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Dominguez-Mompell R, Zhang B, Paredes N, Combs A, Elkenawy I, Sfogliano L, Fijany L, Colak O, Romero-Maroto M, Moon W. Breathing changes following mini-implant-supported maxillary skeletal expander treatment in late adolescent or adult patients : Assessment of objective and subjective functional breathing changes. J Orofac Orthop 2024:10.1007/s00056-024-00521-6. [PMID: 38466417 DOI: 10.1007/s00056-024-00521-6] [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: 11/09/2022] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim of this study was to assess objective and subjective breathing changes in adult patients who underwent maxillary skeletal expansion with the mini-implant-supported maxillary skeletal expander (MSE). METHODS Twenty-nine patients (mean age 18.1 ± 4.3 years) who underwent expansion using the MSE were compared pre- and posttreatment and with a control group (mean age 19.9 ± 2.6 years) to assess objective and subjective functional breathing changes. Objective measurements of the airway including peak nasal inspiratory flow (PNIF) and peak oral inspiratory flow (POIF) were measured utilizing the In-Check medical device (Clement Clarke, Harlow, United Kingdom). Patients reported subjective breathing assessment utilizing the visual analog scale (VAS). Intragroup comparisons were performed with Wilcoxon tests and intergroup comparison with Mann-Whitney U tests. Spearman correlation coefficients were calculated among the studied variables (P < 0.05). RESULTS Following MSE treatment, there were significantly higher values for PNIF total (P < 0.0001), PNIF right (P < 0.0001), PNIF left (P < 0.0001), and POIF (P < 0.01) compared to pretreatment and control group results. Also, patients reported a significant decrease in troubled breathing as measured by the VAS for breathing through the right nostril (P < 0.01), left nostril (P < 0.001), and both nostrils (P < 0.01). Comparing the objective and subjective variables for both the pre-MSE or post-MSE groups, the results indicated no significant correlation between total PNIF and total VAS. However, the values had significant correlations between PNIF and VAS on each side when the patients were asked to block one nostril. CONCLUSIONS Objective functional breathing measurements were increased immediately after treatment with MSE. Subjective functional breathing measurements changes were significantly higher after MSE treatment and compared with the control group. MSE presents a nonsurgical alternative to achieving orthopedic expansion in adult patients which may provide a benefit for patients with nasal airway obstruction.
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Affiliation(s)
| | - Boshi Zhang
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ney Paredes
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA.
| | - Andrew Combs
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Islam Elkenawy
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Luca Sfogliano
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Layla Fijany
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ozge Colak
- Orthodontics Department, State University of New York, 320 Hayes Rd, 14215, Buffalo, NY, USA
| | | | - Won Moon
- Orthodontics and Craniofacial Development Research Forsyth Institute, 245 First Street, 02142, Cambridge, MA, USA.
- Orthodontics Department, AJOU University, Suwon, Korea (Republic of).
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Combs A, Paredes N, Dominguez-Mompell R, Romero-Maroto M, Zhang B, Elkenawy I, Sfogliano L, Fijany L, Colak O, Wu B, Moon W. Long-term effects of maxillary skeletal expander treatment on functional breathing. Korean J Orthod 2024; 54:59-68. [PMID: 38268461 PMCID: PMC10811361 DOI: 10.4041/kjod23.090] [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: 04/21/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/26/2024] Open
Abstract
Objective : To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Methods Objective measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results : Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions : Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.
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Affiliation(s)
- Andrew Combs
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | | | | | | | - Boshi Zhang
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Islam Elkenawy
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Luca Sfogliano
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Layla Fijany
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Ozge Colak
- Department of Orthodontics, State University of New York, Buffalo, NY, USA
| | - Ben Wu
- Orthodontic and Craniofacial Development Research, Forsyth Institute, Cambridge, MA, USA
| | - Won Moon
- Orthodontic and Craniofacial Development Research, Forsyth Institute, Cambridge, MA, USA
- Department of Orthodontics, Ajou University, School of Medicine, Suwon, Korea
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Rajkumar K, Walia BS, Viswambaran M, Ganesh V, Padmavati. Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite. J Maxillofac Oral Surg 2023; 22:900-907. [PMID: 38105837 PMCID: PMC10719231 DOI: 10.1007/s12663-022-01756-9] [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: 05/24/2021] [Accepted: 06/12/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.
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Affiliation(s)
- K. Rajkumar
- Oral and Maxillofacial Surgery, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - B. S. Walia
- Orthodontics & Dentofacial Orthopaedics, Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - M. Viswambaran
- Air Force Institute of Dental Sciences, Agram Post, Bangalore, 560007 India
| | - V. Ganesh
- Fracktal Works Pvt Ltd, Bangalore, India
| | - Padmavati
- Sree Balaji Dental College and Hospital, Chennai, India
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders. BMC Oral Health 2023; 23:714. [PMID: 37794400 PMCID: PMC10552363 DOI: 10.1186/s12903-023-03461-6] [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: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Madrid, Spain
| | - María José González-Olmo
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain.
| | | | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain
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Steegman RM, Renkema AM, Schoeman A, Kuijpers-Jagtman AM, Ren Y. Volumetric changes in the upper airway on CBCT after dentofacial orthopedic interventions - a systematic review. Clin Oral Investig 2023; 27:5737-5754. [PMID: 37723313 PMCID: PMC10560168 DOI: 10.1007/s00784-023-05207-8] [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: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To provide a critical overview of the effect of various orthodontic and/or dentofacial orthopedic interventions on three-dimensional volumetric changes in the upper airway. MATERIALS AND METHODS Four databases were searched for clinical studies concerning 3D volumetric assessments based on CBCT before and after orthodontics interventions. The quality of the studies was assessed using the quality assessment tool of the National Heart, Lung and Blood Institute. After the use of inclusion and exclusion criteria, the pre-and post-treatment volumes were used to visualize the effect of various orthodontics interventions. RESULTS A total of 48 studies were included in this review and none of which were RCTs. The quality of all included studies was assessed as medium. Overall, there is a tendency for an increase in airway volumes after various orthodontic interventions, except for studies concerning extraction therapy with fixed appliances in adults, in which both increases and decreases in airway volumes have been reported. CONCLUSION Orthodontic treatment by growth modification and non-extraction therapy with fixed appliances, regardless of the malocclusion, generally showed positive effects on the airway volume. Orthodontic treatment in combination with extractions does not provide an unambiguous insight. A consensus on the methodology of the airway measurement and nomenclature is urgently needed in order to gain insight into the effect of different interventions on three-dimensional airway changes. CLINICAL RELEVANCE Various orthodontic treatments do not negatively influence the upper airway volume. However, extraction therapy in adults should be chosen with caution, especially in subjects belonging to a group susceptible to airway obstruction.
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Affiliation(s)
- Ralph M. Steegman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
- Zijlweg Orthodontie, Orthodontic Private Practice, Haarlem, The Netherlands
| | - Anne-Marie Renkema
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Adriaan Schoeman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430 Indonesia
| | - Yijin Ren
- Department of Orthodontics, W.J. Kolff Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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de Julián-López C, Veres J, Marqués-Martínez L, García-Miralles E, Arias S, Guinot-Barona C. Upper airway changes after rapid maxillary expansion: three-dimensional analyses. BMC Oral Health 2023; 23:618. [PMID: 37653376 PMCID: PMC10472727 DOI: 10.1186/s12903-023-03324-0] [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: 03/26/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
The objective of this study was to evaluate volumetric changes in the upper airway using Cone Beam Computed Tomography (CBCT) in orthodontic patients with maxillary transversal hypoplasia undergoing maxillary disjunction. The influence of factors such as sex, age, and growth pattern on airway volumetric changes was also assessed. The sample consisted of 50 growing patients from the dental clinic of Cardenal Herrera CEU University of Valencia. Airway volume was measured in mm3 before treatment (T0) and after palatal disjunction (T1). The final sample included 37 subjects in the treatment group and 13 in the control group. The volume gained exclusively from the disjunction treatment was determined to differentiate it from natural growth. The control group showed a mean volume increase from 10,911.3 ± 1,249.6 mm3 to 13,168.9 ± 1,789.7 mm3, representing a mean increase of 2,257.6 mm3 or + 20.9%. The treatment group exhibited an increase from 14,126.3 ± 4,399.8 mm3 at T0 to 18,064.1 ± 4,565.9 mm3 at T1, corresponding to a gain of 3,937.8 mm3 or + 31.8%. Significant differences in airway volume were observed after palatal disjunction compared to the control group. The expansion of the maxilla led to a significant increase in airway volume in the treated patients, estimated at 5,183 mm3 (+ 41.5%).
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Affiliation(s)
- Carlos de Julián-López
- Orthodontics, Dentistry Department, Faculty of Medicine and Health Sciences, University CEU-Cardenal Herrera, C/Del Pozo s/n, Alfara del Patriarca, Valencia, 46115, Spain
| | - Jesús Veres
- Orthodontics, Dentistry Department, Faculty of Medicine and Health Sciences, University CEU-Cardenal Herrera, C/Del Pozo s/n, Alfara del Patriarca, Valencia, 46115, Spain
| | - Laura Marqués-Martínez
- Dentistry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, 46001, Spain.
| | - Esther García-Miralles
- Dentistry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, 46001, Spain
| | - Santiago Arias
- Orthodontics, Dentistry Department, Faculty of Medicine and Health Sciences, University CEU-Cardenal Herrera, C/Del Pozo s/n, Alfara del Patriarca, Valencia, 46115, Spain
| | - Clara Guinot-Barona
- Dentistry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, 46001, Spain
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Anéris FF, El Haje O, Rosário HD, de Menezes CC, Franzini CM, Custodio W. The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification. J World Fed Orthod 2023; 12:150-155. [PMID: 37344294 DOI: 10.1016/j.ejwf.2023.05.005] [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: 12/09/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. METHODS This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n = 10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α = 0.05). RESULTS Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increase for all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P = 0.3356). CONCLUSIONS MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.
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Affiliation(s)
- Fábio Ferreira Anéris
- Graduate student, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Ossam El Haje
- Professor, Departament of Oral Biology, Univeristy Center UNIFACVEST, Lages, Santa Catarina, Brazil
| | - Henrique Damian Rosário
- Professor, Departament of Dentistry, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Carolina Carmo de Menezes
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Cristina Maria Franzini
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - William Custodio
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil.
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Gorucu-Coskuner H, Al-Yassary M, Billiaert K, Kiliaridis S, Antonarakis GS. Age-related transversal changes in craniofacial sutures of the anterior viscerocranium in growing rats. Front Physiol 2023; 14:1201990. [PMID: 37398902 PMCID: PMC10311509 DOI: 10.3389/fphys.2023.1201990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
Objective: To evaluate the dimensional changes that occur in the internasal and nasopremaxillary sutures, and related transverse craniofacial dimensions, of rats from 4 to 38-weeks of age. Methods: Four groups of twelve male Wistar rats were sacrificed at different ages [4-weeks (immature), 16-weeks (adolescent), 26-weeks (young adult), 38-weeks (adult)]. The rats were scanned with a high-resolution micro-computed tomography imaging device with 90 µm voxel size and 45 mm × 45 mm field of view (FOV) to obtain images of the viscreocranium, and with 10 µm voxel size and 5 mm × 5 mm FOV to obtain images of the internasal and left nasopremaxillary sutures. The nasal bone width, transverse width between the nasopremaxillary sutures and interzygomatic width were measured as craniofacial measurements. The endocranial, ectocranial and mean suture widths (cross-sectional area between endocranial and ectocranial borders/suture height), and suture height were measured at 5 frontal planes with 1.2 mm intervals. Outcomes were compared at different ages, and correlation coefficients were used to assess the relationship between craniofacial and suture changes. Results: All transverse craniofacial dimensions increased significantly from 4-16 weeks of age (p < 0.001). After 16-weeks of age, the only significant increase was observed in interzygomatic width (p = 0.02), between 26 and 38 weeks. In both the internasal and nasopremaxillary sutures, the endocranial suture mean widths decreased from 4-16 weeks (p < 0.001 and p = 0.002, respectively), but did not show any significant change after 16-weeks of age. The ectocranial internasal suture width decreased from 4-16 weeks (p < 0.001), increased until 26-weeks (p = 0.035), and subsequently decreased (p < 0.001). The nasopremaxillary suture widths decreased from 4-38 weeks to varying degrees in different frontal planes. Except for the internasal ectocranial suture width, all suture measurements were found highly and negatively correlated with the transverse craniofacial dimensions. The height of the sutures increased with time, with the most significant changes occurring between 4 and 16 weeks of age (p < 0.001). Conclusion: Although the internasal and nasopremaxillary endocranial suture widths nearly reach their final widths during adolescence, the changes in the ectocranial and mean suture widths continue into early adulthood. These results may serve as a reference for future studies aiming to evaluate the effects of functional demands on suture development and dimensional changes of the viscerocranium.
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Affiliation(s)
- Hande Gorucu-Coskuner
- Department of Orthodontics, Hacettepe University, Ankara, Türkiye
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mustafa Al-Yassary
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Kelly Billiaert
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Department of Orthodontics, University of Bern, Bern, Switzerland
| | - Gregory S. Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Xie B, Zhang L, Lu Y. The role of rapid maxillary expansion in pediatric obstructive sleep apnea: Efficacy, mechanism and multidisciplinary collaboration. Sleep Med Rev 2023; 67:101733. [PMID: 36566679 DOI: 10.1016/j.smrv.2022.101733] [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: 09/03/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in pediatric obstructive sleep apnea (OSA). OSA is a chronic disease characterized by progressively increasing upper airway resistance, with various symptoms and signs. Increasingly the evidence indicates that RME is a non-invasive and effective therapy option for children with OSA. Besides, the therapeutic mechanism of RME includes increasing upper airway volume, reducing nasal resistance, and changing tongue posture. Recent clinical researches and case reports also show that a multidisciplinary approach improves sleep-disordered breathing in children. Applied with adenotonsillectomy, mandibular advancement, continuous positive airway pressure, and comprehensive orthodontic treatment, RME can be more effective in recurrent or residual OSA.
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Affiliation(s)
- Bintao Xie
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Lingling Zhang
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Yanqin Lu
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China.
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Kang JH, Kim HJ, Song SI. Obstructive sleep apnea and anatomical structures of the nasomaxillary complex in adolescents. PLoS One 2022; 17:e0272262. [PMID: 35925992 PMCID: PMC9352039 DOI: 10.1371/journal.pone.0272262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of the present study was to reveal the associations between skeletal and soft tissue features of the nasomaxillary complex and development and severity of obstructive sleep apnea (OSA) in adolescents. A total of 100 adolescents (mean age, 14.9 ± 1.4 years; age range, 13–17 years) were enrolled. All participants underwent full-night polysomnography and had an assessment of size and position of the tongue, tonsillar size, body mass index (BMI), and circumference of the waist, neck, and hip. The skeletal features of the nasomaxillary complex, including the zygomatic arch width, nasal cavity width, nasal base width, intercanine width, intermolar width, maxillary dental arch length, palatal vault angle, palatal depth, and SNA were measured on the three-dimensional images constructed with computed tomography data. Participants with an apnea and hypopnea index (AHI) of lower than 5 (AHI ≤ 5) were classified as control and participants while those with an AHI of greater than 5 were classified as OSA group. Each variable with a significant outcome in the independent T-test and age and sex factors were integrated into the multivariate linear regression and the dependent variable was AHI. There were significant differences in the BMI and hip circumference between two groups. The width of nasal base, palatal vault angle and SNA also showed significant differences between groups. The results from multivariate linear regression demonstrated that the BMI, width of the nasal base, and SNA showed significant contributions to the severity of OSA in adolescents. The features of the nasomaxillary complex seemed to have significant influences on development and severity of OSA.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
| | - Hyun Jun Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Gyeonggi-do, Korea (ROK)
| | - Seung Il Song
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea (ROK)
- * E-mail:
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11
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Fagundes NCF, Flores-Mir C. Pediatric obstructive sleep apnea-Dental professionals can play a crucial role. Pediatr Pulmonol 2022; 57:1860-1868. [PMID: 33501761 DOI: 10.1002/ppul.25291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/15/2022]
Abstract
The significant contribution of dental professionals to the management of selected adult obstructive sleep apnea (OSA) cases is understood. Among children, it has also been suggested that dental professionals may also help screen and manage this morbidity in selected cases. It has also been noted that our understanding of pediatric OSA lags significantly behind adult OSA. During the screening process for potential pediatric OSA cases, dental professionals may be quite helpful as specific craniofacial abnormalities have been previously associated with pediatric OSA, including Class II malocclusion, vertical facial growth and maxillary transversal deficiency. As dental professionals assess children more frequently than physicians, they can help screen sleep-disordered breathing signs and symptoms using validated questionnaires. In more advanced cases, orthodontists may be leading contributors to the management of selected cases where a craniofacial involvement is suspected. Rapid maxillary expansion and mandibular or maxillary anterior repositioning devices have been proposed as managing alternatives. So far, there is no substantial evidence if these approaches can be adopted to treat OSA fully or if the reported OSA signs and symptoms improvements observed in a selected group of patients are stable long-term. Nevertheless, dentists and orthodontists' integration into a transdisciplinary team should be encouraged to play a significant role. This review discusses dentists or orthodontists' potential contribution to screen and manage selective pediatric OSA patients as part of a transdisciplinary team.
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Affiliation(s)
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Canada
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12
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Gokce G, Basoglu OK, Veli I. Polygraphic evaluation of the effects of different rapid maxillary expansion appliances on sleep quality: A randomized clinical trial. Sleep Breath 2022; 27:651-659. [DOI: 10.1007/s11325-022-02677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
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13
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Upper Airway Changes in Diverse Orthodontic Looms: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Upper airway assessment is particularly important in the daily work of orthodontists, because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Three-dimensional cone-beam computed tomography images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements. However, the association between upper airway dimensions and skeletal malocclusion is unclear. Therefore, the current systematic review evaluates the effects of different surgical movements on the upper airway. Materials and Methods: Medline (PubMed, OVID Medline, and EBSCO), Cochrane Library (Cochrane Review and Trails), Web of Knowledge (social science, and conference abstracts), Embase (European studies, pharmacological literature, and conference abstracts), CINAHL (nursing and allied health), PsycInfo (psychology and psychiatry), SCOPUS (conference abstracts, and scientific web pages), and ERIC (education) databases were searched. Two authors independently performed the literature search, selection, quality assessment, and data extraction. Inclusion criteria encompassed computed tomography evaluations of the upper airway spaces with retrospective, prospective, and randomised clinical trial study designs. To grade the methodological quality of the included studies a GRADE risk of bias tool was used. Results and conclusion: In total, 29 studies were included. Among these, 17 studies had a low risk of bias, whereas 10 studies had a moderate risk of bias. A meta-analysis was performed with the mean differences using a fixed-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (p ≤ 0.001, 95% confidence interval) increases in upper airway volume after rapid maxillary expansion and surgical advancement for the correction of Class II.
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14
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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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Aljawad H, Lee KM, Lim HJ. Three-dimensional evaluation of upper airway changes following rapid maxillary expansion: A retrospective comparison with propensity score matched controls. PLoS One 2021; 16:e0261579. [PMID: 34941970 PMCID: PMC8699684 DOI: 10.1371/journal.pone.0261579] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate upper airway changes three-dimensionally following rapid maxillary expansion (RME) and compare the changes with matched controls. MATERIALS AND METHODS Seventeen patients (mean age 12.6 ± 1.8 years) with maxillary transverse deficiency were treated with RME. Using the propensity score matching method, 17 patients (mean age 12.3 ± 1.5 years) were selected from a non-RME control group of 33. Case-control matching was performed based on 5 covariates: age, gender, CBCT scan interval, sagittal skeletal pattern, and tongue posture. Airway volumes of nasopharynx and oropharynx and minimum cross-sectional areas (MCA) of oropharynx were measured and compared between the case and control groups in CBCT scan images. RESULTS In the case group, significant increases from before to after RME were found in all measurements except MCA of the retroglossal segment of oropharynx. Before treatment, there were no significant differences between case group and control group. While comparing the case group with the control group after treatment showed overall greater increases in the case group. In particular, MCA of retropalatal segment showed statistically significant differences. CONCLUSION The results of this study indicate that RME causes an increase in upper airway dimensions.
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Affiliation(s)
- Hussein Aljawad
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Kyung-Min Lee
- Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Hoi-Jeong Lim
- Department of Orthodontics and Dental Education, School of Dentistry, Chonnam National University, Dental Science Research Institute, Gwangju, Korea
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Yi L, Jeon HH, Li C, Boucher N, Chung CH. Transverse Growth of the Maxillo-Mandibular Complex in Untreated Children: A Longitudinal Cone Beam Computed Tomography Study. SENSORS 2021; 21:s21196378. [PMID: 34640696 PMCID: PMC8512966 DOI: 10.3390/s21196378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022]
Abstract
The aim of this study is to evaluate the longitudinal transverse growth of the maxillo-mandibular complex in untreated children using the Cone Beam Computed Tomography (CBCT). Two sets of scans on 12 males (mean 8.75 years at T1 and 11.52 years at T2) and 18 females (mean 9.09 years at T1 and 10.80 years at T2) were analyzed using Dolphin 3D imaging. The transverse widths of various maxillary and mandibular skeletal landmarks and the dentoalveolar and dental landmarks at the level of first molars were measured. Overall, there were greater increases in the transverse dimension in the posterior than anterior portions of the maxilla and mandible. The increase in intergonial width of the mandible seems to be primarily due to the lengthening of the mandibular body. The dentoalveolar process at the first molar level increases at an equal rate corono-apically and is independent to the changes in molar inclination. When comparing maxillary dentoalveolar changes with that of the mandible, greater increases were noticed in the maxilla, which might be explained by the presence of sutural growth in the maxilla. Moreover, the first molars maintain their coordination with each other despite the differential increase in the maxillary and mandibular dentoalveolar processes.
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17
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Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children. Sleep Med 2021; 86:81-89. [PMID: 34479051 DOI: 10.1016/j.sleep.2021.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). METHODS 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). RESULTS In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. CONCLUSION RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.
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18
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DiCosimo C, Alsulaiman AA, Shah C, Motro M, Will LA, Parsi GK. Analysis of nasal airway symmetry and upper airway changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2021; 160:695-704. [PMID: 34373154 DOI: 10.1016/j.ajodo.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/01/2020] [Accepted: 06/01/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objectives of this study were to assess the changes in right vs left nasal cavity volumes and minimum cross-sectional width, nasopharyngeal, and oropharyngeal volumes of the upper airway in response to rapid maxillary expansion (RME). METHODS Pretreatment and posttreatment cone-beam computed tomography scans of 28 patients with a mean age of 9.86 ± 2.43 years and 20 age- and sex-matched controls were digitized and linear, angular, and volumetric measurements were obtained. RESULTS Nasopharyngeal volume, right, and left nasal cavity volumes, and minimum cross-sectional widths increased significantly 2 years post RME (P <0.05). These measurements did not show any significant increase in the control group (P >0.05), whereas the oropharyngeal volume increase for both groups was comparable (P = 0.92). In the experimental group, the right and left nasal cavity volumes were not significantly different at baseline or posttreatment. However, the change that occurred was significantly larger for the left nasal cavity. This change for the control group was more significant for the right nasal cavity. Maxillary right and left molar inclinations were positively correlated to the nasal cavity volume, showing that the more buccally inclined the maxillary molars were, the smaller the nasal cavity volume. CONCLUSIONS Nasopharyngeal and right and left nasal cavity volumes and minimum cross-sectional widths increase significantly after RME in young children. Expansion decreases the degree of difference in volume between the right and left nasal cavities. The buccal inclination of maxillary molars is correlated with nasal cavity volume.
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Affiliation(s)
- Charles DiCosimo
- Department of Orthodontics & Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Ahmed A Alsulaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Charmi Shah
- Department of Orthodontics and Dentofacial Orthopedics, Rutgers University School of Dental Medicine, Newark, NJ
| | - Melih Motro
- Department of Orthodontics & Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Leslie A Will
- Department of Orthodontics & Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Goli K Parsi
- Department of Orthodontics & Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass.
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Kim JE, Hwang KJ, Kim SW, Liu SYC, Kim SJ. Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients. Sleep Breath 2021; 26:585-594. [PMID: 34181174 DOI: 10.1007/s11325-021-02426-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the correlation between the changes in respiratory function and dimensions of the nasomaxillary complex (NMC) and upper airway (UA) compartments after nasomaxillary skeletal expansion (NMSE) treatment for pediatric patients with obstructive sleep apnea (OSA). METHODS Nonobese OSA patients (mean age, 13.6 ± 2.9 years; mean body mass index, 18.1 ± 3.0 kg/m2); mean apnea-hypopnea index (AHI, 7.0 ± 5.4 events/h) presenting with transverse nasomaxillary constriction were evaluated before and after NMSE using cone-beam computed tomography (CBCT), home sleep test, and modified pediatric sleep questionnaire (m-PSQ). Paired t tests were performed to examine the treatment-related changes in all the parameters, and a multiple regression analysis adjusted for age and sagittal and vertical skeletal patterns was conducted to determine the dimensional parameters to affect the functional improvement. RESULTS Among 26 patients, NMSE treatment significantly increased NMC dimensions at all tested levels and all UA compartments in CBCT, except glossopharyngeal airway. Concurrently, AHI, oxygen desaturation index, the lowest oxygen saturation (LSaO2), flow limitation (FL), snoring, and m-PSQ were significantly improved. AHI reduction was correlated with UA enlargement with no correlation with NMC expansion, whereas FL reduction was affected by NMC expansion. The minimal cross-sectional area was the most predictive of functional improvement, presenting correlations with AHI, LSaO2, and m-PSQ. CONCLUSION NMSE can be a good treatment for pediatric OSA patients when applied to enhance the nasal and pharyngeal airway patencies beyond the NMC, ultimately to improve pharyngeal collapsibility as well as nasal airflow.
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Affiliation(s)
- Jung-Eun Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Kyoung-Jin Hwang
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Sung-Wan Kim
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology, and of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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The Efficacy of Lingual Laser Frenectomy in Pediatric OSAS: A Randomized Double-Blinded and Controlled Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116112. [PMID: 34204017 PMCID: PMC8200995 DOI: 10.3390/ijerph18116112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients. Background: Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum. Methods: Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%). Results: In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe. Conclusion: The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
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21
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Niu X, Di Carlo G, Cornelis MA, Cattaneo PM. Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res 2020; 23:250-276. [PMID: 32248642 DOI: 10.1111/ocr.12378] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The purpose of this systematic review was to evaluate the three-dimensional (3D) changes occurring at short- and long-term follow-up after rapid maxillary expansion (RME) in nasal cavity (NC) and upper airway (UA) in growing patients. METHODS A literature search up to 1 July 2019 was performed. Randomized and non-randomized clinical trials and cohort studies comparing the effects of RME in a paediatric population using 3D analyses based on computed tomography (CT), cone-beam CT and MRI were included. The risks of bias of the included studies were assessed using the Cochrane Collaboration's risk of bias tool, the GRADE approach and a customized tool. The random-effects meta-analyses of the mean differences and 95% confidence intervals of NC and UA volume changes were carried out, followed by subgroup analyses. RESULTS Twenty-seven studies were included, with 18 selected for quantitative synthesis. Immediately after expansion, the nasopharynx and oropharynx increased significantly. After 3 months of retention, only the NC and nasopharynx showed a significant volume increase. Two studies mentioned the use of a sleep-disordered breathing questionnaire, and one study reported the difference before and after RME. None of the 27 articles included assessed the correlation between the skeletal widening and NC or UA volume changes after RME. CONCLUSIONS The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.
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Affiliation(s)
- Xiaowen Niu
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Gabriele Di Carlo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Department of Oral and Maxillofacial Sciences, Unit of Pediatric Dentistry, Sapienza University of Rome, Rome, Italy
| | - Marie A Cornelis
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Paolo M Cattaneo
- Section of Orthodontics, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
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Fastuca R, Michelotti A, Nucera R, D’Antò V, Militi A, Logiudice A, Caprioglio A, Portelli M. Midpalatal Suture Density Evaluation after Rapid and Slow Maxillary Expansion with a Low-Dose CT Protocol: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E112. [PMID: 32150850 PMCID: PMC7143279 DOI: 10.3390/medicina56030112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 ± 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.
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Affiliation(s)
- Rosamaria Fastuca
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy; (R.F.); (A.C.)
| | - Ambra Michelotti
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy;
| | - Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Vincenzo D’Antò
- School of Orthodontics, University of Naples, 80131 Naples, Italy;
| | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Antonino Logiudice
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
| | - Alberto Caprioglio
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy; (R.F.); (A.C.)
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy; (R.N.); (A.M.); (A.L.)
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Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear. J Craniofac Surg 2020; 31:172-177. [DOI: 10.1097/scs.0000000000006197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Li M, Zhang Z, Gu X, Jin Y, Feng C, Yang S, Wei F. MicroRNA-21 affects mechanical force-induced midpalatal suture remodelling. Cell Prolif 2019; 53:e12697. [PMID: 31713930 PMCID: PMC6985676 DOI: 10.1111/cpr.12697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
Objectives miR‐21 can promote osteoblast differentiation of periodontal ligament stem cells. However, the effect of miR‐21 on bone remodelling in the midpalatal suture is unclear. This study aimed to elucidate the effects of miR‐21 on the midpalatal suture bone remodelling by expanding the palatal sutures. Materials and methods miR‐21 deficient (miR‐21−/−) and wild‐type (WT) mice were used to establish animal models by expanding the palatal sutures. Micro‐CT, haematoxylin‐eosin (HE) staining, tartrate‐resistant acid phosphatase (TRAP) staining, fluorescence labelling and immunohistochemistry were used to investigate the function of miR‐21 in midpalatal suture bone remodelling. Besides, bone mesenchymal stem cells (BMSCs) derived from both miR‐21−/− and WT mice were cultured. The MTT, CCK8, EdU analysis, transwell and wound healing test were used to assess the effects of miR‐21 on the characteristics of cells. Results The expression of ALP was suppressed in miR‐21‐/‐ mice after expansion except 28 days. The expression of Ocn in WT mice was much higher than that of miR‐21‐/‐ mice. Besides, with mechanical force, miR‐21 deficiency downregulated the expression of Opg, upregulated the expression of Rankl, and induced more osteoclasts as TRAP staining showed. After injecting agomir‐21 to miR‐21‐/‐ mice, the expression of Alp, Ocn and Opg/Rankl were rescued. In vitro, the experiments suggested that miR‐21 deficiency reduced proliferation and migration ability of BMSCs. Conclusions The results showed that miR‐21 deficiency reduced the rate of bone formation and prolonged the process of bone formation. miR‐21 regulated the bone resorption and osteoclastogenesis by affecting the cell abilities of proliferation and migration.
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Affiliation(s)
- Mengying Li
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
| | - Zijie Zhang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
| | - Xiuge Gu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
| | - Ye Jin
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
| | | | - Shuangyan Yang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
| | - Fulan Wei
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Orthodontics, School of Stomatology, Shandong University, Jinan, China
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Sánchez-Súcar AM, Sánchez-Súcar FDB, Almerich-Silla JM, Paredes-Gallardo V, Montiel-Company JM, García-Sanz V, Bellot-Arcís C. Effect of rapid maxillary expansion on sleep apnea-hypopnea syndrome in growing patients. A meta-analysis. J Clin Exp Dent 2019; 11:e759-e767. [PMID: 31598206 PMCID: PMC6776408 DOI: 10.4317/jced.55974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Changes produced in the upper airway after rapid maxillary expansion makes this procedure a therapeutic option for treating sleep apnea-hypopnea syndrome (SAHS) in children. The objective of this systematic review and meta-analysis was to analyze the evidence available for the effects of rapid maxillary expansion (RME) on SAHS, analyzing changes produced in oximetric variables: apnea-hypopnea index (AHI); oxygen saturation (SO2); sleep efficiency (SE), total sleep time (TST), percentage of rapid eye movement (REM) phase; and arousal index (AI). Material and Methods An electronic search was conducted in the PubMed, Scopus, Embase, and Cochrane databases, and in grey literature (Opengrey). No limit was placed on publication date or language. Inclusion criteria were: patients in growth with sleep apnea who underwent rapid maxillary expansion with oximetric values registered before and after treatment. Articles with patient sample sizes <10 were excluded. Ten articles were included for qualitative synthesis and nine for meta-analysis (eliminating one observational study). Results AHI values underwent a mean reduction of 5.79 events/hour (CI -95% 9.06 to 2.5); an increase in mean oxygen saturation of 2.54 % (CI-95% -0.28 to 4.80, 6.7 %); a reduction in AI of 2.17 events/hour (CI-95% -5.25 to -0.582); an increase in REM phase of 1.20 % (CI-95% 1.02 to 1.38); and an increase in SE of 0.961% (CI-95% -1.574 to 3.495). Conclusions RME would appear efficient for treating slight or moderate SAHS, as indicated by improvement in oximetric parameters; it may be effective as coadjuvant therapy to adenotonsillectomy in severe cases of children with maxillary compression. Key words:Rapid maxillary expansion, obstructive sleep apnea.
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Affiliation(s)
- Ana-Matilde Sánchez-Súcar
- Doctorate student, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | | | | | - Vanessa Paredes-Gallardo
- Teaching Assistant, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - José-María Montiel-Company
- Teaching Assistant, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - Verónica García-Sanz
- Associate Professor, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
| | - Carlos Bellot-Arcís
- Assistant Professor, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia
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Effect of maxillary expansion and protraction on the oropharyngeal airway in individuals with non-syndromic cleft palate with or without cleft lip. PLoS One 2019; 14:e0213328. [PMID: 31361754 PMCID: PMC6667113 DOI: 10.1371/journal.pone.0213328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/15/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L). Methods CBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison. Results There was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group. Conclusion The findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.
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Garcez AS, Suzuki SS, Storto CJ, Cusmanich KG, Elkenawy I, Moon W. Effects of maxillary skeletal expansion on respiratory function and sport performance in a para-athlete – A case report. Phys Ther Sport 2019; 36:70-77. [DOI: 10.1016/j.ptsp.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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Alyessary AS, Othman SA, Yap AUJ, Radzi Z, Rahman MT. Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review. Int Orthod 2019; 17:12-19. [PMID: 30732977 DOI: 10.1016/j.ortho.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. MATERIALS AND METHODS An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. RESULTS The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. CONCLUSIONS Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.
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Affiliation(s)
- Akram S Alyessary
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia; Karbala University, College of dentistry, Department of Orthodontics, Karbala, Iraq.
| | - Siti A Othman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Adrian U J Yap
- National University Health System, Ng Teng Fong General Hospital, Department of Dentistry, Singapore, Singapore; University of Malaya, Faculty of Dentistry, Department of Restorative Dentistry, Kuala Lumpur, Malaysia
| | - Zamri Radzi
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Mohammad T Rahman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
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Digregorio MV, Fastuca R, Zecca PA, Caprioglio A, Lagravère MO. Buccal bone plate thickness after rapid maxillary expansion in mixed and permanent dentitions. Am J Orthod Dentofacial Orthop 2019; 155:198-206. [DOI: 10.1016/j.ajodo.2018.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 01/04/2023]
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Stark TR, Pozo-Alonso M, Daniels R, Camacho M. Pediatric Considerations for Dental Sleep Medicine. Sleep Med Clin 2018; 13:531-548. [DOI: 10.1016/j.jsmc.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Benefits of Maxillary Expansion for a Patient With Spinal Muscular Atrophy Type 2. Am J Phys Med Rehabil 2018; 98:e32-e34. [PMID: 30138129 DOI: 10.1097/phm.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case report involves a 10-yr-old boy diagnosed with spinal muscular atrophy type 2 who underwent nighttime mechanical ventilation with bilevel positive airway pressure. The oral examination revealed restricted mouth opening, lip interposition, dental crowding, and maxillary compression. After maxillary expansion, the upper airway volume increased 18.6%; 13 episodes of airway infections (20 days of hospitalization) were recorded in the 2 yrs before the maxillary expansion and only 4 episodes (no hospital admissions) in the 2 subsequent years. In conclusion, maxillary expansion in children with systemic disease that involves respiratory impairment may, in some cases, provide functional and clinical improvements, increase upper airway airflows, and possibly decrease the number of respiratory infections.
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Giuliani A, Mazzoni S, Mangano C, Zecca PA, Caprioglio A, Vercellini N, Raspanti M, Mangano F, Piattelli A, Iezzi G, Fastuca R. Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography. BMC Oral Health 2018; 18:125. [PMID: 30045728 PMCID: PMC6060467 DOI: 10.1186/s12903-018-0590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/12/2018] [Indexed: 11/11/2022] Open
Abstract
Background Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. Methods Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. Results In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. Conclusions The microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME. Electronic supplementary material The online version of this article (10.1186/s12903-018-0590-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra Giuliani
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy.
| | - Serena Mazzoni
- Sezione di Biochimica, Biologia e Fisica Applicata, Department of Clinical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 1, 60131, Ancona, Italy
| | | | - Piero Antonio Zecca
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Nicolò Vercellini
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, Varese, Italy
| | | | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti Scalo, CH, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
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Fastuca R, Campobasso A, Zecca PA, Caprioglio A. 3D facial soft tissue changes after rapid maxillary expansion on primary teeth: A randomized clinical trial. Orthod Craniofac Res 2018; 21:140-145. [PMID: 29927048 DOI: 10.1111/ocr.12229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the present randomized controlled trial (RCT) was therefore the tridimensional evaluation of soft tissue changes after rapid maxillary expansion in growing patients. SETTING AND SAMPLE POPULATION Treated group comprised 17 patients (10 males and 7 females) with a mean age of 9.8 ± 1.2 years, and control group comprised 17 patients (13 males and 4 females) with a mean age of 9.1 ± 2.1 years. MATERIAL & METHODS All patients of the treated group underwent maxillary expansion with Haas-type expander while patients of the control group underwent no treatment. 3D facial scans were acquired at T1, at the beginning of treatment or observation period, and at T2, 18 months apart. The mean interval between the timepoints was 18.2 ± 0.4 months. RESULTS The main differences between groups were reported in the nasal area. Nasal width (Alr-All) significantly increased in the treated group compared with the control. The increase in intereye and mouth width in the study group did not show differences with the control group. No significant differences were reported for lips' protrusion, angular measurements and facial heights between groups. The total nose volume difference was significantly higher in the treated group compared with control, and this result was related mainly to the significant increase in the nasal dorsum volume. CONCLUSION Maxillary expansion produced significant increase in the nasal base and nasal volumes, but its clinical relevance is still questionable.
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Affiliation(s)
- R Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
| | - A Campobasso
- Division of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - P A Zecca
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - A Caprioglio
- Departmet of Medicine and Surgery, University of Insubria, Varese, Italy
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Ngan P, Nguyen UK, Nguyen T, Tremont T, Martin C. Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study. APOS TRENDS IN ORTHODONTICS 2018. [DOI: 10.4103/apos.apos_27_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction
Microimplant-assisted rapid palatal expansion (MARPE) has recently been offered to adult patients for correcting maxillary transverse deficiency. However, there is limited information in the literature on the success of this appliance and its skeletal and dental effects on skeletally matured patients. The purpose of this study was to investigate the immediate skeletal, dentoalveolar, and periodontal response to MARPE appliance using cone-beam computed tomography in a skeletally matured patient as assessed by the cervical vertebral maturation method.
Materials and Methods
Eight consecutively treated patients (2 females, 6 males; mean age of 21.9 ± 1.5 years) treated with a maxillary skeletal expander were included in the study. Measurements were taken before and after expansion to determine the amount of midpalatal suture opening, upper facial bony expansion, alveolar bone bending, dental tipping, and buccal bone thickness (BBT). Data were analyzed using a one-way ANOVA and matched-pair t-test (α = 0.05).
Results
Midpalatal suture separation was found in 100% of the patients with no dislodged microimplants. Total maxillary expansion was attributed to 41% skeletal, 12% alveolar bone bending, and 48% dental tipping. Pattern of midpalatal suture opening was found to be parallel in both the coronal and axial planes. On average, the absolute dental tipping ranged from 4.17° to 4.96° and the BBT was reduced by an average of 39% measured at the premolars and molars.
Conclusions
The MARPE appliance can be a clinically acceptable, nonsurgical treatment option for correcting mild to moderate maxillary transverse discrepancies for skeletally matured adult patients with a healthy periodontium.
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Affiliation(s)
- Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
| | | | - Tung Nguyen
- Department of Orthodontics, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Timothy Tremont
- Department of Orthodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Martin
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, USA
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Chardey EK, Fastuca R, Beretta M, Di Blasio A, Vercellini N, Caprioglio A, Zecca PA, Macchi A. Digital Dynamic 3D Monitoring of Lower Incisors Intrusion in Lingual Orthodontics. Open Dent J 2018; 12:104-117. [PMID: 29492176 PMCID: PMC5815052 DOI: 10.2174/1874210601812010104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots. Methods 9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch. Results The root displacement of the incisors during their intrusion in the early stage was totally "bone-safe" in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured. Conclusion This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.
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Affiliation(s)
- Elia Kodjo Chardey
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Rosamaria Fastuca
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Di Blasio
- Department of Biotechnological, Biomedical and Translational Sciences, Section of Orthodontics, University of Parma, Parma, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Alberto Caprioglio
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Early Orthopaedic Treatment of Hemifacial Microsomia. Case Rep Dent 2018; 2017:7318715. [PMID: 29387494 PMCID: PMC5745710 DOI: 10.1155/2017/7318715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/01/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to report treatment effects of functional therapy in a growing patient affected by hemifacial microsomia (HM). According to Kaban's classification, the patient was classified as grade IIa as she presented all mandibular and temporomandibular joint components and a normal shaped, hypoplastic mandible. The therapeutic approach included the use of an asymmetrical functional activator (AFA) to stimulate the growth of the affected side and consequently to improve symmetry of the mandible and maxillary deficiency. Further effects were the lengthening of the mandibular ramus, restoration of occlusion, and expansion of soft tissues.
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Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy. Case Rep Dent 2018; 2017:8013874. [PMID: 29318057 PMCID: PMC5727690 DOI: 10.1155/2017/8013874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/05/2017] [Indexed: 02/08/2023] Open
Abstract
In maxillofacial surgery, every patient presents special problems requiring careful evaluation. Conventional methods to study the deformities are still reliable, but the advent of tridimensional (3D) imaging, especially computed tomography (CT) scan and laser scanning of casts, created the opportunity to better understanding the skeletal support and the soft tissue structures. Nowadays, virtual technologies are increasingly employed in maxillofacial surgery and demonstrated precision and reliability. However, in complex surgical procedures, these new technologies are still controversial. Especially in the less frequent cases of three-part maxillary surgery, the experience is limited, and scientific literature cannot give a clear support. This paper presents the case of a young patient affected by a complex long face dentofacial deformity treated by a bimaxillary surgery with three-part segmentation of the maxilla. The operator performed the surgical study completely with a virtual workflow. Pre- and postoperative CT scan and optical scanning of plaster models were collected and compared. Every postoperatory maxillary piece was superimposed with the presurgical one, and the differences were examined in a color-coded map. Only mild differences were found near the osteotomy lines, when the bony surface and the teeth demonstrated an excellent coincidence.
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Fastuca R, Lorusso P, Lagravère MO, Michelotti A, Portelli M, Zecca PA, D’ Antò V, Militi A, Nucera R, Caprioglio A. Digital evaluation of nasal changes induced by rapid maxillary expansion with different anchorage and appliance design. BMC Oral Health 2017; 17:113. [PMID: 28705206 PMCID: PMC5513127 DOI: 10.1186/s12903-017-0404-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/04/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Scientific evidence showed that rapid maxillary expansion (RME) affects naso-maxillary complex, increasing nasal width and volume. This study aimed to evaluate nasal changes induced by rapid maxillary expansion with different anchorage and appliance design by using low dose and cone beam computed tomography. METHODS A total of 44 patients (20 males, mean age 8y 8 m ± 1y 2 m; 24 females mean age 8y 2 m ± 1y 4 m) were included in the investigation and divided into three groups according to the appliance: Hyrax-type expander anchored to permanent teeth, modified Hyrax-type expander anchored to deciduous teeth, modified Haas-type expander anchored to deciduous teeth. Maxillary expansion was performed until overcorrection and the expander was passively kept in situ for 7 months at least. All patients had three-dimensional imaging before expansion (T0) and after the retention period (T1). Nasal floor width, nasal wall width, maxillary inter-molar width were measured by means of Mimics software. The paired sample t-test was employed to assess the significance of the differences between the time points; the analysis of variance test (ANOVA) was used to compare differences between groups. RESULTS The statistical analysis revealed significant differences between T0 and T1 for each recorded measurement in each group; no significant differences were found by comparing groups. CONCLUSIONS Rapid maxillary expansion produces a significant skeletal transverse expansion of nasal region in growing patients. No significant differences in nasal effects are expected when the appliance is anchored onto deciduous teeth, with or without the palatal acrylic coverage.
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Affiliation(s)
- Rosamaria Fastuca
- Department of Surgical and Morphological Sciences, University of Messina, Via Consolare Valeria 1, Messina, Italy
- C/O Dental School, Via G. Piatti, 10, 21100 Velate, VA Italy
| | - Paola Lorusso
- Private Practice in Orthodontics, Bari, Italy
- Research Fellow, University of insubria, Via G. Piatti, 10 Varese, Italy
| | - Manuel O Lagravère
- Department of Dentistry, University of Alberta, 11400 University Avenue, Edmonton, AB Canada
| | - Ambra Michelotti
- Section of Orthodontics, Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, Naples, Italy
| | - Marco Portelli
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Via G. Piatti, 10 Varese, Italy
| | | | - Angela Militi
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Riccardo Nucera
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy
| | - Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, Via G. Piatti, 10 Varese, Italy
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Asymmetric Expansion with a Modified Quad Helix for Treatment of Isolated Crossbite. Case Rep Dent 2017; 2017:7275846. [PMID: 28589044 PMCID: PMC5446872 DOI: 10.1155/2017/7275846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/24/2017] [Indexed: 12/05/2022] Open
Abstract
Unilateral posterior crossbite often involves only one tooth, especially upper first molar; in these cases it is never easy to obtain an asymmetrical movement of a molar and a proper planning of the orthodontic device with its anchorage is necessary to avoid arch overexpansion. Thanks to its simplicity and efficacy, the modified Quad Helix here described represents a valid therapeutic tool in cases of isolated posterior crossbite.
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Cephalometric changes in growing patients with increased vertical dimension treated with cervical headgear. J Orofac Orthop 2017; 78:312-320. [DOI: 10.1007/s00056-017-0087-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/04/2017] [Indexed: 10/19/2022]
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Caprioglio A, Bergamini C, Franchi L, Vercellini N, Zecca PA, Nucera R, Fastuca R. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition. Prog Orthod 2017; 18:9. [PMID: 28367605 PMCID: PMC5376539 DOI: 10.1186/s40510-017-0163-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to identify cephalometric pretreatment parameters for prediction of Class II improvement induced by rapid maxillary expansion. METHODS Lateral cephalograms of 30 patients (mean age 8.3 ± 1.6 years old) showing Class II molar relationship and undergone to rapid maxillary expansion on the upper deciduous molars were traced before treatment, and molar relation changes were evaluated on dental casts before and after treatment. Overall treatment time lasted 10.2 ± 2 months. Good responders (18 subjects, 10 females and 8 males) showed improvement of at least 2.50 mm, and bad responders (12 subjects, 7 females and 5 males) showed no improvement, improvement less than 2.50 mm, or worsening of molar relationship after treatment. Student's t test was used to assess significance of differences between groups, and discriminant analysis allowed identification of predictive pretreatment variables. RESULTS Articular angle, superior gonial angle, and mandibular dimensions (Co-Gn, S-Ar, Ar-Go, Go-Me) showed significant differences in the comparison between groups. Mandibular length Co-Gn and superior gonial angle were selected as significant predictive variable for discrimination. CONCLUSIONS Patients with smaller mandibular length and more acute superior gonial angle are expected to have more chances to improve molar Class II after rapid maxillary expansion.
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Affiliation(s)
- Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Chiara Bergamini
- Division of Orthodontics, Department of Surgical and Morphological Sciences, Orthodontic Programme, School of Medicine, University of Insubria, Varese, Italy
| | - Lorenzo Franchi
- Division of Dentistry, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Nicolò Vercellini
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Riccardo Nucera
- Division of Orthodontics, Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy. .,C/O Dental School, Via G. Piatti, 10, Velate, 21100, Varese, Italy.
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Caprioglio A, Fastuca R, Zecca PA, Beretta M, Mangano C, Piattelli A, Macchi A, Iezzi G. Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report. Int J Mol Sci 2017; 18:ijms18030615. [PMID: 28287481 PMCID: PMC5372631 DOI: 10.3390/ijms18030615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/25/2022] Open
Abstract
The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 ± 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing.
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Affiliation(s)
- Alberto Caprioglio
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, 98100 Messina, Italy.
| | - Piero Antonio Zecca
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Matteo Beretta
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Carlo Mangano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Aldo Macchi
- Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy.
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
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Caprioglio A, Fastuca R. [Etiology and treatment options of anterior open bite in growing patients: a narrative review]. Orthod Fr 2016; 87:467-477. [PMID: 27938658 DOI: 10.1051/orthodfr/2016038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Anterior open bite represents a malocclusion that is still under study because of the still lacking evidence about etiology and best treatment options in growing subjects according to success rate and stability. Etiology involves the interaction of environmental factors such as prolonged sucking habits, mouth breathing, tongue or lip thrusting, tongue dimension, eruption disturbances with a genetically determined vertical facial growth pattern. The treatment options for the early treatment of anterior open bite are still controversial. OBJECTIVES The aim of this study was to evaluate the actual available evidence on treatments of anterior open bite in the mixed dentition in order to assess the effectiveness of the early treatment in reducing open bite, the most efficacious treatment strategy and the stability of the results.
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Affiliation(s)
- Alberto Caprioglio
- Division of Orthodontics, Department of Surgical and Morphological Sciences, School of Medicine, University of Insubria, Varese, Italy
| | - Rosamaria Fastuca
- Department of Medical, Surgical and Health Sciences, University of Messina, Messina, Italy
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Camacho M, Chang ET, Song SA, Abdullatif J, Zaghi S, Pirelli P, Certal V, Guilleminault C. Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 127:1712-1719. [PMID: 27796040 DOI: 10.1002/lary.26352] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). DATA SOURCES PubMed/MEDLINE and eight additional databases. REVIEW METHODS Three authors independently and systematically reviewed the international literature through February 21, 2016. RESULTS Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea-hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is -1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73-95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5-12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction). CONCLUSIONS Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712-1719, 2017.
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Affiliation(s)
- Macario Camacho
- Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.,Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A
| | - Edward T Chang
- Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
| | - Sungjin A Song
- Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A
| | - Jose Abdullatif
- Sleep Surgery Department, Instituto Ferrero de Neurología y Sueño, Buenos Aires, Argentina
| | - Soroush Zaghi
- Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Paola Pirelli
- Department of Clinical Sciences and Translational Medicine, University of Rome, Rome, Tor Vergata, Italy
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Center, , Companhia União Fabril & Centro Hospitalar Entre Douro e Vouga Hospital, Porto, Portugal.,Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Christian Guilleminault
- Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Redwood City, California, U.S.A
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McNamara JA, Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA, Cozza P. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 2015; 16:33. [PMID: 26446931 PMCID: PMC4596248 DOI: 10.1186/s40510-015-0105-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Abstract
Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life.
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Affiliation(s)
- James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Cell and Developmental Biology, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, The University of Michigan, Ann Arbor, MI, USA
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Lorenzo Franchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA.
- Department of Surgery and Translational Medicine, University of Florence, Via del Ponte di Mezzo, 46-48, Florence, 50127, Italy.
| | - Fernanda Angelieri
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Department of Orthodontics, São Paulo Methodist University, São Bernardo do Campo, Brazil
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - M Ali Darendeliler
- Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
- Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Dentistry, UNSBC, Tirana, Albania
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