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Magalhães MC, Normando D, Soares CJ, Araujo E, Novaes RMO, Teodoro VV, Flores-Mir C, Kim KB, Almeida GA. Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial. Pediatr Pulmonol 2024. [PMID: 39239911 DOI: 10.1002/ppul.27239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship. STUDY DESIGN/METHODS Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test. RESULTS The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT. CONCLUSIONS Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.
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Affiliation(s)
- Maria Cecilia Magalhães
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
| | - David Normando
- Department of Orthodontics, Federal University of Para, Belem, Brazil
| | - Carlos José Soares
- Department of Dental Materials, School of Dentistry, Federal University of Uberlândia Uberlândia, Brazil
| | - Eustaquio Araujo
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | | | | | - Carlos Flores-Mir
- Department of Dentistry and Dental Hygiene, University of Alberta, Edmonton, Alberta, Canada
| | - Ki Beom Kim
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | - Guilherme A Almeida
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
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Empson I, Del Santo M, Kuo CL, Vich ML, Liu D, Yadav S, Mehta S. Short- and long-term effects of conventional and miniscrew-assisted rapid palatal expansion on hard tissues using voxel-based superimposition of serial cone-beam computed tomography scans. Am J Orthod Dentofacial Orthop 2024:S0889-5406(24)00268-3. [PMID: 39046384 DOI: 10.1016/j.ajodo.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION The objective of this study was to evaluate the short-term and long-term hard-tissue changes with miniscrew-assisted rapid palatal expansion (MARPE) and rapid palatal expansion (RPE) compared with a matched control group with voxel-based superimposition using 3-dimensional cone-beam computed tomography (CBCT) scans. METHODS A total of 180 CBCT scans were analyzed for 60 patients with a mean age of 13.9 years at 3 time points: pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were divided into 3 groups: MARPE, RPE, and controls. Voxel-based superimposition was performed for CBCTs from T1 to T2 and T1 to T3 using the anterior cranial base as a reference. The hard-tissue surfaces were extracted after the superimposition procedure. Nine landmarks were analyzed: nasion, A-point, pogonion, left and right alar bases, zygoma, and gonion. Within-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effect of time (T1, T2, or T3) with test P values adjusted for multiple testing using Tukey's method. Between-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effects of time, group, and group × time interaction with P values adjusted for multiple testing using the Benjamin-Hochberg false discovery rate method. RESULTS In the short term, both MARPE and RPE led to a significant downward movement of the right gonion and lateral movement of the right alar base compared with controls at T2 (P <0.05). In addition, MARPE led to a significant downward movement of pogonion and left gonion. RPE led to a significant downward movement of the A-point and lateral movement of the left alar base compared with controls at T2 (P <0.05). However, in the long-term, no changes were observed between the groups at T3. CONCLUSIONS There were significant differences in pogonion, alar base, and gonion between MARPE, RPE, and control groups in the short term. However, all the hard-tissue changes were transient, as there were no differences between the 3 groups in the long term.
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Affiliation(s)
| | - Marinho Del Santo
- Departments of Developmental Sciences and Orthodontics, School of Dentistry, Marquette University, Milwaukee, Wis
| | - Chia-Ling Kuo
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, Conn
| | | | - Dawei Liu
- Departments of Developmental Sciences and Orthodontics, School of Dentistry, Marquette University, Milwaukee, Wis
| | - Sumit Yadav
- Henry and Anne Cech Professor of Orthodontics, University of Nebraska Medical Center College of Dentistry and Children's Hospital and Medical Center, Lincoln, Nebr
| | - Shivam Mehta
- Department of Orthodontics, School of Dentistry, Texas A&M University, Dallas, Tex.
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Krijt LL, Kapetanović A, Sijmons WJL, Bruggink R, Baan F, Bergé SJ, Noverraz RRM, Xi T, Schols JGJH. What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study. Clin Oral Investig 2023; 27:5343-5351. [PMID: 37507601 PMCID: PMC10492756 DOI: 10.1007/s00784-023-05154-4] [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: 10/05/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS 3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS. RESULTS Twenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06). CONCLUSIONS Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited. CLINICAL RELEVANCE MARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.
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Affiliation(s)
- Laura L Krijt
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands.
| | - Aldin Kapetanović
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Wouter J L Sijmons
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Robin Bruggink
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Frank Baan
- Radboudumc 3D Lab, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - René R M Noverraz
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jan G J H Schols
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboudumc Graduate School, Radboud University Medical Center, PO Box 9101, Dentistry 309, 6500, HB, Nijmegen, the Netherlands
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Georgiadis T, Angelopoulos C, Papadopoulos MA, Kolokitha OE. Three-Dimensional Cone-Beam Computed Tomography Evaluation of Changes in Naso-Maxillary Complex Associated with Rapid Palatal Expansion. Diagnostics (Basel) 2023; 13:diagnostics13071322. [PMID: 37046539 PMCID: PMC10093383 DOI: 10.3390/diagnostics13071322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
The introduction of Cone-Beam Computed Tomography (CBCT) in orthodontics has added a new tool to diagnosis and treatment planning. The aim of this prospective clinical trial was to investigate the changes in the dimensions of the naso-maxillary complex in growing patients after RPE using CBCT. A total of 16 growing children (8 females, 6 males) with a mean age of 11, 12 ± 1 and 86 years underwent RPE as part of their comprehensive orthodontic treatment. CBCT scans were obtained before RPE (T1), immediately after RPE (T2) and 6 months after RPE (T3). The dimensions of the nasal width, nasal floor and the aperture of the midpalatal suture were calculated in different coronal slices of CBCT. Evaluation of the mean value variance per measurement at the three time intervals were performed using the paired Wilcoxon signed-rank test. Differences between the three time intervals were assessed by performing Multiple Pairwise Comparisons. A statistically significant increase in all measurements was seen immediately after RPE expansion (T2–T1) and six months after expansion (T3–T1). Between the end of expansion and 6 months in retention (T3–T2), a decrease was observed for all measurements. RPE can cause expansion of the nasal cavity in growing patients. The expansion of the midpalatal suture follows a triangular pattern of opening.
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Affiliation(s)
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Moschos A. Papadopoulos
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olga-Elpis Kolokitha
- Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Ahmida A, Mehta S, Amelemah E, Bashir R, Vich ML, Tadinada A, Allareddy V, Yadav S. Short-term and long-term effects of miniscrew-assisted and conventional rapid palatal expansion on the cranial and circummaxillary sutures. Am J Orthod Dentofacial Orthop 2023; 163:e115-e126. [PMID: 36754700 DOI: 10.1016/j.ajodo.2023.01.007] [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: 09/01/2022] [Revised: 01/01/2023] [Accepted: 01/01/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The objective of this study was to analyze the short-term and long-term effects of miniscrew-assisted rapid palatal expansion (MARPE) and conventional rapid palatal expansion (RPE) appliances on cranial and circummaxillary sutures as compared with a matched control group. METHODS One hundred and eighty cone-beam computed tomography scans for 60 subjects were evaluated for the 3 groups: (1) MARPE (n = 20; aged 13.7 ± 1.74 years), (2) RPE (n = 21; age 13.9 ± 1.14 years), and (3) control (n = 19; age 13.3 ± 1.49 years) at pretreatment (T1), postexpansion (T2), and posttreatment (T3) (T1 to T3: MARPE, 2 years 8 months; RPE, 2 years 9 months; control, 2 years 7 months). Frontonasal suture, frontomaxillary suture, zygomaticomaxillary suture, zygomaticofrontal suture, intermaxillary suture, pterygomaxillary suture, nasomaxillary suture, and zygomaticotemporal suture were measured on the right and left sides for all 3 time labels. In addition, midpalatal suture was measured at the incisor, canine, and molar levels. RESULTS Within-group analysis showed that MARPE and RPE led to a significant increase in the widths of frontonasal, frontomaxillary, intermaxillary, nasomaxillary, and midpalatal suture at incisor, canine, and molar levels at T2 compared with T1. Between-group analysis showed that MARPE and RPE significantly increased the width of the intermaxillary and midpalatal suture at the incisor, canine, and molar compared with controls at T2. In the long term, between-group comparisons showed no significant difference among the 3 groups except that MARPE led to a significant increase in the width of midpalatal suture at incisor, canine, and molar levels compared with RPE and controls at T3. CONCLUSIONS MARPE led to a significant increase in the width of the midpalatal suture at incisor, canine, and molar levels compared with RPE and controls in the long term. There was no difference in the width of other cranial and circummaxillary sutures among the 3 groups in the long term.
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Affiliation(s)
- Ahmad Ahmida
- Jefferson Dental and Orthodontics, San Antonio, Tex
| | - Shivam Mehta
- Department of Developmental Sciences and Orthodontics, School of Dentistry, Marquette University, Milwaukee, Wis.
| | - Edward Amelemah
- School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Rehana Bashir
- Division of Orthodontics, University of Connecticut Health, Farmington, Conn
| | | | - Aditya Tadinada
- Division of Oral and Maxillofacial Radiology, University of Connecticut Health, Farmington, Conn
| | | | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, Conn
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Si J, Hu X, Du Y, Wei M, Xu L, Li B, Chen X, Li X. Rapid maxillary expansion treatment increases mid-facial depth in early mixed dentition. Front Pediatr 2022; 10:1028968. [PMID: 36819196 PMCID: PMC9929059 DOI: 10.3389/fped.2022.1028968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the effects of rapid maxillary expansion (RME) on mid-facial depth in early mixed dentition and to investigate the relationship between change in mid-facial depth and maxillary sinus and nasal cavity. METHODS A total of 35 patients with mixed dentition treated with a Haas expander were included in this retrospective study. All patients underwent a cone-beam computed tomography scan before and after rapid maxillary expansion. The Wilcoxon signed-rank test was performed to evaluate the changes in maxillary width, facial depth, maxillary sinus, and nasal cavity volume before and after expansion. Multiple linear regression analysis was applied to evaluate the correlations among them. RESULTS The hard and soft tissue facial depth in the middle third increased significantly (P < 0.001). The gain on the outer sagittal plane (1.04-1.52 mm) was slightly bigger than that on the inner sagittal plane (0.91-1.30 mm). Maxillary width and nasal cavity width increased 3.42 ± 0.93 mm (P < 0.001) and 2.25 ± 0.77 mm (P < 0.001), respectively, after treatment. A gain was also achieved in both nasal cavity volume (2,236.15 mm3, P < 0.001) and maxillary sinus volume (1,227.33 mm3, P < 0.001). Multiple linear regression analysis showed that with the increase in maxillary sinus volume, the facial depth increased as well (B = 0.455-0.683, P < 0.05). Also, statistically significant correlations were found between nasal width and nasal cavity volume (B = 0.384, P < 0.05). CONCLUSION The depth of the middle third face increased significantly. The facial depth increase was related to the enlargement of maxillary sinus volume, while the nasal cavity volume gain was related to the nasal width increase. This indicated that RME might enhance the fullness of the mid-face and facilitate the patency of nose breathing.
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Affiliation(s)
- Jiaping Si
- Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyi Hu
- Department of Stomatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yu Du
- Department of Stomatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Mengyao Wei
- Department of Stomatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lehan Xu
- Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Li
- Department of Stomatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaoyan Chen
- Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuan Li
- Department of Stomatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
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Mehta S, Gandhi V, Vich ML, Allareddy V, Tadinada A, Yadav S. Long-term assessment of conventional and mini-screw-assisted rapid palatal expansion on the nasal cavity. Angle Orthod 2021; 92:315-323. [PMID: 34964860 DOI: 10.2319/021221-122.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the long-term effects of mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion-ANS height, ANS-PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated. RESULTS The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls. CONCLUSIONS MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.
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