research fellow, Department of Health Science, UniCamillus-Saint Camillus International Medical University, Rome, Italy
| | - Letizia Lugli
- Research fellow, Department of Health Science, UniCamillus-Saint Camillus International Medical University, Rome, Italy.
| | - Paola Cozza
- Professor, Department of Health Science, Unicamillus-Saint Camillus International Medical University, Rome, Italy
| | - Roberta Lione
- Researcher, Department of Health Science, Unicamillus-Saint Camillus International Medical University, Rome, Italy
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de Mesquita EV, Meloti F, Silva E, de Almeida Cardoso M, An TL, do Carmo Chagas Nascimento M. Craniomandibular transverse tomographic evaluation after anterior open bite orthodontic treatment with miniplates anchorage. Prog Orthod 2024; 25:19. [PMID: 38797777 PMCID: PMC11128423 DOI: 10.1186/s40510-024-00519-1] [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: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Skeletal anterior open bite (SAOB) represents one of the most complex and challenging malocclusions in orthodontics. Orthodontic treatment supported by miniplates enable to reduce the need for orthognathic surgery. Transverse dimension may be affected by intrusion biomechanics. This study aims to assess transverse bone alterations in patients with SAOB who underwent orthodontic treatment with absolute anchorage using four miniplates. METHODS A total of 32 patients of both sexes, with an average age of 33.8 years, diagnosed with SAOB and treated orthodontically with four miniplates (one in each hemiarch), were selected for this study. Tomographic examinations were performed before (T1) and after (T2) orthodontic treatment. Linear measurements (width of the maxillary base, maxillary alveolar, maxillary root, maxillary dental cusp, mandibular alveolar) and angular measurements (maxillary intermolar angle) were assessed in these images. The Shapiro-Wilks normality tests were applied to verify data distribution, and the paired t-test was used to compare the initial and final measures obtained. RESULTS Among the evaluated parameters, the maxillary alveolar width, maxillary dental cusp width, mandibular alveolar cusp width, and intermolar angle showed statistically significant differences between T1 and T2 (p < 0.05). However, maxillary base and maxillary root widths showed no significant difference (p > 0.05). CONCLUSIONS Intrusion and distalization with miniplates in SAOB therapy may lead to significant expansive changes, due to molars cusps width and buccal inclination increase restricted at the alveolar level.
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Affiliation(s)
- Enio Vitor de Mesquita
- Division of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, SP, Brazil
| | - Fernanda Meloti
- Division of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, SP, Brazil
| | - Ertty Silva
- Division of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, SP, Brazil
| | - Mauricio de Almeida Cardoso
- Division of Orthodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, SP, Brazil
| | - Tien-Li An
- Department of Dentistry, University of Brasilia, School of Health Sciences, Distrito Federal, Brasília, Brazil
| | - Monikelly do Carmo Chagas Nascimento
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, R. Dr. José Rocha Junqueira, 13-Pte. Preta, Campinas, São Paulo, SP, 13045-755, Brazil.
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Verplanken T, Vanroose R, Ureel M, Coopman R, Van Paepegem W. Numerical study of the impact of osteotomies and distractor location in surgically assisted rapid palatal expansion for transverse maxillary deficiency. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101916. [PMID: 38763267 DOI: 10.1016/j.jormas.2024.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION This paper employs finite element analysis to assess the biomechanical behavior of surgically assisted rapid palatal expansion (SARPE) with a bone-borne transpalatal distractor (TPD) by varying surgical parameters. MATERIAL AND METHODS Nine models were constructed to scrutinize the effects of pterygomaxillary disjunction (PMD), lateral osteotomy positioning, and TPD placement on displacement profiles and Von Mises stresses. These models encompassed variations such as no, unilateral or bilateral PMD, asymmetrical lateral osteotomy, and five TPD locations. RESULTS Performing a PMD reduces posterior resistance to transverse expansion, resulting in 10-20 % stress reduction around the maxillofacial complex. No significant changes in horizontal tipping were observed post-PMD. The asymmetric lateral osteotomy model exhibited larger displacements on the side with a more superiorly positioned osteotomy. Reduced stresses were observed at the maxillary body and medial pterygoid plate (superiorly), while increased stresses were observed at the medial (inferiorly) and lateral pterygoid plates. More posterior TPD placement facilitated more parallel expansion thus less horizontal tipping, albeit with increased vertical tipping. DISCUSSION SARPE procedures (distractor and osteotomy positions) can be tailored based on desired outcomes. PMD reduces stress within the maxillofacial complex but doesn't significantly affect tipping. Higher lateral osteotomies lead to increased displacements, more posterior distractors to more parallel expansion.
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Affiliation(s)
- Tomas Verplanken
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Robin Vanroose
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium.
| | - Matthias Ureel
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Wim Van Paepegem
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
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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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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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Šefeldaitė S, Mitalauskienė A, Trakinienė G, Vasiliauskas A, Lopatienė K, Venskutonis T. Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study. Med Sci Monit 2023; 29:e940539. [PMID: 37598290 PMCID: PMC10448776 DOI: 10.12659/msm.940539] [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: 03/28/2023] [Accepted: 07/01/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.
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Affiliation(s)
- Simona Šefeldaitė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Austėja Mitalauskienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Giedrė Trakinienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arunas Vasiliauskas
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Lopatienė
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tadas Venskutonis
- Department of Dental and Oral Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Zhao H, Wang X, Jin A, Wang M, Wang Z, Huang X, Dai J, Wang X, Lin D, Shen SGF. Reducing relapse and accelerating osteogenesis in rapid maxillary expansion using an injectable mesoporous bioactive glass/fibrin glue composite hydrogel. Bioact Mater 2022; 18:507-525. [PMID: 35415307 PMCID: PMC8976096 DOI: 10.1016/j.bioactmat.2022.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Rapid maxillary expansion (RME), as a common treatment for craniomaxillofacial deformity, faces the challenge of high relapse rates and unsatisfactory therapeutic effects. In this study, a standardized Sprague-Dawley (SD) rat RME model was first established with a modified expander as well as retainer design and optimized anterior maxillary expanding force of 100 g which exerted the most synchronized mobility of mid-palatal suture and incisors. Via the standardized model, the high relapse rate was proven to be attributed to insufficient osteogenesis in expanded suture, requiring long-term retainer wearing in clinical situations. To reduce the relapse rate, mesoporous bioactive glass/fibrin glue (MBG/FG) composite hydrogels were developed for an in situ minimal invasive injection that enhance osteogenesis in the expanded palate. The component of 1 wt% MBG was adopted for enhanced mechanical strength, matched degradation rate and ion dissolution, excellent in vitro biocompatibility and osteoinductivity. Effects of 1%MBG/FG composite hydrogel on osteogenesis in expanded mid-palatal sutures with/without retention were evaluated in the standardized model. The results demonstrated that injection of 1%MBG/FG composite hydrogel significantly promoted bone formation within the expanded mid-palatal suture, inhibited osteoclastogenesis and benefited the balance of bone remodeling towards osteogenesis. Combination of retainer and injectable biomaterial was demonstrated as a promising treatment to reduce relapse rate and enhance osteogenesis after RME. The model establishment and the composite hydrogel development in this article might provide new insight to other craniomaxillofacial deformity treatment and design of bone-repairing biomaterials with higher regenerative efficiency. A standardized rat RME model was established with optimized parameters. Sufficient osteogenesis was the prerequisite of reducing relapse ratio. Design of an injectable MBG/FG composite hydrogel for osteogenic enhancement. Combinatory treatment of injection and retention was developed for relapse reduction.
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Solano Mendoza P, Aceytuno Poch P, Solano Reina E, Solano Mendoza B. Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography. J Clin Med 2022; 11:jcm11164652. [PMID: 36012886 PMCID: PMC9410327 DOI: 10.3390/jcm11164652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.
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Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:4509-4523. [PMID: 35211817 DOI: 10.1007/s00784-022-04415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency. MATERIALS AND METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99). CONCLUSIONS MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination. REGISTRATION This study is registered with PROSPERO, CRD42021256750. CLINICAL RELEVANCE MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.
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Feştilă D, Enache AM, Nagy EB, Hedeşiu M, Ghergie M. Testing the Accuracy of Pont’s Index in Diagnosing Maxillary Transverse Discrepancy as Compared to the University of Pennsylvania CBCT Analysis. Dent J (Basel) 2022; 10:dj10020023. [PMID: 35200248 PMCID: PMC8871275 DOI: 10.3390/dj10020023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Assessment of maxillary transverse discrepancy requires an accurate tool in order to implement the appropriate treatment plan. Aim: To evaluate the accuracy of Pont’s Index in confirming a transverse maxillary deficiency by comparing its results with the corresponding results yielded by the University of Pennsylvania CBCT analysis. Material and methods: The study was performed on dental casts and CBCT’s of 60 randomly selected patients by adopting a cluster sampling method. The results of Pont’s Index and University of Pennsylvania CBCT analysis were analyzed through McNemar’s test using Excel Data Analysis, and the accuracy indicators for Pont’s Index were computed using MedCalc Ltd. Results: Mc Nemar’s test revealed a p-value of 0.85. The accuracy indicators of Pont’s Index were: sensitivity: 69%; specificity: 16.6%; positive predictive value: 65%; negative predictive value: 18.75%; positive likelihood ratio: 0.83; negative likelihood ratio: 1.86; and accuracy: 53.28%. Conclusion: Due to the fact that CBCT is not used on a daily basis and Pont’s Index has a relatively high sensitivity (69%) making it suitable to detect patients with a narrow maxilla, assessment of the maxillary deficiency on CBCT can be recommended for cases were the midpalatal suture maturation should be evaluated.
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Affiliation(s)
- Dana Feştilă
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
| | - Aurelia Magdalena Enache
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, “C. Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (A.M.E.); (E.B.N.)
| | - Evelyn Beatrix Nagy
- B-Line Dent, Str. Observatorului nr. 7 ap. 35, 400500 Cluj-Napoca, Romania
- Correspondence: (A.M.E.); (E.B.N.)
| | - Mihaela Hedeşiu
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
| | - Mircea Ghergie
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
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Araujo MTDS, Squeff LR. Orthodontic camouflage as a treatment alternative for skeletal Class III. Dental Press J Orthod 2021; 26:e21bbo4. [PMID: 34524381 PMCID: PMC8439187 DOI: 10.1590/2177-6709.26.4.e21bbo4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. Objective: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.
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Loriato L, Ferreira CE. Surgically-assisted rapid maxillary expansion (SARME): indications, planning and treatment of severe maxillary deficiency in an adult patient. Dental Press J Orthod 2020; 25:73-84. [PMID: 32844966 PMCID: PMC7437145 DOI: 10.1590/2177-6709.25.3.073-084.bbo] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Maxillary deficiency, also called transverse deficiency of the maxilla, may be associated with posterior crossbite, as well as with other functional changes, particularly respiratory. In adult patients, because of bone maturation and the midpalatal suture fusion, rapid maxillary expansion has to be combined with a previous surgical procedure to release the areas of resistance of the maxilla. This procedure is known as surgically-assisted rapid maxillary expansion (SARME). Objective: This study discusses the indications, characteristics and effects of SARME, and presents a clinical case of transverse and sagittal skeletal maxillary discrepancy treated using SARME and orthodontic camouflage.
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Affiliation(s)
- Lívia Loriato
- Pontifícia Universidade Católica, Belo Horizonte, MG, Brazil
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