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Raghupathy Y, Ananthanarayanan V, Kailasam V. Evaluation of pain intensity with prostaglandin E2 biomarker and visual analog scale during initiation of orthodontic treatment: A prospective study. J World Fed Orthod 2024; 13:72-77. [PMID: 37985293 DOI: 10.1016/j.ejwf.2023.10.002] [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: 05/26/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The aim of this study was to assess subjectively and objectively, at which timepoint the patient undergoing fixed orthodontic treatment will have maximum pain during the initiation of orthodontic treatment. MATERIALS AND METHOD A total of 22 patients (21 ± 2.7 years, [15 female and 7 male]) requiring extraction of maxillary first premolar participated in the study. Following bonding, an initial archwire of 0.016" NiTi was placed with a distal force of 100 g applied to the canines. The concentration of prostaglandin E2 (PGE2) in the gingival crevicular fluid was assessed at four time points: 1 hour before (T0); 24 hours (T1); 48 hours (T2); 72 hours (T3) after initial archwire placement. The pain intensity was recorded with visual analog scale. RESULTS The concentration of PGE2 increased from T0 to T1. The highest concentration was observed at T2 following which there was a mild decline at T3. Statistically significant difference in the PGE2 concentration was observed between T0 to T1 and T1 to T2. The visual analogue scale (VAS) scores increased from T0 to T1. The highest score was observed at T2 followed by a decline at T3. A statistically significant difference in the VAS score was noted between T0 to T1 and T2 to T3. On correlating PGE2 and VAS score, a weak negative correlation was noted between T0 to T1 and no correlation was noted between T1 to T2 and T2 to T3. CONCLUSION The patients experience maximum pain between 24 hours (T1) and 48 hours (T2) following initial archwire placement. The highest concentration of PGE2 and VAS score was observed at 48 hours (T2).
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Affiliation(s)
- Yuvashree Raghupathy
- Former Postgraduate, Department of Orthodontics and Dentofacial Orthopaedics, Sri Ramachandra dental college and hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Venkateswaran Ananthanarayanan
- Reader, Department of Orthodontics and Dentofacial Orthopaedics, Sri Ramachandra dental college and hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
| | - Vignesh Kailasam
- Professor & Head, Department of Orthodontics and Dentofacial Orthopaedics, Sri Ramachandra dental college and hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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de Oliveira Chami V, da Rocha JG, Knorst JK, Fensterseifer CK, Ferrazzo VA, Serra-Negra JMC, Marquezan M. Effects of rapid maxillary expansion on sleep disturbance scale for children: A longitudinal CASE-series study. Orthod Craniofac Res 2024; 27:27-32. [PMID: 37282841 DOI: 10.1111/ocr.12678] [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: 01/19/2023] [Revised: 04/02/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the effects of rapid maxillary expansion (RME) on Sleep Disturbance Scale for Children (SDSC) with maxillary atresia. MATERIALS AND METHODS The sample consisted of 27 paediatric patients evaluated through a Brazilian version of the SDSC, answered by their guardians at the following experimental time points: T0 (before installing the Hyrax expander), T1 (on the day of expander stabilization), T2 (3 months after expander stabilization), T3 (immediately after expander removal, following 6 months of retention), and T4 (3 months post-retention). Multilevel Poisson analysis adjusted for repeated measures was performed to compare outcomes across the assessment time points. RESULTS The mean age of patients was 9.1 years (SD = 1.46). The total SDSC scores decreased and were statistically significant from T2 onwards (P < .01), with a decrease of 24% at T4 compared with T1 (IRR 0.76; 95% CI 0.69-0.84). The mean scores at T4 were already lower than the cutoff point for risk of sleep disorders. Regarding the specific domains, there was a significant reduction in sleep breathing disorders, sleep-wake transition disorders, and disorders of excessive somnolence as of T2 (P < .01), T3 (P < .05) and T4 (P < .05), respectively. CONCLUSION RME in children with maxillary atresia had a positive effect on the reduction of total SDSC scores after 3 months of expander stabilization, sustained over 6 and 9 months and significant reduction in sleep breathing disorders domain, sleep-wake transition disorders domain, and disorders of excessive somnolence domain over time points.
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Affiliation(s)
- Vitória de Oliveira Chami
- Post-Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Jessica Klockner Knorst
- Post-Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Vilmar Antônio Ferrazzo
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Junia Maria Cheib Serra-Negra
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mariana Marquezan
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
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Inchingolo AM, Patano A, De Santis M, Del Vecchio G, Ferrante L, Morolla R, Pezzolla C, Sardano R, Dongiovanni L, Inchingolo F, Bordea IR, Palermo A, Inchingolo AD, Dipalma G. Comparison of Different Types of Palatal Expanders: Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1258. [PMID: 37508755 PMCID: PMC10378123 DOI: 10.3390/children10071258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Maxillary bone contraction is caused by genetics or ambiental factors and is often accompanied by dental crowding, with the possibility of canine inclusion, crossbite, class II and III malocclusion, temporomandibular joint disorder, and obstructive sleep apnea (OSAS). Transverse maxillary deficits, in which the maxillary growth is unusually modest, are frequently treated with maxillary expansion. The purpose of this study is to compare the dental and skeletal effects of different types of expanders, particularly the Leaf Expander, rapid and slow dental-anchored or skeletal-anchored maxillary expanders. METHODS We chose studies that compared effects determined by palatal expansion using a rapid palatal expander, expander on palatal screws, and leaf expander. RESULTS Reports assessed for eligibility are 26 and the reports excluded were 11. A final number of 15 studies were included in the review for qualitative analysis. CONCLUSIONS Clinically and radiographically, the outcomes are similar to those obtained with RME and SME appliances; Therefore, it might be a useful treatment choice as an alternative to RME/SME equipment in cases of poor patient compliance or specific situations. Finally, all of the devices studied produce meaningful skeletal growth of the palate. The use of skeletally anchored devices does, without a doubt, promote larger and more successful growth in adolescent patients.
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Affiliation(s)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Matteo De Santis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Sardano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | | | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
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Altuhafy M, Jabr L, Michelogiannakis D, Khan J. Self-perceived pain in Hyrax versus other maxillary expansion orthodontic appliances: a systematic review of clinical studies. Eur Arch Paediatr Dent 2023; 24:279-292. [PMID: 37022607 DOI: 10.1007/s40368-023-00795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/19/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE To evaluate self-perceived pain levels in the Hyrax compared to other types of maxillary expansion (ME) appliances in growing patients. METHODS An unrestricted search of indexed databases and manual searching were performed up to October 2022. Randomized controlled trials (RCTs) comparing the Hyrax appliance with other ME appliances were included. Data screening, extraction, and Risk of Bias (RoB) assessment with the Cochrane tool were performed by two authors. RESULTS Six RCTs were included. The number of participants in the included RCTs ranged between 34 to 114 and included both male and female growing patients. Various tools were used to measure self-perceived pain including the Graphic Rating Scale for Pain, the Wong-Baker Faces Pain Scale, the Numerical Rating Scale, the visual analogue scale, and a questionnaire. One RCT reported that pain intensity in patients treated with the Hyrax was higher than in the Haas appliance, with a statistically significant difference limited to the first day. Two RCTs reported that pain intensity in patients treated with the Leaf expander was lower than in the Hyrax during the first 7 days of treatment. Two RCTs reported no significant differences in pain intensity between the Hyrax and other ME appliances. One RCT reported that pain intensity in patients using the computer-guided skeletal ME appliance was higher than in the Hyrax appliance at the first day after expansion. Four RCTs had a high RoB, and two RCTs had a moderate RoB. CONCLUSIONS Within the limitations of the present systematic review and based on the currently available evidence, it is challenging and inconclusive to identify the best maxillary expansion appliances, regarding pain levels for growing patients.
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Affiliation(s)
- M Altuhafy
- Department of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY, 14620, USA.
| | - L Jabr
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY, USA
| | - D Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY, USA
| | - J Khan
- Department of Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY, 14620, USA
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Hansson S, Josefsson E, Lindsten R, Magnuson A, Bazargani F. Pain and discomfort during the first week of maxillary expansion using two different expanders: patient-reported outcomes in a randomized controlled trial. Eur J Orthod 2023; 45:271-280. [PMID: 36331513 PMCID: PMC10230245 DOI: 10.1093/ejo/cjac067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Quad Helix (QH) is the appliance most preferred by orthodontists to correct unilateral posterior crossbite in the early mixed dentition while other orthodontists suggest rapid maxillary expansion (RME) on deciduous teeth in these patients. OBJECTIVES To evaluate and compare perceived pain intensity, discomfort, functional jaw impairment, and analgesic consumption during the first week of treatment with either RME or QH appliances. TRIAL DESIGN Two-arm parallel group, two-centre, randomized controlled trial. MATERIAL AND METHODS Seventy-two patients, mean age 9.5 (SD ±0.8) years, with unilateral posterior crossbite requiring maxillary expansion were randomly allocated to either the RME (22 boys, 14 girls) or QH (22 boys, 14 girls) group. Validated questionnaires were used to assess pain intensity, discomfort, jaw function impairment, and analgesic consumption, on the first, fourth, and seventh days after appliance insertion and activation. BLINDING Due to clinical limitations, only the outcome assessors were blinded to the groups to which the patients were allocated. RESULTS Seventy patients completed the questionnaires. Pain from the tongue and chafe from the appliance were significantly higher in the QH group on the first day of treatment (P = 0.003 and P = 0.000, respectively). On the fourth day, the chafe from the appliance was still significantly higher in the QH group (P = 0.007). Speech was affected in both groups on day 1; this impairment continued and was significantly higher in the RME group days 4 and 7. No significant difference in analgesic consumption was found between the groups at any time. The analgesic consumption was highest at day 1 of treatment. HARMS No harm was observed in any patient. LIMITATIONS Double blinding was not possible due to the clinical limitations. CONCLUSION During the initial 4 days of treatment, pain from the tongue and chafe from the appliance caused the most reported inconvenience in the patients in the QH group. A majority of reported visual analogue scale values were in the lower mid-range, suggesting low to moderate pain and discomfort in both groups. CLINICAL TRIAL REGISTRATION NCT04458506.
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Affiliation(s)
- Stina Hansson
- Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Josefsson
- Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rune Lindsten
- Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Farhan Bazargani
- Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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Ji L, Li B, Wu X. Evaluation of biomechanics using different traction devices in distalization of maxillary molar with clear aligners: a finite element study. Comput Methods Biomech Biomed Engin 2023; 26:559-567. [PMID: 35543236 DOI: 10.1080/10255842.2022.2073789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The study aimed to mechanically evaluate the tooth displacement of molar distalization by clear aligners combined with micro-implant through different traction devices using finite element analysis. A three-dimensional finite element model of complete maxillary dentition was constructed. Simultaneously move the maxillary first and second molars 0.2 mm distally at the height of 4 mm and 6 mm of micro-implant, and 150 g force was applied to button, precision cut and angelbutton respectively. Initial tooth movement in six different conditions of anterior tooth and molars was analyzed and calculated with ANSYS software. All the upper anterior tooth exhibited uncontrolled labial tipping and intrusion upon the six conditions, and the central incisor showed the largest tendency of crown labial inclination. Among the absolute values of crown-root displacement difference of the anterior tooth in sagittal direction, the angelbutton was the smallest, which means the torque control ability was superior to others. However, button played a more accurate role in the sagittal and vertical control of canine. With the increase of micro-implant height, the torque control ability of anterior tooth was decreased, but the intrusion trend increased. The controlled distal inclination with extrusion of the first molar and uncontrolled distal inclination with intrusion of the second molar were observed, and the angelbutton had more effective horizontal and vertical control on molars, which was close to bodily movement than others. As a new type of traction device, angelbutton has excellent anchorage control effect in clear aligners therapy of molar distalization, which further realizes the accurate expression of orthodontic force.
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Affiliation(s)
- Lili Ji
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
| | - Bing Li
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
| | - Xiuping Wu
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
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Barone M, De Stefani A, Cavallari F, Gracco A, Bruno G. Pain during Rapid Maxillary Expansion: A Systematic Review. CHILDREN 2023; 10:children10040666. [PMID: 37189916 DOI: 10.3390/children10040666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Aim: The aim of the present systematic review is to evaluate the pain perceived by patients during rapid maxillary expansion (RME) in relation to factors such as demographic characteristics, appliance type, activation protocol, and the eventual use of medication or pain management strategies. Materials and methods: An electronic search of available articles on the subject was conducted on three electronic databases, using predefined keywords. Sequential screenings based on pre-established eligibility criteria were performed. Results: Ten studies were ultimately included in this systematic review. The main data of the reviewed studies were extracted according to the PICOS approach. Conclusions: Pain is a common effect of RME treatment that tends to decrease over time. Gender and age differences in pain perception are not clear. Perceived pain is influenced by the expander design and expansion protocol used. Some pain management strategies can be useful for reducing RME-associated pain.
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Büyükbayraktar ZÇ, Kuruca TÖ. The effects of orthodontic treatment type, depression, and treatment need on perceived pain intensity. APOS TRENDS IN ORTHODONTICS 2023. [DOI: 10.25259/apos_21_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objectives:
The objectives of this study were to evaluate how orthodontic treatment type, treatment need, and depression affect perceived pain intensity (PPI).
Material and Methods:
This prospective study included 172 patients (80 girls and 92 boys, mean age 14.32 ± 1.57 years) treated at the Sivas Cumhuriyet University Faculty of Dentistry, Department of Orthodontics. The patients were divided into three groups: the first group was treated with fixed orthodontic appliances, the second group was treated with twin blocks, and the third group was treated with rapid maxillary expansion and reverse headgear (RME/RH). Data were collected and classified with the Index of Orthodontic Treatment Need-Dental Health Component (DHC), Children’s Depression Scale, and Visual Analog Scale. PPI was recorded in the 1st week (T0), 2nd week (T1), the 1st month (T2), 2nd month (T3), 3rd month (T4), and the 6th month (T5).
Results:
PPI was higher in boys at T1 (P = 0.005) compared with girls. There was a significant difference of PPI between the treatment groups at T2 (P = 0.036), T3 (P = 0.012), T4 (P = 0.000), and T5 (P = 0.006). A statistically significant positive correlation was found between DHC and PPI at T3 (r = 0.182; P = 0.000), T4 (r = 0.161; P = 0.03), and T5 (r = 0.189; P = 0.000) time periods. There was no significant correlation between depression and PPI.
Conclusion:
Girls were more resistant to pain than boys. The type of treatment and the need for treatment both had an effect on PPI. Further studies are needed to investigate the effects of psychological states on PPI during orthodontic treatment.
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ElNaghy R, Al-Qawasmi R, Hasanin M. Do patient-reported outcomes of miniscrew-supported maxillary expansion in adolescent patients differ between slow and rapid activation protocol? Evid Based Dent 2023; 24:28-29. [PMID: 36890253 DOI: 10.1038/s41432-023-00858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/10/2023]
Abstract
DESIGN Single-center randomized clinical trial with two parallel arms. The protocol of the study was approved by the institutional review board (IRB) of the Faculty of Dentistry, Alexandria University (IRB: 00010556-IORG: 0008839) and registered in Clinicaltrials.gov (identifier number: NCT04225637). Before the trial commencement, parents/legal guardians signed informed consents. The study complied with the CONSORT (Consolidated Standards of Reporting Trials). CASE SELECTION 30 adolescent patients aged between 12 to 16 years with transversely deficient maxilla requiring skeletal maxillary expansion were recruited to be included in the study. Patients received miniscrew-supported Penn expanders and they were randomly allocated (ratio 1:1) into two groups based on the activation protocol; slow maxillary expansion (SME = turn every other day) or rapid maxillary expansion (RME = 2 turn/day). DATA ANALYSIS The patient-reported outcome measures were the following: pain, headache, pressure, dizziness, speech, chewing and swallowing difficulties, swallowing difficulty. The participants rated the reported outcomes using numeric rating scale (NRS) at 4 time points: t1 = before appliance insertion, t2 = after first activation, t3 = after 1 week of activation, and t4 = after last activation. Patients were advised not to use analgesics, and to contact their provider in case of severe pain. Descriptive measures and patient-reported outcomes at various time points were calculated. Comparisons between the two groups at each time point were assessed using Mann-Whitney U-test. Comparisons of time points in each group were assessed using the Friedman test and followed by post-hoc tests with Bonferroni correction. RESULTS 6 patients were not included in the analysis for different reasons, allowing a total of 24 patients (12 patients in each group) to be analyzed. Mean ages of the patients in the SME and RME group were 14.30 ± 1.37 and 15.07 ± 1.59, respectively. Median scores were in the bottom quartiles of NRS for all reported outcomes. RME group reported significantly higher scores for all measured variables, with exception of headache and dizziness, which showed no statistical difference between the two group. CONCLUSIONS Mild to moderate discomfort and functional limitation is anticipated with the activation of miniscrew-anchored Penn expanders. Slow activation protocol provided a better overall patient experience when compared to a rapid activation protocol.
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Affiliation(s)
- Rahma ElNaghy
- Department of Graduate Orthodontics, University of Detroit Mercy, Detroit, MI, USA.
| | - Riyad Al-Qawasmi
- Department of Graduate Orthodontics, University of Detroit Mercy, Detroit, MI, USA
| | - Majd Hasanin
- Department of Graduate Orthodontics, University of Detroit Mercy, Detroit, MI, USA
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Miranda F, Parra LD, Bastos JCDC, dos Santos AM, de Souza Silva I, Quevedo B, Aliaga-Del Castillo A, Garib D. Pain and discomfort perception during miniscrew-anchored maxillary protraction: secondary data analysis of a randomized clinical trial. Angle Orthod 2023; 93:490739. [PMID: 36795039 PMCID: PMC10117207 DOI: 10.2319/092022-655.1] [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: 09/01/2022] [Accepted: 12/01/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders. MATERIALS AND METHODS Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%). RESULTS Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P = .608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P < .001; T2: 23.15, P < .001; T3: 9.35, P = .008). CONCLUSIONS MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders.
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Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod 2022; 23:47. [PMID: 36503984 PMCID: PMC9742070 DOI: 10.1186/s40510-022-00440-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients. OBJECTIVE The objective of this systematic review was to compare PROMs in RME versus SME in growing patients. MATERIALS AND METHODS Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied. RESULTS Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I2 = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction. CONCLUSIONS Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.
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Affiliation(s)
- Valentina Rutili
- grid.8404.80000 0004 1757 2304Postgraduate Program in Orthodontics, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Michele Nieri
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Debora Franceschi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Felicita Pierleoni
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Veronica Giuntini
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Lorenzo Franchi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy ,grid.214458.e0000000086837370Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA
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Yacout YM, Abdalla EM, El Harouny NM. Patient-reported outcomes of slow vs rapid miniscrew-supported maxillary expansion in adolescents: secondary outcomes of a randomized clinical trial. Angle Orthod 2022; 93:487444. [PMID: 36256584 PMCID: PMC9933559 DOI: 10.2319/061022-418.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare patient-reported experience between a Penn expander activated every other day vs twice daily. MATERIALS AND METHODS A total of 30 patients aged 12-16 years with transverse maxillary deficiency were recruited from the outpatient clinic, Faculty of Dentistry, Alexandria University (February 2019-December 2020). They were randomly allocated to two groups using block randomization (block size of six) and an allocation ratio of 1:1, which was concealed using opaque, sealed, sequentially numbered envelopes. Both groups received Penn expanders anchored by four palatal miniscrews. The slow maxillary expansion (SME) group activated the appliance once every other day. The rapid maxillary expansion (RME) group activated the appliance twice daily. Outcome measures were pain, pressure, headache, dizziness, speech difficulty, chewing difficulty, and swallowing difficulty scores rated by the participants on an 11-point numeric rating scale (NRS) at the following four time points: before appliance insertion (t1), after first activation (t2), after 1 week of activation (t3), and after last activation (t4). RESULTS Data of 24 patients in the SME group (n = 12, mean age = 14.30 ± 1.37 years) and RME group (n = 12, mean age = 15.07 ± 1.59 years) were analyzed. Median scores for all outcomes were in the bottom quartiles of the NRS. No difference was found between the two groups at t1 or t2. Significantly higher scores for all variables, except dizziness and headache, were reported in the RME group at t4. CONCLUSIONS Activation of miniscrew-supported expanders resulted in mild to moderate discomfort and functional limitation. Slow activation resulted in a better overall patient experience compared with rapid activation.
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Rabah N, Al-Ibrahim HM, Hajeer MY, Ajaj MA, Mahmoud G. Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial. Cureus 2022; 14:e22793. [PMID: 35261839 PMCID: PMC8893008 DOI: 10.7759/cureus.22793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to evaluate and compare the levels of pain, discomfort, and functional impairments between slow and rapid maxillary expansion (RME) in treating skeletal maxillary constriction in the adolescence period (i.e., between 12 and 16 years). Materials and methods The study sample consisted of 52 patients (21 males and 31 females) with maxillary skeletal constriction in the posterior region. The patients were randomly distributed into either RME (26 patients, with a mean age of 13.87 (± 1.31) years) or slow maxillary expansion group (SME, 26 patients, with a mean age of 14.31 (± 1.19) years). The levels of pain, discomfort, and functional difficulties were assessed after 24 hours (T1), 7 days (T2), 15 days (T3), one month (T4), and four months (T5) following the onset of the expansion procedure. Results Patients in the RME group encountered significantly greater levels of pain and discomfort than those in the SME group at T1, T2, and T3 (p>0.001). Chewing and swallowing difficulties were significantly greater in the RME group at T1, T2, T3, and T4 (P≤0.001). The pressure on soft tissue was greater in the RME group at T2 and T3 (p>0.001). After four months (T5), the levels of pain and discomfort decreased to their lowest levels, as well as the difficulties of chewing and swallowing, and the pressure on soft tissue were almost non-existent in both groups. Conclusion Patients treated with the removable slow maxillary expander reported lower levels of pain and discomfort, fewer chewing and swallowing difficulties, and less pressure on soft tissues than those treated with the bonded rapid maxillary expander. These difficulties gradually decreased over time in both groups. The lower levels of pain and discomfort may make the SME an effective and comfortable treatment alternative for adolescents with skeletal maxillary constriction.
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Affiliation(s)
- Nancy Rabah
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Heba M Al-Ibrahim
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Mohammad Y Hajeer
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Mowaffak A Ajaj
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Ghiath Mahmoud
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
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14
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Verma P, George AM. Efficacy of clear aligners in producing molar distalization: Systematic review. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_37_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The aim of this review is to systematically analyze the efficacy of molar distalization using clear aligners in non-growing Class II patients.
Materials and Methods:
A complete search across the electronic database through PubMed, Cochrane, Google scholar, LILACS, and manual search of orthodontic journals were done till 2019. Studies were selected on the basis of PRISMA guidelines.
Results:
A total of four articles were included in this review. The amount of molar distalization reported was 2–3 mm.
Conclusion:
Out of the four studies included. In all the studies a significant amount of distalization was reported. Three retrospective studies concluded that distalization with aligners is the most effective of all tooth movements. One study concluded that aligners effectively achieved distalization with an efficacy of 87%, other two studies concluded that aligners effectively distalized the molars with good control over vertical dimension and mesiodistal tipping.
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Affiliation(s)
- Purva Verma
- Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India,
| | - Ashwin Mathew George
- Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India,
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15
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Pithon MM, Marañón-Vásquez GA, da Silva LP, Coqueiro RDS, Lacerda Dos Santos R, Tanaka OM, Maia LC. Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial. Am J Orthod Dentofacial Orthop 2021; 161:172-181. [PMID: 34711482 DOI: 10.1016/j.ajodo.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children. METHODS Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after the appliance removal (T3). Generalized mixed models were used for data analysis (α = 0.05). RESULTS Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. CONCLUSIONS Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. REGISTRATION This trial was not registered. PROTOCOL The protocol was not published before trial commencement. FUNDING This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.
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Affiliation(s)
- Matheus Melo Pithon
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Health I, School of Dentistry, Southwest Bahia State University, Jequié, Bahia, Brazil.
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luciana Pereira da Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Baruah D, Nagesh S, Sarma H, Mattu N. Comparative Assessment of Anxiety, Pain, and Discomfort During Rapid Maxillary Expansion Using Two Different Activation Protocols in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2021; 59:1010-1016. [PMID: 34397282 DOI: 10.1177/10556656211033105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare and assess the pain perception, anxiety, and discomfort between two different rapid maxillary expansion (RME) protocols in patients with unilateral cleft lip and palate (UCLP). DESIGN This is a prospective study. SETTING The study was done in a comprehensive cleft care center. PATIEN AND PARTICIPANTS The sample included 26 patients between ages 6 and 9 years with a history of repaired UCLP. INTERVENTIONS The patients were randomly allotted into 2 groups-Group A and Group B. Group A received 1 RME activation per day and Group B received 2 activations per day. The participants after RME activation completed a self-report questionnaire and ranked the pain and anxiety levels using Faces pain scale and Hamilton anxiety scale, respectively. The evaluation was done every day for 1 week. MAIN OUTCOME MEASURE The Faces Pain Scale, Hamilton Anxiety Scale, and self-report questionnaires assessed the pain, anxiety, and discomfort experienced by the patients after 2 different types of RME activation protocols. RESULTS Group B experienced significantly higher pain in the molars than Group A (P < .001). There was no significant difference between the 2 RME activation protocols regarding anxiety and jaw discomfort. CONCLUSION Patients who received 2 activations per day experienced significantly higher levels of pain in the molars compared to the patients who received a single activation per day. There were no significant differences between the 2 activation protocols in terms of pain in the palate, tongue, anxiety, and jaw discomfort.
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Affiliation(s)
- Dipjyoti Baruah
- Guwahati Comprehensive Care Centre (GC4), Mission Smile, Mahendra Mohan Choudhary Hospital, Guwahati, Assam, India
| | - Shweta Nagesh
- 28856KLE Society's Institute of Dental Sciences, Bengaluru, India
| | - Hiteswar Sarma
- Guwahati Comprehensive Care Centre (GC4), Mission Smile, Mahendra Mohan Choudhary Hospital, Guwahati, Assam, India
| | - Navraj Mattu
- 58891Lady Hardinge Medical College and Kalawati Hospital, New Delhi, India
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17
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Perceived Pain during Rapid Maxillary Expansion (RME): Trends, Anatomical Distinctions, and Age and Gender Correlations. Pain Res Manag 2021; 2021:7396466. [PMID: 34336069 PMCID: PMC8295004 DOI: 10.1155/2021/7396466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Objectives To investigate pain trends and characteristics of different facial districts in patients undergoing rapid maxillary expansion (RME) and its possible correlations with age and gender. Materials and Methods 85 subjects (45 males and 40 females) undergoing RME were selected and analyzed during first two weeks of treatment. Patients rated daily two types of pain perception: the general perceived pain (GPP), i.e., the pain overall perceived in the face, and the local perceived pain (LPP), i.e., the pain perceived locally in the following anatomical areas: anterior palate (APA), posterior palate (PPA), nasal (NA), joint (JA), and zygomatic (ZA). Patients were provided the Numeric Rating Scale (NRS) and Wong–Baker Faces Pain Rating Scale (FPS) to correctly assess their GPP and LPP. Pearson correlation coefficient and analysis of variance (ANOVA) were, respectively, used to define the linear relationship between all the variables considered and to verify whether the response variables (gender and age) were significantly different (α < 0.05). Results Sample's mean age was 10.11 years. Average pain values of GPP and LPP progressively rise from day 1 to days 2-3 (pain peak) and tended to decrease until day 14, with a linear decrease for GPP and a not linear decrease for LPP. PPA and APA resulted the most painful areas, followed, respectively, by JA, ZA, and NA. Statistically significant differences resulted in average pain values according to patients' age and gender, both in GPP and LPP. Conclusion RME causes perception of pain in several maxillofacial areas. Pain reported during RME resulted positively correlated with age and gender of patients.
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18
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de Araújo MC, Bocato JR, Berger SB, Oltramari PVP, de Castro Ferreira Conti AC, de Almeida MR, Freire Fernandes TM. Perceived pain during rapid maxillary expansion in children with different expanders. Angle Orthod 2021; 91:484-489. [PMID: 33621314 DOI: 10.2319/092820-829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate and compare the intensity of pain caused by rapid maxillary expansion (RME) with two expanders: Hyrax and Haas type, in growing patients. MATERIALS AND METHODS Thirty-nine patients (23 girls and 16 boys) with an average age of 9.3 years (SD = 1.39 years) were randomized into two groups and treated with Hyrax- and Haas-type expanders. In both groups, initial activation of the expander screw was one full turn on the first day followed by 2/4 of a turn two times a day (morning and night) for 7 days. Inclusion criteria were patients presenting with a posterior crossbite or maxillary atresia between 7 and 12 years old. To evaluate the intensity of pain during the active phase of the treatment, a combination of the Numerical Rating Scale and Wong-Baker Faces Pain Scale was used. Mann-Whitney test was used to compare the two treatment groups. RESULTS There was significant inverse correlation between days following insertion and pain. During the expansion period, 100% of the children reported some pain. Hyrax expander subjects reported greater pain than those treated with the Haas-type expander only on the first day. The level of pain remained greater in girls throughout treatment. CONCLUSIONS Pain was reported regardless of the type of expander and was higher in the Hyrax group only on the first day of activation.
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19
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Lopponi G, Maino BG, Dalessandri D. Rapid Palatal Expansion Should Not Be Trivialized: Two Case Reports of Unexpected Complications. Eur J Dent 2021; 15:599-605. [PMID: 34171932 PMCID: PMC8382503 DOI: 10.1055/s-0041-1728840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Rapid maxillary expansion is one of the most common orthodontic procedures performed in the pediatric population, easy to accomplish and compliance free, therefore really effective. Nevertheless, a careful diagnosis and frequent clinical follow-up appointments are necessary during the first weeks of active treatment. The purpose of this article was to report two cases of unexpected complications during orthopaedic maxillary expansion, involving two 7-year-old female patients, one presenting a saddle nose with suborbital hematoma and the other one an asymmetric palatal expansion. In both cases, the clinical situation progressively relapsed during the months following expansion appliance removal.
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Affiliation(s)
- Gaia Lopponi
- Department of Endodontics, University of Florence, Firenze, Italy.,Department of Orthodontics, University of Cagliari, Cagliari, Italy
| | - Bortolo Giuliano Maino
- Postgraduate Orthodontic School, Ferrara University, Ferrara, Italy.,Private Practice of Orthodontics, Vicenza, Italy
| | - Domenico Dalessandri
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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20
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Nieri M, Paoloni V, Lione R, Barone V, Marino Merlo M, Giuntini V, Cozza P, Franchi L. Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient's reported outcome measures. Eur J Orthod 2021; 43:293-300. [PMID: 33215652 DOI: 10.1093/ejo/cjaa063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to compare an expansion screw of the maxilla that generates moderate and continuous forces versus a conventional screw for rapid maxillary expansion (RME) on patient-reported outcome measure during the first 12 weeks of treatment. TRIAL DESIGN This is a superiority, multicenter, two-arm parallel balanced randomization trial. METHODS Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group, treated with an expansion screw with Ni-Ti springs) was compared to a conventional RME screw that generates intermittent heavy forces (RME group). The primary response variable was the visual analogue scale (VAS) on pain calculated in the first 12 weeks of therapy. The VAS on difficulty on speaking and oral hygiene, patient satisfaction, and complications were also evaluated. A computer-generated block randomization was used with allocation concealed in sequentially numbered opaque-sealed envelopes. Blinding was not applicable. Linear models were used for statistical analysis. RESULTS Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. The mean of the VAS for pain was 0.3 ± 0.4 in the Leaf group and 0.6 ± 0.5 in the RME group. The difference was -0.3 (95 per cent CI from -0.5 to -0.0; P = 0.017) in favour of the Leaf group. The difference in pain was marked in the first week (Leaf group 2.2 ± 2.3; RME group 3.7 ± 2.6; difference -1.5; 95 per cent CI from -2.7 to -0.3; P = 0.019). CONCLUSIONS Patients in the Leaf group experienced a lower degree of pain, especially during the first week following the application of the expander. For the other variables, no significant differences were reported between the two treatments. REGISTRATION The study was registered in the ISRCTN register on 8 November 2016 with the number ISRCTN18263886.
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Affiliation(s)
- Michele Nieri
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Valeria Paoloni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | | | - Matilde Marino Merlo
- Scuola di Specializzazione in Ortognatodonzia, The University of Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - Veronica Giuntini
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
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21
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Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis. Eur J Orthod 2021; 43:301-312. [PMID: 33950178 DOI: 10.1093/ejo/cjaa086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND No systematic review and meta-analysis of dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols is available. OBJECTIVE To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients. SEARCH METHODS PubMed (MEDLINE), Cochrane Library, Scopus, Embase, and OpenGrey were searched with no language or publication date restrictions. SELECTION CRITERIA Only randomized controlled trials (RCTs) were selected and the following inclusion criteria were used: growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). For the aggregation of continuous data, the mean of the differences (MD) between treatments was used. A random effect model was applied. RESULTS From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias. Maxillary intermolar distance showed no significant differences between the two modalities of expansion [pooled MD = 0.99 mm favouring RME, with 95% confidence interval (CI) = -2.09 to 4.06, P = 0.53, I2 = 90%]. As for maxillary molar inclination measured as the angle formed by the axes passing through the disto-buccal cusps and the apexes of the palatine root of the first upper molars, it was significantly smaller in the SME group (MD = -11.51°, with 95% CI = -15.23 to -7.79, P < 0.0001). Posterior maxillary expansion was significantly greater in RME than SME (pooled MD = 0.75 mm, with 95% CI = 0.27-1.23, P = 0.002, I2 = 0%). CONCLUSIONS Both RME and SME produce an effective dento-skeletal expansion of the maxilla. RME is slightly more effective in increasing the posterior transverse skeletal width of the maxilla while SME induces smaller molar inclination. REGISTRATION PROSPERO CDR42018105530.
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Affiliation(s)
- Valentina Rutili
- Postgraduate Program in Orthodontics, Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | | | - Michele Nieri
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Debora Franceschi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Felicita Pierleoni
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, The University of Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA
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22
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Paoloni V, Giuntini V, Lione R, Nieri M, Barone V, Merlo MM, Mazza F, Passaleva S, Cozza P, Franchi L. Comparison of the dento-skeletal effects produced by Leaf expander versus rapid maxillary expander in prepubertal patients: a two-center randomized controlled trial. Eur J Orthod 2021; 44:163-169. [PMID: 34114608 DOI: 10.1093/ejo/cjab035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to compare the skeletal and dentoalveolar effects produced by slow maxillary expansion (SME) with the Leaf expander versus the conventional rapid maxillary expansion (RME) on digital dental casts, lateral and postero-anterior cephalometric radiographs. TRIAL DESIGN This is a superiority, two-center, two arms parallel balanced randomization trial. METHODS Patients in the mixed dentition were included with a transverse interarch discrepancy of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group) was compared to a conventional RME screw (RME group). The primary response variable was the difference in maxillary intermolar width (U6-U6) measured at baseline (T0) and one-year follow-up (T1) on the digital dental casts. Other dento-skeletal variables were also measured on digital dental casts and cephalograms. Computer-generated block randomization was used with allocation concealed in sequentially numbered opaque sealed envelopes. The examiner was blinded on the type of expander used. Linear models were used for statistical analysis. RESULTS Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. U6-U6 did not show a statistically significant difference between the two groups (-0.4 mm in favor of the RME group, 95% CI from -1.2 to 0.5, P = 0.365). As for the other secondary variables no statistically significant differences were found between the two groups except maxillary intercanine width (U3-U3, -0.9 mm in favor of the RME group, 95%CI from -1.5 to -0.3, P = 0.005) and maxillary skeletal width (Mx-Mx, -1.4 mm in favor of the RME group, 95%CI from -2.4 to -0.3, P = 0.013). CONCLUSIONS No significant differences between the RME and Leaf groups were detected for any of the analyzed dento-skeletal variables except the T1-T0 differences in U3-U3 and Mx-Mx that were significantly greater in the RME group. REGISTRATION The study was registered in the ISRCTN register on 08/11/2016 with the number ISRCTN18263886. FUNDING No funding or conflict of interest to be declared.
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Affiliation(s)
- Valeria Paoloni
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Veronica Giuntini
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | - Roberta Lione
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy.,UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, The University of Florence, Italy
| | | | - Matilde Marino Merlo
- Postgraduate Program in Orthodontics, The University of Florence, Florence, Italy
| | - Francesca Mazza
- SOC Odontostomatologia, AUSL Toscana centro, Florence, Italy
| | | | - Paola Cozza
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy.,UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy.,Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
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23
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Nota A, Quinzi V, Floriani F, Cappelli C, Tecco S, Marzo G. 3D Morphometric Analysis of Human Primary Second Molar Crowns and Its Implications on Interceptive Orthodontics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126201. [PMID: 34201156 PMCID: PMC8229238 DOI: 10.3390/ijerph18126201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
The second primary molar represents an anchorage element in interceptive orthodontics. The present study aims to analyze the 3D morphology of primary second molars in order to provide reference data and implications about the development of orthodontic bands for second primary molars. Digital models of dental arches from 150 subjects in primary or mixed dentition were analyzed. Six dimensional variables were digitally measured for each second primary molar, and the mean and standard error of the mean (SEM) were calculated and compared applying Student t-test statistical analysis. The mean value results show statistically significant dimensional differences between the upper and lower teeth, (mostly p < 0.0001), except for the variable h1, while only the variable h1 showed significant differences between the antimetric teeth (left and right). The dimensional variations between the right and left molars were considerably minor compared to those found by comparing the upper and lower arches. A significantly higher dimension of the lower molars and a more rectangular shape were observed.
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Affiliation(s)
- Alessandro Nota
- Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele, 20132 Milan, Italy;
| | - Vincenzo Quinzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.Q.); (G.M.)
| | | | | | - Simona Tecco
- Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele, 20132 Milan, Italy;
- Correspondence:
| | - Giuseppe Marzo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.Q.); (G.M.)
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Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
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Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Altieri F, Cassetta M. The impact of tooth-borne vs computer-guided bone-borne rapid maxillary expansion on pain and oral health–related quality of life: A parallel cohort study. Am J Orthod Dentofacial Orthop 2020; 158:e83-e90. [PMID: 32978017 DOI: 10.1016/j.ajodo.2020.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
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26
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Matos DS, Palma-Dibb RG, de Oliveira Santos C, da Conceição Pereira Saraiva M, Marques FV, Matsumoto MAN, Romano FL. Evaluation of photobiomodulation therapy to accelerate bone formation in the mid palatal suture after rapid palatal expansion: a randomized clinical trial. Lasers Med Sci 2020; 36:1039-1046. [PMID: 32901379 DOI: 10.1007/s10103-020-03141-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
To evaluate the efficiency of photobiomodulation therapy (PBMT) in the midpalatal suture (MPS) and pain sensation in patients undergoing rapid palatal expansion (RPE). Thirty-four individuals with the diagnosis of skeletal maxillary hypoplasia were divided in two groups: laser (n = 18) and control (n = 16). Treatment plan consisted of the use of the Hyrax expander in all patients. Subjects in the laser group were irradiated with diode laser (980 nm, 0.3 W) in six spots bilaterally distributed along the MPS for 10 s during the active phase of treatment and after overcorrection (passive phase of RPE). Control group received sham irradiations with the laser in standby mode to characterize the placebo effect. Digital occlusal radiographs were performed at different time-points for bone formation evaluation in both groups. The effects of laser irradiation on pain were assessed by the visual analog scale (Wong-Baker Faces Pain Scale). Bone formation between groups was not significantly different (p = 0.2273). At 3 months, bone formation was not yet complete in both groups. Pain sensation was similar between groups (p = 0.3940). However, pain was significantly higher for the first 7 days of treatment compared with the 14th day. PBMT did not accelerate bone regeneration in the MPS and pain sensation was similar.
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Affiliation(s)
- Denise Souza Matos
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, MG, Brazil
| | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Christiano de Oliveira Santos
- Department of Stomatology, Public Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Maria da Conceição Pereira Saraiva
- Department of Paediatric Clinics, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café, s/n. Monte Alegre, Ribeirao Preto, SP, Brazil
| | - Fernanda Vicioni Marques
- Department of Paediatric Clinics, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café, s/n. Monte Alegre, Ribeirao Preto, SP, Brazil
| | - Mírian Aiko Nakane Matsumoto
- Department of Paediatric Clinics, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café, s/n. Monte Alegre, Ribeirao Preto, SP, Brazil
| | - Fábio Lourenço Romano
- Department of Paediatric Clinics, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café, s/n. Monte Alegre, Ribeirao Preto, SP, Brazil.
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Ugolini A, Cossellu G, Farronato M, Silvestrini-Biavati A, Lanteri V. A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: Leaf expander versus hyrax expander. Int J Paediatr Dent 2020; 30:421-428. [PMID: 31894603 DOI: 10.1111/ipd.12612] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pain suffered by the young patient is the most frequent symptom during orthodontic treatment and is the one that most frightens children and causes worry in their families. AIM To investigate pain perception and function impairment during the first week of activation of two palatal expansion screws. DESIGN A total of 101 subjects were randomly divided into two groups: RME group included patients treated with the standard hyrax expansion screw and LEAF group included patients treated with Leaf Expander appliance. Pain intensity was assessed via the Wong-Baker scale. A questionnaire on oral function impairments was also compiled by the patients. RESULTS The Pain Scale analysis showed that patients in the RME group suffered from a significantly higher level of pain than those in the LEAF group (88.6% vs 25%, P < .01). RME group showed highest pain indexes from day 1 to day 4 (51.4% RME vs 9.7% LEAF suffered at least once from strong pain in the first 4 days, P < .01). Furthermore, oral functions were similarly affected in both groups. CONCLUSIONS Pain reported during maxillary arch expansion is influenced by clinical activation protocol and by the screw type. Patients treated with Leaf Expander reported significantly lower pain level in the first 7 days of treatment.
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Affiliation(s)
- Alessandro Ugolini
- Department of Surgical and Diagnostic Sciences, University of Genova, Genoa, Italy
| | - Gianguido Cossellu
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Farronato
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Valentina Lanteri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
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Caruso S, Nota A, Ehsani S, Maddalone E, Ojima K, Tecco S. Impact of molar teeth distalization with clear aligners on occlusal vertical dimension: a retrospective study. BMC Oral Health 2019; 19:182. [PMID: 31409348 PMCID: PMC6692944 DOI: 10.1186/s12903-019-0880-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background A common strategy in the non-extraction treatment of Class II molar relationship is maxillary molar distalization, which could increase lower face height and cause clockwise mandibular rotation. The aim of this retrospective study was to analyse the effects on vertical dentoskeletal dimension of young adults treated with sequential distalization with orthodontic aligners. Methods Lateral cephalometric radiographs of 10 subjects (8 females 2 males; mean age 22.7 ± 5.3 years) treated with upper molars sequential distalization with orthodontic aligners (Invisalign, Align Technology, San Josè, California, USA) were analyzed. Results No statistically significant difference was observed for the primary outcome SN-GoGn between T0 and T1 and it was recorded a mean variation of 0.1 ± 2.0 degrees. Statistically significant differences were found in the linear position of the upper molars (6-PP, 7-PP) the molar class relationship parameter (MR) and the upper incisive inclination (1^PP) with at least p < 0.01. Conclusions Upper molar distalization with orthodontic aligners guarantee an excellent control of the vertical dimension representing an ideal solution for the treatment of hyperdivergent or openbite subjects. It also allows an excellent control of the incisal torque without loss of anchorage during the orthodontic procedure.
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Affiliation(s)
- Silvia Caruso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Coppito, Italy
| | - Alessandro Nota
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Coppito, Italy. .,Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy.
| | - Shideh Ehsani
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
| | - Elena Maddalone
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
| | - Kenji Ojima
- Private Practice of Orthodontics, Tokyo, Japan
| | - Simona Tecco
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
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Khosravi M, Ugolini A, Miresmaeili A, Mirzaei H, Shahidi-Zandi V, Soheilifar S, Karami M, Mahmoudzadeh M. Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review. Int Orthod 2019; 17:425-436. [PMID: 31280998 DOI: 10.1016/j.ortho.2019.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.
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Affiliation(s)
- Mahdieh Khosravi
- Orthodontic Department Dental Faculty, 17 Shahrivar boulevard, Seman, Iran
| | - Alessandro Ugolini
- University of Genoa, Orthodontic Department, Largo Rosanna Benzi 10, Genova, Italy
| | - Amirfarhang Miresmaeili
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Hamed Mirzaei
- Faculty of Management of University of Tehran, Tehran, Iran
| | - Vahid Shahidi-Zandi
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Sepideh Soheilifar
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran
| | - Manoochehr Karami
- Hamedan University of medical sciences, Department of Epidemiology School of Health, Shahid Fahmide boulevard, Hamedan, Iran
| | - Majid Mahmoudzadeh
- Hamedan University of Medical sciences, Orthodontic Department Dental Faculty, Shahid Fahmide Boulevard, Hamedan, Iran.
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Marino A, Nota A, Caruso S, Gatto R, Malagola C, Tecco S. Obstructive sleep apnea severity and dental arches dimensions in children with late primary dentition: An observational study. Cranio 2019; 39:225-230. [PMID: 31238802 DOI: 10.1080/08869634.2019.1635296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The aim of this study was to compare the dimensions of the upper and lower arches in children affected by OSAS with different levels of severity of obstruction.Methods: Twenty-seven Caucasian children (14 males, 13 females; mean age 6, range 5.2-6.1 years) with a diagnosis of OSAS determined by polysomnography were enrolled in this study. The dimensions of both dental arches were measured, and the data were compared among children affected by severe, moderate, and mild OSAS.Results: Statistically significant differences among the three groups revealed that children with severe OSAS had the highest values of upper intercanine and intermolar distances in the sample.Discussion: A severe OSAS grade (AHI > 10) is associated with statistically significantly higher upper intercanine and intermolar distances compared with mild and moderate grades. An early approach to OSAS in children with late primary dentition is auspicated in order to prevent an influence on dental arches growth.
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Affiliation(s)
- Alessandra Marino
- Faculty of Psychology and Medicine, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Alessandro Nota
- Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele, Milan, Italy.,Department MeSVA, University of L'Aquila, L'Aquila, Italy
| | - Silvia Caruso
- Department MeSVA, University of L'Aquila, L'Aquila, Italy
| | - Roberto Gatto
- Department MeSVA, University of L'Aquila, L'Aquila, Italy
| | - Caterina Malagola
- Faculty of Psychology and Medicine, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Simona Tecco
- Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele, Milan, Italy
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Abstract
Rapid maxillary expansion (RME) is an orthopaedic treatment frequently used to correct transversal problems in the maxilla. The aim of this case report was to evaluate the transversal skeletal and dental changes in a 12-year-old male patient with maxillary atresia and bilateral posterior crossbite who had been treated with rapid maxillary expansion assisted by mini-implant anchorage. The results showed an increase of 6.2mm in the maxillary width, an increase of 6mm, 8mm and 9mm in the fossa-fossa measurements between first premolars, second premolars and first molars respectively, also there was a vestibuloversion of molars as an undesirable effect. Mini-implants, as skeletal anchorage in rapid maxillary appliances is a good alternative to achieve an increase of transverse skeletal and dental dimensions with a minimum amount of side effects.
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Cossellu G, Lanteri V, Lione R, Ugolini A, Gaffuri F, Cozza P, Farronato M. Efficacy of ketoprofen lysine salt and paracetamol/acetaminophen to reduce pain during rapid maxillary expansion: A randomized controlled clinical trial. Int J Paediatr Dent 2019; 29:58-65. [PMID: 30298560 DOI: 10.1111/ipd.12428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/31/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid maxillary expansion (RME) is an orthopaedic procedure indicated for a wide variety of clinical conditions. AIM The aim of the study was to compare the effects of ketoprofen lysine salt (KLS) vs paracetamol/acetaminophen (P) on pain perception during RME. DESIGN One hundred and fifty-one subjects (mean age 8.6 year) were enrolled in this prospective controlled clinical trial according to inclusion criteria: prepuberal stage of development, negative posterior transverse interarch discrepancy, non-concurrent use of other drugs. First phase: n.40 allocated to Group 1 used 40 mg of KLS, n.40 to Group 2 used 250 mg of P, n.36 to Group 3 as control group. Second phase: n.35 allocated to Group 4 used 40 mg ketoprofen lysine salt once a day for the first 3 days of activation. Pain experience was reported on a numeric rating scale (0-4) and a 100-mm visual analogue scale. Pain perception was tested with the Mann-Whitney test (P < 0.05). RESULTS Pain perception was higher during the first 3 days of activation and it was described as mild to moderate. Group 1 experienced significantly less pain during the fourth, fifth, and sixth day (P < 0.05) compared with Group 2. Patients of the Group 4 reported significantly lower pain during the whole period of RME activation (P < 0.05). CONCLUSIONS The perceived higher pain was reported during the second and third day of expansion. The analgesic effect of KLS is more effective than P during the fourth, fifth, and sixth day. The use of KLS during the first 3 days of activation seems to be able reducing pain during the whole active phase.
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Affiliation(s)
- Gianguido Cossellu
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Valentina Lanteri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Francesca Gaffuri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Farronato
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
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Mummolo S, Nota A, De Felice ME, Marcattili D, Tecco S, Marzo G. Periodontal status of buccally and palatally impacted maxillary canines after surgical-orthodontic treatment with open technique. J Oral Sci 2018; 60:552-556. [PMID: 29984786 DOI: 10.2334/josnusd.17-0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study investigated differences in periodontal health variables between buccally impacted maxillary canines (BIMC) and palatally impacted maxillary canines (PIMC) after surgical-orthodontic treatment with open technique. Nineteen patients were enrolled: 10 with unilateral BIMC (5 men, 5 women; mean age 18.50 ± 1.96 years) and 9 with unilateral PIMC (4 men, 5 women; mean age 19.44 ± 2.40 years). Probing depth and keratinized tissue were recorded 12 months after surgical-orthodontic treatment, and the differences between the 2 sides were analyzed as primary outcomes. In addition, data for BIMC and PIMC were directly compared. In the BIMC group, probing depths were significantly higher for lateral incisors than for the untreated side (P = 0.044), and keratinized tissue values were significantly lower for canines than for the untreated side (P = 0.006). No significant differences were observed in the PIMC group. In BIMC, surgical-orthodontic treatment with open technique resulted in loss of periodontal keratinized tissue in the treated tooth and periodontal attachment loss in adjacent lateral incisors. However, the periodontal status of PIMC was not affected by surgical-orthodontic treatment with open technique.
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Affiliation(s)
- Stefano Mummolo
- Department of Life Health and Environmental Sciences, University of L'Aquila
| | - Alessandro Nota
- Department of Life Health and Environmental Sciences, University of L'Aquila.,Dental School, Vita-Salute San Raffaele University
| | | | - Domenico Marcattili
- Department of Life Health and Environmental Sciences, University of L'Aquila
| | - Simona Tecco
- Dental School, Vita-Salute San Raffaele University
| | - Giuseppe Marzo
- Department of Life Health and Environmental Sciences, University of L'Aquila
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34
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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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35
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Orthodontics in Growing Patients: Clinical/Biological Evidence and Technological Advancement 2018. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7281846. [PMID: 30622960 PMCID: PMC6304191 DOI: 10.1155/2018/7281846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022]
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36
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Class III Treatment with Skeletal and Dental Anchorage: A Review of Comparative Effects. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7946019. [PMID: 30057910 PMCID: PMC6051274 DOI: 10.1155/2018/7946019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/26/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022]
Abstract
Objectives This review addresses the comparative effects of skeletal anchored maxillary protraction (MP) versus dental anchored MP. Materials and Methods The studies retrieved had to have both test and control groups treated by the use of a facemask with or without the use of skeletal anchorage though either (palatal/buccal) maxillary or mandibular miniscrews/miniplates, respectively. Results Nine articles were included. Dentoalveolar changes were seen in all the studies. In particular, a significant proclination of the upper incisors was documented in the group treated with a dental anchorage facial mask, as compared to that treated with skeletal anchorage. Comparing the two methods, almost all the studies indicated a greater maxillary advancement in the group treated with skeletal anchorage. Conclusions Therapies with skeletal anchorage produce greater maxillary protraction, reducing undesirable dental effects.
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Salivary Markers and Microbial Flora in Mouth Breathing Late Adolescents. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8687608. [PMID: 29693018 PMCID: PMC5859862 DOI: 10.1155/2018/8687608] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
Abstract
Objective This is a 6-month observational case-control study that aims to estimate plaque index (PI), salivary flow, buffering capacity of saliva, and specific Streptococcus mutans (S. mutans) and Lactobacillus rates in a mouth breathing late adolescents sample, after a professional oral hygiene procedure and home oral hygiene instructions. Subjects and Methods A sample of 20 mouth breathing late adolescents/young adults (average: 19.2 ± 2.5; range: 18–23 years) and a matched control group of nose breathing subjects (average: 18.3 ± 3.2; range 18–23 years) were included in the study. All the participants were subjected to a professional oral hygiene procedure and appropriate home oral hygiene instructions (t0). After three months (t1) and six months (t2), the PI, salivary flow, buffering capacity of saliva, and S. mutans and Lactobacilli rates were recorded. Results The mean buffering capacity of saliva and the salivary flow rate showed no significant difference between the two groups, all over the observational period. For PI, a significantly higher mode (score 1 of PI) was observed in the study group at t1 (score 0 = 35% of subjects; score 1 = 60%; score 2 = 5%) and t2 (score 1 = 65% of subjects, score 2 = 35%), with respect to control group. Furthermore, mouth breathing subjects show a significant 4 times higher risk to develop S. mutans CFU > 105 (CI lower limit: 0.95; CI upper limit: 9.48; chi-square: 4.28; p = 0.03), with respect to the control subjects. Conclusions Mouth breathing late adolescents show a significantly higher risk to develop S. mutans CFU > 105 and an increased level of PI. Interceptive orthodontic treatments in growing subjects, like palatal expansion, are encouraged to improve the nasal air flow. In older subjects, orthodontic treatments should be performed with removable appliances like clear aligners, in order to allow a better oral hygiene level.
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Kumari L, Nayan K. Non-surgical Management of Skeletal Class III Malocclusion with Bilateral Posterior Crossbite: A Case Report. J Clin Diagn Res 2017; 10:ZD04-ZD06. [PMID: 28209011 DOI: 10.7860/jcdr/2016/19752.8962] [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: 02/24/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
Abstract
A 16-year-old female patient with skeletal Class III malocclusion and bilateral posterior cross bite complaining of difficulty in chewing was treated orthodontically without surgery (camouflage treatment). The treatment comprised of fixed orthodontic treatment with MBT prescription (0.022˝×0.028˝ slot) using quad helix appliance for bilateral expansion of maxillary arch and Class III elastics for occlusal correction. Post-treatment records showed normal overbite and overjet with acceptable occlusion. So with this treatment strategy of expanding the maxillary arch using a quad helix appliance and use of Class III elastics, we achieved a good result with optimal occlusion.
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Affiliation(s)
- Lalima Kumari
- Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, Haldia Institute of Dental Sciences and Research , Banbishnupur, West Bengal, India
| | - Kamal Nayan
- Senior Lecturer, Department of Prosthodontics and Crown and Bridge, Mithila Minority Dental College and Hospital , Darbhanga, Bihar, India
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39
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Feldmann I, Bazargani F. Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: A randomized controlled trial. Angle Orthod 2016; 87:391-396. [PMID: 28029266 DOI: 10.2319/091216-686.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate and compare perceived pain intensity, discomfort, and jaw function impairment during the first week with tooth-borne or tooth-bone-borne rapid maxillary expansion (RME) appliances. MATERIALS AND METHODS Fifty-four patients (28 girls and 26 boys) with a mean age of 9.8 years (SD 1.28 years) were randomized into two groups. Group A received a conventional hyrax appliance and group B a hybrid hyrax appliance anchored on mini-implants in the anterior palate. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment on the first and fourth days after RME appliance insertion. RESULTS Fifty patients answered both questionnaires. Overall median pain on the first day in treatment was 13.0 (range 0-82) and 3.5 (0-78) for groups A and B, respectively, with no significant differences in pain, discomfort, analgesic consumption, or functional jaw impairment between groups. Overall median pain on the fourth day was 9.0 (0-90) and 2.0 (0-71) for groups A and B, respectively, with no significant differences between groups. There were also no significant differences in pain levels within group A, while group B scored significantly lower concerning pain from molars and incisors and tensions from the jaw on day 4 than on the first day in treatment. There was a significant positive correlation between age and pain and discomfort on the fourth day in treatment. No correlations were found between sex and pain and discomfort, analgesic consumption, and jaw function impairment. CONCLUSIONS Both tooth-borne and tooth-bone-borne RME were generally well tolerated by the patients during the first week of treatment.
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Long H, Wang Y, Jian F, Liao LN, Yang X, Lai WL. Current advances in orthodontic pain. Int J Oral Sci 2016; 8:67-75. [PMID: 27341389 PMCID: PMC4932774 DOI: 10.1038/ijos.2016.24] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 02/05/2023] Open
Abstract
Orthodontic pain is an inflammatory pain that is initiated by orthodontic force-induced vascular occlusion followed by a cascade of inflammatory responses, including vascular changes, the recruitment of inflammatory and immune cells, and the release of neurogenic and pro-inflammatory mediators. Ultimately, endogenous analgesic mechanisms check the inflammatory response and the sensation of pain subsides. The orthodontic pain signal, once received by periodontal sensory endings, reaches the sensory cortex for pain perception through three-order neurons: the trigeminal neuron at the trigeminal ganglia, the trigeminal nucleus caudalis at the medulla oblongata and the ventroposterior nucleus at the thalamus. Many brain areas participate in the emotion, cognition and memory of orthodontic pain, including the insular cortex, amygdala, hippocampus, locus coeruleus and hypothalamus. A built-in analgesic neural pathway—periaqueductal grey and dorsal raphe—has an important role in alleviating orthodontic pain. Currently, several treatment modalities have been applied for the relief of orthodontic pain, including pharmacological, mechanical and behavioural approaches and low-level laser therapy. The effectiveness of nonsteroidal anti-inflammatory drugs for pain relief has been validated, but its effects on tooth movement are controversial. However, more studies are needed to verify the effectiveness of other modalities. Furthermore, gene therapy is a novel, viable and promising modality for alleviating orthodontic pain in the future.
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Affiliation(s)
- Hu Long
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan Jian
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li-Na Liao
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Yang
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen-Li Lai
- State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Ballanti F, Baldini A, Ranieri S, Nota A, Cozza P. Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects. Int J Pediatr Otorhinolaryngol 2016; 83:109-12. [PMID: 26968064 DOI: 10.1016/j.ijporl.2016.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/26/2016] [Accepted: 01/31/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Deviated nasal septum may cause a reduction of the nasal airflow, thus, during the craniofacial development, a reduced nasal airflow could originate a chronic mouth-breathing pattern, related with moderate to severe maxillary constriction. The aim of this retrospective study is to analyze the correlation between maxillary transverse deficiency and nasal septum deviation. METHODS Frontal cephalograms were performed on 66 posterior-anterior radiographs of subjects (34M, 32F; mean age 9.95±2.50 years) with maxillary transverse deficiency and on a control group of 31 posterior-anterior radiographs of subjects (13M, 18F; 9.29±2.08 years). Angular parameters of the nasal cavities were recorded and compared between the two groups using a Student's t-test. RESULTS Generally all the parameters are very similar between the two groups except for the ASY angle that differs for about the 27%; anyway the Student's t-test showed no statistically significant differences between the two groups (mostly p>0.20). CONCLUSIONS This study failed to show an association between transverse maxillary deficiencies and nasal septum deviations. Moreover, no significant differences were found between the mean nasal cavities dimensions in subjects with transverse maxillary deficiency and the control group.
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Affiliation(s)
- Fabiana Ballanti
- Department of Orthodontics, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy.
| | - Alberto Baldini
- Department of Orthodontics, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy.
| | - Salvatore Ranieri
- Department of Orthodontics, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy.
| | - Alessandro Nota
- Department of Orthodontics, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy.
| | - Paola Cozza
- Department of Orthodontics, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy.
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