Nonsurgical maxillary expansion in adults: report on clinical cases using the Hyrax expander

Dentoperiodontal and skeletal changes induced by miniscrew-assisted rapid maxillary expansion (C-expander) treatment in adults: A retrospective clinical trial

INTRODUCTION

The objective of this study was to evaluate the dental periodontal and skeletal response to ≥5 mm of expansion width achieved by C-expander treatment with posterior miniscrews placed between the first and second molars in adults.

METHODS

A total of 28 patients aged 21.91 ± 3.20 years with maxillary transverse deficiency underwent C-expander treatment. Anterior miniscrews were positioned between the first and second premolars, whereas posterior miniscrews were positioned between the first and second molars. Cone-beam computed tomography records were obtained before expansion and 3 months after expansion. The dental periodontal and skeletal changes for all patients were recorded.

RESULTS

The C-expander treatment expanded the palatal suture with slight buccal alveolar bone inclination. An increase in the nasal cavity width and a greater increase in the maxillary base bone width were observed after maxillary expansion. The expansion at the posterior nasal spine (3.78 mm) was approximately 85.7% of that at the anterior nasal spine (4.41 mm). No significant buccal dehiscence occurred after expansion, whereas the mesiobuccal alveolar bone thickness of the first molars was decreased at the 8 mm level with respect to the cementoenamel junction. The first molar showed decreased inclination (right, -0.45°; left, -0.38°, P >0.05), whereas the expansion at the apical level was less than that at the crown level. Age and the skeletal/dental expansion ratio had no discernible relationship.

CONCLUSIONS

Miniscrew-assisted C-expander treatment can be effective for adults with maxillary transverse deficiency. Rearward placement of the miniscrews may create an approximately parallel expansion. Most maxillary expansion was derived from skeletal expansion with slight alveolar bone buccal inclination.

Effect of Low-Level Laser Therapy on Bone Formation in Rapid Palatal Expansion: A Systematic Review

Introduction: Crossbite is a common malocclusion with a 7-23% prevalence rate. Treatment is based on the expansion of the mid-palatal suture (MPS) with Rapid Palatal Expansion(RPE) followed by a retention period to reach new bone maturation, enough to maintain the results stable. This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in increasing bone formation in MPS. Methods: This article was written by the PRISMA checklist. Electronically, 3 databases, namely PubMed, Scopus, and Embase, were searched with the keywords selected based on PICO. Time (2010-2021) and language restrictions were performed. Results: 528 articles, out of which 374 studies were screened, were found, and 9 full-text articles were subsequently included considering these inclusion criteria: randomized clinical trial (RCT) that examines the efficacy of LLLT in rapid palatal expansion (RPE), age under 15 years, non-surgical RPE with a tooth-supported appliance, and low-intensity laser application. Finally, 4 articles were appraised by Cochrane version 5.2.0 with 7 domains. 3 of 4 articles showed LLLT has a significant impact on bone formation. One of them showed no significant difference in pain perception and bone density between the laser and non-laser groups. Conclusion: While many studies have assessed the effect of LLLT on bone formation in animal models, high-quality clinical trials are missing in this regard. The available clinical trials suggest a positive effect of LLLT on sutural bone formation after RPE.

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

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.