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Sader LHB, Siécola G, Marin Ramirez CM, Otazu A, Torres DM, Cotrin P, Valarelli FP, Pinzan-Vercelino CRM, Freitas KMS. Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion. Orthod Craniofac Res 2024; 27:421-428. [PMID: 38124269 DOI: 10.1111/ocr.12745] [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] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE(S) This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. RESULTS The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. CONCLUSION Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.
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Affiliation(s)
| | - Gustavo Siécola
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | - Aldo Otazu
- Department of Orthodontics and Public Health, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Dino Marcelo Torres
- Department of Orthodontics, Institute of Advanced Dentistry, Asunción, Paraguay
| | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil
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da Silva AV, da Rosa BM, Matje PRB, Rizzatto SMD, de Oliveira RB, Haas OL, de Menezes LM. Effects of SARPE and MISMARPE on correction of transverse maxillary deficiency: A preliminary comparative evaluation. Orthod Craniofac Res 2024; 27:332-338. [PMID: 37728033 DOI: 10.1111/ocr.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
AIM The present study was designed to compare, on cone-beam computed tomography imaging, the skeletal and dental effects of the SARPE (Surgically assisted rapid palatal expansion) and MISMARPE (Minimally Invasive Surgical and Miniscrew-Assisted Rapid Palatal Expansion) techniques. MATERIALS AND METHODS The sample of adult patients with transverse maxillary deficiency (TMD) was divided into two groups, and scans were obtained preoperatively (T0) and immediately after completion of expansion (T1). The posterior and anterior linear transverse distances of the maxilla and the angulation of the maxillary first molars were evaluated. The data were entered into a generalized estimating equations model to verify the postoperative effects of the different techniques. RESULTS None of the techniques caused any appreciable change in the angulation of the molars. The skeletal changes were similar, with significantly greater gains in the nasal fossa and intermaxillary distance when using the MISMARPE. CONCLUSION The technique can be an effective and lower morbidity alternative to SARPE.
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Affiliation(s)
- Andreza Vieira da Silva
- Postgraduate Program in Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bibiana Mello da Rosa
- Postgraduate Program in Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Oral and Maxillofacial Surgery, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Private Practice at Belle & Haas OrthoFacial Surgery, Porto Alegre, RS, Brazil
| | - Paulo R B Matje
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Susana Maria Deon Rizzatto
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rogério Belle de Oliveira
- Department of Oral and Maxillofacial Surgery, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Private Practice at Belle & Haas OrthoFacial Surgery, Porto Alegre, RS, Brazil
| | - Orion L Haas
- Department of Oral and Maxillofacial Surgery, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Private Practice at Belle & Haas OrthoFacial Surgery, Porto Alegre, RS, Brazil
| | - Luciane Macedo de Menezes
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Benetti M, Montresor L, Cantarella D, Zerman N, Spinas E. Does Miniscrew-Assisted Rapid Palatal Expansion Influence Upper Airway in Adult Patients? A Scoping Review. Dent J (Basel) 2024; 12:60. [PMID: 38534284 DOI: 10.3390/dj12030060] [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: 12/19/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Objective: This scoping review evaluates the effects of miniscrew-assisted rapid palatal expansion (MARPE) on different regions of the upper airway in adult patients and investigates various methods of measurement. (2) Methods: The search encompassed Pubmed, Cochrane Library, Scopus and Web of Science. This review was conducted following the PRISMA_ScR guidelines, and the inclusion criteria for examined studies were chosen in accordance with the PICOS framework. (3) Results: Seven studies were included in this review, comprising four retrospective studies, one prospective and two case reports. All studies involved the use of Cone Beam Computed Tomography (CBCT) for measurements of the areas of interest. The percentage of increase in the volume of the nasal cavity varied between 31% and 9.9%, depending on the study. Volumetric variations in the nasopharynx were reported as increases between T0 (before expansion) and T1 (immediately after expansion) of 6.4%, 20.7% and 14.1%. All studies considered T0 before expansion and T1 immediately after expansion. Only one study evaluated remote follow-up to assess if the results were maintained after one year. (4) Conclusions: MARPE appears to lead to a statistically significant increase in the upper airway, especially in the nasal cavity and nasopharynx immediately after expansion. However, further prospective and retrospective trails with long-term controls are required to verify the effects of MARPE on the upper airway.
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Affiliation(s)
- Mariachiara Benetti
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Luca Montresor
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Daniele Cantarella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, 20122 Milan, Italy
| | - Nicoletta Zerman
- Department of Pediatric Dentistry and Dental Hygiene, University of Verona, Via San Marco 121, 37138 Verona, Italy
| | - Enrico Spinas
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
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Wang C, Liu C, Mao Q, Zhou L, Xiang X. Skeletal and dentoalveolar modifications in adults with different sagittal facial patterns after personalized miniscrew-assisted rapid palatal expansion: A prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2023; 164:843-854. [PMID: 37632488 DOI: 10.1016/j.ajodo.2023.05.033] [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: 10/01/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION This study aimed to compare the skeletal and dental modifications in adults with different sagittal facial patterns by a personalized miniscrew-assisted rapid palatal expander (pMARPE). METHODS Forty subjects (aged 18-28 years; 15 females and 25 males) with maxillary transverse deficiency were assigned to 1 of 3 groups (Class I, II, and III relationship) on the basis of their sagittal facial patterns. Each patient was treated with an individually customized expander. A similar expansion protocol was used for all patients. Cone-beam computed tomography scans were obtained before and after expansion. One-way analysis of variance was used to analyze differences among 3 groups in skeletal, dentoalveolar, and periodontal changes (P <0.05). RESULTS The success rates of expansion were higher in patients with a Class I or II relationship than those with a Class III relationship. Patients with a Class I or II relationship had greater changes in the anterior nasal spine and maxillary basal bone widths. A more parallel sutural opening in the anteroposterior direction was seen in those with a Class II relationship. The tipping of the maxillary first molar increased, and the buccal alveolar bone thickness decreased in all groups after expansion, especially in patients with a Class III relationship. CONCLUSIONS The pMARPE effectively split the midpalatal suture among adults. However, midpalatal suture expansion was more difficult, and there were more dentoalveolar side effects and fewer orthopedic effects in patients with a Class III relationship than in those with Class I or II relationships.
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Affiliation(s)
- Chunlin Wang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Conghua Liu
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Qin Mao
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Lishu Zhou
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaosong Xiang
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China.
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Zhang Y, Yang J, Li X. Assessment of early dental arch growth modification with removable maxillary expansion by cone-beam computed tomography and lateral cephalometric radiographs: a retrospective study. BMC Oral Health 2023; 23:727. [PMID: 37805525 PMCID: PMC10559620 DOI: 10.1186/s12903-023-03433-w] [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: 11/26/2022] [Accepted: 09/20/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND This study evaluated the skeletal and dental changes of patients brought by early removable maxillary expansion (ERME) treatment to explore the clinical treatment effect of ERME on early dental arch growth modification. METHODS Subject children aged 6-10 years with a maxillary transverse deficiency received ERME treatment, cone-beam computed tomography (CBCT) and lateral cephalometric radiographs were measured before and after treatment, and statistical differences in the measured items were evaluated with corresponding statistical methods to explore the skeletal and dental changes. RESULTS After ERME treatment, there was a statistical increase in the maxillary basal bone arch width, nasal cavity width, maxillary alveolar bone arch width, and maxillary dental arch width. A buccal inclination of the maxillary alveolar bone and a buccal inclination and buccal movement in the alveolar bone of maxillary first molars were found. The maxillary skeletal expansion was statistically greater than the dental expansion. Increases in the mandibular alveolar bone arch width and dental arch width happened after treatment. A decrease in angle ANB and an increase in Ptm-A, U1-SN, U1-PP, L1-MP, and L6-MP were found after treatment. No statistical changes in the growth pattern-related measured items were observed. CONCLUSIONS ERME could expand the maxillary basal bone arch width, nasal cavity width, maxillary alveolar bone arch width, and maxillary dental arch width. The maxillary skeletal expansion was greater than the dental expansion. Secondary increases in the mandibular alveolar bone and dental arch widths would happen after ERME. ERME would result in a mandibular advancement, a labial inclination of maxillary anterior teeth, and an increase of maxillary sagittal length, and would not change the patient's growth pattern. TRIAL REGISTRATION This study was approved by the Institutional Review Board of the West China Hospital of Stomatology, Sichuan University. (WCHSIRB-D-2020-446).
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Affiliation(s)
- Yun Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, 610041 Sichuan China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 Sichuan China
| | - Jing Yang
- Department of Pediatric Dentistry, Department of Stomatology, Dandong Central Hospital, Dandong, 118000 Liaoning China
| | - Xiaobing Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, 610041 Sichuan China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 Sichuan China
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders. BMC Oral Health 2023; 23:714. [PMID: 37794400 PMCID: PMC10552363 DOI: 10.1186/s12903-023-03461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Madrid, Spain
| | - María José González-Olmo
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain.
| | | | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain
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Naveda R, Dos Santos AM, Miranda F, da Cunha Bastos JC, Garib D. Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults. Am J Orthod Dentofacial Orthop 2023; 164:416-422. [PMID: 37041098 DOI: 10.1016/j.ajodo.2023.02.014] [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: 07/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.
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Affiliation(s)
- Rodrigo Naveda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | | | - Felicia Miranda
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | | | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil; Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
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Abate A, Ugolini A, Maspero C, Silvestrini-Biavati F, Caprioglio A, Lanteri V. Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni-Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation. Clin Oral Investig 2023; 27:5249-5262. [PMID: 37466717 PMCID: PMC10492880 DOI: 10.1007/s00784-023-05144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars. METHODS Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes. RESULTS The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group. CONCLUSIONS According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.
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Affiliation(s)
- Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, Genoa, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
| | | | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Valentina Lanteri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
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Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Changes in Molar Tipping and Surrounding Alveolar Bone with Different Designs of Skeletal Maxillary Expanders. Biomedicines 2023; 11:2380. [PMID: 37760821 PMCID: PMC10525421 DOI: 10.3390/biomedicines11092380] [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: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This study compared the buccolingual angulation (BLA) of the upper and lower first permanent molars before and after using the different methods of microimplant-assisted expansion in adults and its influence on bone insertion loss. METHODS Cone-beam computed tomography scans taken before and after the expansion in 36 patients (29.9 ± 9.4 years) were used to assess dental and periodontal changes and compare changes between the groups. RESULTS This research shows a statistically significant increase in the BLA of the upper first molars. An increase of the BLA of the lower molars is also observed in MARPE. Regarding the comparison between cases treated with MARPE (4.42° ± 10.25°; 3.67° ± 9.56°) and BAME (-0.51° ± 4.61°; 2.34° ± 4.51°), it was observed that upper molar torque increased significantly less in cases treated with BAME. In cases with CWRU < 96° at T0, a slight bone insertion gain was observed at T1, whereas if CWRU ≥ 96°, a slight bone insertion loss was observed. Regarding the labial cortical bone loss, a slight gain of CBW was observed in all cases. This labial cortical enlargement (T0-T1) is greater in cases where the CWRU < 96° at T0. CONCLUSIONS Patients treated with MARPE show torque increase in the teeth selected to support the expansion appliance compared to cases treated with BAME. In cases where the BLA at T0 < 96°, an increase in thickness and cortical insertion is observed in the upper molars after treatment with disjunction appliances assisted with microscrews.
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Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), 28922 Alcorcón, Spain;
| | | | | | - Martín Romero
- Department of Orthodontics, Rey Juan Carlos University, 28922 Alcorcón, Spain;
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Zhao Z, Zhang S, Zhang F, Duan Z, Wang Y. Monitoring the Opening of Rapid Palatal Expansion (RPE) in a 3D-Printed Skull Model Using Fiber Optic F-P Sensors. SENSORS (BASEL, SWITZERLAND) 2023; 23:7168. [PMID: 37631702 PMCID: PMC10458582 DOI: 10.3390/s23167168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
We present a novel method for the online measurement of multi-point opening distances of midpalatal sutures during a rapid palatal expansion (RPE) using fiber optic Fabry-Perot (F-P) sensors. The sensor consists of an optical fiber with a cut flat end face and an optical reflector, which are implanted into the palatal base structure of an expander and is capable of measuring the precise distance between two optical reflective surfaces. As a demonstration, a 3D-printed skull model containing the maxilla and zygomaticomaxillary complex (ZMC) was produced and a miniscrew-assisted rapid palatal expander (MARPE) with two guide rods was used to generate the midpalatal suture expansion. The reflected spectrums of the sensors were used to dynamically extract cavity length information for full process monitoring of expansion. The dynamic opening of the midpalatal suture during the gradual activation of the expander was measured, and a displacement resolution of 2.5 μm was demonstrated. The angle of expansion was derived and the results suggested that the midpalatal suture was opened with a slight V-type expansion of 0.03 rad at the first loading and subsequently expanded in parallel. This finding might be useful for understanding the mechanical mechanisms that lead to different types of expansion. The use of a fiber optic sensor for mounting the rapid palatal expander facilitates biomechanical studies and experimental and clinical evaluation of the effects of RPE.
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Affiliation(s)
- Zhen Zhao
- Institute of Stomatology, Shandong University, Jinan 250012, China
- Department of Orthodontics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Shijie Zhang
- Institute of Stomatology, Shandong University, Jinan 250012, China
- Department of Orthodontics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Faxiang Zhang
- Faculty of Computer Science and Technology, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, China
| | - Zhenhui Duan
- Faculty of Computer Science and Technology, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, China
| | - Yingying Wang
- Institute of Automation, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250014, China
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Chamberland S. Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update. J World Fed Orthod 2023; 12:173-183. [PMID: 37344295 DOI: 10.1016/j.ejwf.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/22/2023] [Indexed: 06/23/2023]
Abstract
Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.
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Bazzani M, Cevidanes LHS, Al Turkestani NN, Annarumma F, McMullen C, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Franchi L, Ngan P, He H, Angelieri F, Aghazada H, Migliorati M. Three-dimensional comparison of bone-borne and tooth-bone-borne maxillary expansion in young adults with maxillary skeletal deficiency. Orthod Craniofac Res 2023; 26:151-162. [PMID: 35737876 PMCID: PMC10257795 DOI: 10.1111/ocr.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the transverse dental and skeletal changes in patients treated with bone-anchored palatal expander (bone-borne, BB) compared to patients treated with tooth and bone-anchored palatal expanders (tooth-bone-borne, TBB) using cone-beam computer tomography (CBCT) and 3D image analysis. METHODS The sample comprised 30 patients with transverse maxillary discrepancy treated with two different types of appliances: bone-borne (Group BB) and tooth-bone-borne (Group TBB) expanders. CBCT scans were acquired before (T1) and after completion of maxillary expansion (T2); the interval was 5.4 ± 3.4 and 6.2 ± 2.1 months between the T1 and the T2 scans of Group TBB (tooth-bone-borne) and Group BB (bone-borne), respectively. Transverse, anteroposterior and vertical linear and angular three-dimensional dentoskeletal changes were assessed after cranial base superimposition. RESULTS Both groups displayed marked transverse skeletal expansion with a greater ratio of skeletal to dental changes. Greater changes at the nasal cavity, zygoma and orbital levels were found in Group BB. A relatively parallel sutural opening in an anterior-posterior direction was observed in Group TBB; however, the Group BB presented a somewhat triangular (V-shaped) opening of the suture that was wider anteriorly. Small downward-forward displacements were observed in both groups. Asymmetric expansion occurred in approximately 50% of the patients in both groups. CONCLUSION Greater skeletal vs dental expansion ratio and expansion of the circummaxillary regions were found in Group BB, the group in which a bone-borne expander was used. Both groups presented skeletal and dental changes, with a similar amount of posterior palate expansion. Asymmetric expansion was observed in both groups.
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Affiliation(s)
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Craig McMullen
- Private Practice of Orthodontics, Brighton, Michigan, USA
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, West Virginia, USA
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | | | - Marco Migliorati
- Department of Orthodontics, Genoa University School of Dentistry, Genoa, Italy
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Alves ACDM, de Carvalho NO, Cunha ÂCPDP, Rabelo SGF, Pereira HSG. Do the miniscrews of the prefabricated systems for the "appliance first" protocol of miniscrew-assisted rapid palatal expansion have lengths that meet the palatal thickness of patients? Am J Orthod Dentofacial Orthop 2023; 163:e152-e161. [PMID: 37125981 DOI: 10.1016/j.ajodo.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION In the "appliance first" protocol of miniscrew-assisted rapid palatal expansion, the prefabricated shape of the expanders limits the potential locations for miniscrew placement. Considering the influence of palatal thickness on the selection of the optimal length of miniscrews, this study aimed to evaluate the thickness of both bone and mucosa of the palate of patients aged 6-65 years and suggest optimal lengths of miniscrews for this approach. METHODS Two hundred and eighty-two cone-beam computed tomography of patients of both sexes were divided into 3 groups according to age. The thicknesses of bone and mucosa were measured in the anterior and posterior regions of the palate. RESULTS Males showed a greater thickness of palatal bone than females. The thickness of both bone and mucosa was greater in the anterior region of the palate. The young patients showed greater bone thickness than adults and mature adults. The mature adults showed thinner bone thickness in the posterior region of the palate and greater mucosal thickness along the palate than young patients and adults. Development of miniscrews with longer thread lengths is necessary. Miniscrews with a 3-mm thread length would prevent excessive extravasation in the posterior region of the palate. CONCLUSIONS The thickness of both bone and mucosa of the palate is variable and influenced by sex and age. Manufacturing additional miniscrews with different lengths of thread is suggested to achieve bicortical anchorage in patients undergoing the "appliance first" protocol of miniscrew-assisted rapid palatal expansion.
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Affiliation(s)
- Arthur César de Medeiros Alves
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Nathália Oliveira de Carvalho
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Sergei Godeiro Fernandes Rabelo
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Hallissa Simplício Gomes Pereira
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Shayani A, Merino-Gerlach MA, Garay-Carrasco IA, Navarro-Cáceres PE, Sandoval-Vidal HP. Midpalatal Suture Maturation Stage in 10- to 25-Year-Olds Using Cone-Beam Computed Tomography-A Cross-Sectional Study. Diagnostics (Basel) 2023; 13:diagnostics13081449. [PMID: 37189552 DOI: 10.3390/diagnostics13081449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 05/17/2023] Open
Abstract
In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10-25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults.
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Affiliation(s)
- Anis Shayani
- Master Program in Dental Science, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia 5090000, Chile
| | | | | | - Pablo Eliseo Navarro-Cáceres
- Centro de Investigación en Ciencias Odontológicas (CICO), Departamento de Odontología Integral de Adultos, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Universidad Autónoma de Chile, Temuco 4780000, Chile
| | - Héctor Paulo Sandoval-Vidal
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
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Meirelles CM, Ferreira RM, Suzuki H, Oliveira CB, Souza de Jesus A, Garcez AS, Suzuki SS. Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00063-X. [PMID: 36868909 DOI: 10.1016/j.ajodo.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 10/01/2022] [Accepted: 10/01/2022] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects. METHODS Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM + CP technique (SMCP), failure MARPE (FM), and FM + CP (FMCP). RESULTS Successful groups presented more skeletal expansion and dental tipping than failure groups (P <0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P <0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P <0.05). CONCLUSIONS Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears to have a positive impact, increasing the chance of treatment success.
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Affiliation(s)
- Carolina Marques Meirelles
- Department of Post-graduation in Orthodontics, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil.
| | - Rafael Malagutti Ferreira
- Department of Post-graduation in Orthodontics, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Hideo Suzuki
- Department of Orthodontics, São Leopoldo Mandic School and Dental Institute, Campinas, São Paulo, Brazil
| | | | - Adriana Souza de Jesus
- Department of Orthodontics, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Aguinaldo Silva Garcez
- Department of Oral Microbiology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Department of Orthodontics, São Leopoldo Mandic School and Dental Institute, Campinas, São Paulo, Brazil
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Three-Dimensional Evaluation Effects of Microimplant-Assisted Rapid Palatal Expansion on the Upper Airway Volume: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051790. [PMID: 36902577 PMCID: PMC10003187 DOI: 10.3390/jcm12051790] [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: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Microimplant-assisted rapid palatal expansion is increasingly used clinically; however, the effect on the upper airway volume in patients with maxillary transverse deficiency has not been thoroughly evaluated yet. The following electronic databases were searched up to August 2022: Medline via Ovid, Scopus, Embase, Web of Science, Cochrane Library, Google Scholar, and ProQuest. The reference lists of related articles were also reviewed by manual search. The Revised Cochrane Risk of Bias Tool for randomized trials (ROB2) and the Risk of Bias in non-randomized Studies of Interventions (ROBINS-I) tool were used to evaluate the risks of bias of the included studies. The mean differences (MD) and 95% confidence intervals (CI) of changes in nasal cavity and upper airway volume were analyzed using a random-effects model, and subgroup and sensitivity analyses were also performed. Two reviewers independently completed the process of screening studies, extracting data, and assessing the quality of studies. In total, twenty-one studies met the inclusion criteria. After assessing the full texts, only thirteen studies were included, with nine studies selected for quantitative synthesis. Oropharynx volume increased significantly after immediate expansion (WMD: 3156.84; 95% CI: 83.63, 6230.06); however, there was no significant change in nasal volume (WMD: 2527.23; 95% CI: -92.53, 5147.00) and nasopharynx volume (WMD: 1138.29; 95% CI: -52.04, 2328.61). After retention a period, significant increases were found in nasal volume (WMD: 3646.27; 95% CI: 1082.77, 6209.77) and nasopharynx volume (WMD: 1021.10; 95% CI: 597.11, 1445.08). However, there was no significant change after retention in oropharynx volume (WMD: 789.26; 95% CI: -171.25, 1749.76), palatopharynx volume (WMD: 795.13; 95% CI: -583.97, 2174.22), glossopharynx volume (WMD: 184.50; 95% CI: -1745.97, 2114.96), and hypopharynx volume (WMD: 39.85; 95% CI: -809.77, 889.46). MARPE appears to be linked with long-term increases in nasal and nasopharyngeal volume. However, high-quality clinical trials are required to further verify the effects of MARPE treatment on the upper airway.
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Abdelsalam R, Nucci L, Carrino R, Shahen S, Abdelaziz F, Fahim F, Perillo L. Comparison of palatal volume and surface changes between bone-borne and tooth-tissue-borne maxillary expansion on cone beam computed tomography digital cast models. Angle Orthod 2023; 93:490508. [PMID: 36719265 PMCID: PMC10117217 DOI: 10.2319/040922-278.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/01/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To compare the changes of palatal volume and area in patients treated with tooth-tissue-borne palatal expanders (conventional Haas) and miniscrew-supported palatal expanders (modified Haas). MATERIALS AND METHODS The sample included casts of 22 patients treated as part of a clinical study at the Department of Orthodontics, Al-Azhar University, to correct their crossbite malocclusion. Patients were divided equally into two groups upon arrival. The first group, with a mean age of 12 years and 6 months, received the miniscrew-supported palatal expander. The second group, with a mean age of 12 years and 2 months, received the Haas design-palatal expansion appliance. Pre- and post-expansion dental casts were cone beam computed tomography scanned and the slices were constructed into 3D volumes. Fully automated superimposition was done for pre- and post-expansion 3D models. Palatal volume and area were determined, and all measurements were carried out blindly. Paired t-test was used to assess the mean differences within each group and Welch's t-test was applied to assess the mean changes between the two groups. Shapiro-Wilk test was used to test for the normality of the data. RESULTS There were no statistical differences in volume changes either within each group or between the groups. Although area changes were statistically significant within each group, the difference between the groups was not significant. CONCLUSIONS Changes that result from the use of either method to expand the upper arch occur primarily in the shape of the palate, but not in its size.
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Akyalcin S, Alev Y. Clinical advances in maxillary skeletal expansion and introduction of a new MARPE concept. J ESTHET RESTOR DENT 2023; 35:291-298. [PMID: 36478642 DOI: 10.1111/jerd.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transverse maxillary deficiency, typically characterized by the clinical manifestations of unilateral or bilateral crossbite, is a common orthodontic discrepancy. The primary goal of maxillary expansion should be to obtain a nearly maximum width increase in the basal bone of the constricted maxilla and to avoid the dental expansion of the anchor teeth. The introduction of miniscrew anchorage-supported rapid maxillary expansion (MARPE) devices has helped increase the feasibility of obtaining nonsurgical transverse correction in late adolescents and young adults with optimum orthopedic effects. However, the success rate of MARPE shows a negative correlation with age. Although MARPE offers an effective method for correcting a transverse skeletal deficiency, given the appliance cost and increased risk for complications, it could present challenges for adult patients and practitioners in daily practice. AIMS In this article, current advances in maxillary skeletal expansion are summarized, and a new MARPE concept is introduced. CONCLUSION The new MARPE design offers several advantages to other existing methods: (1) it can be installed directly to the patient in the clinical setting with no additional laboratory waiting times. (2) It is purely a bone-borne appliance. (3) The appliance is designed to be placed in the thickest part of the anterior palate to maximize the cortical and trabecular bone support. (4) Allows for bicortical placement of the miniscrews with no perforations in the nasal floor. Finally, (5) offers an esthetic and minimalistic approach to maxillary skeletal expansion in late adolescent and adult patients.
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Affiliation(s)
- Sercan Akyalcin
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Shayani A, Sandoval Vidal P, Garay Carrasco I, Merino Gerlach M. Midpalatal Suture Maturation Method for the Assessment of Maturation before Maxillary Expansion: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12112774. [PMID: 36428834 PMCID: PMC9689184 DOI: 10.3390/diagnostics12112774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Assessment of midpalatal suture maturation is crucial before deciding which type of maxillary expansion technique will be performed to treat transverse discrepancies. In 2013, Angelieri et al. proposed a new method to evaluate midpalatal maturation using cone-beam computed tomography. The aim of this study was to systematically identify, evaluate, and provide a synthesis of the existing literature about this new method and to rigorously assess the methodological quality of these articles. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluation, assessment, and assess. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Hence, 56 articles were obtained, of which only 10 met the selection criteria. We could not include any of the data into an analysis because of the large variation of the data collected and high methodological heterogeneity found among studies. Of all the studies included, 10% had poor quality, 70% fair, and 20% good quality, respectively. Even though age and sex play a role in midpalatal suture obliteration, there is a poor correlation between these variables. Thus, every patient should be assessed individually before choosing the best protocol for maxillary expansion. The midpalatal suture maturation method has the potential to be used for diagnostic purposes, but clinicians should be cautious of routinely using it because an extensive training and calibration program should be performed prior.
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Affiliation(s)
- Anis Shayani
- Master Program in Dental Science, Faculty of Dentistry, Universidad de la Frontera, Temuco 4780000, Chile
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Paulo Sandoval Vidal
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
- Correspondence:
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Naveda R, dos Santos AM, Seminario MP, Miranda F, Janson G, Garib D. Midpalatal suture bone repair after miniscrew-assisted rapid palatal expansion in adults. Prog Orthod 2022; 23:35. [PMID: 36244995 PMCID: PMC9573844 DOI: 10.1186/s40510-022-00431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Midpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients.
Materials and methods The study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1–45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient.
Results The objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients.
Conclusions A decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.
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Early Class III Treatment Using a Hybrid Rapid Palatal Expander and Facemask in a Patient with Partially Edentulous Maxilla Post MNTI Removal: A Case Report. Healthcare (Basel) 2022; 10:healthcare10091746. [PMID: 36141358 PMCID: PMC9498524 DOI: 10.3390/healthcare10091746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
This case report describes the orthodontic treatment of a 9-year-old girl who presented with multiple agenesis, maxillary contraction, and skeletal Class III malocclusion after the surgical removal of a melanocytic neuroectodermal tumour of infancy (MNTI) or the so-called melanocytic progonoma at 40 days of age. The lack of dental anchorage in the posterior segment of the second quadrant and the search for maximum control during suture expansion to reduce dental effects led to the use of a hybrid rapid palatal expander (RPE) with dental anchorage in the first quadrant and skeletal anchorage on the two miniscrews placed in the second quadrant, to allow a more even distribution of expansion forces. The expansion procedures performed with the hybrid anchorage device and extraoral traction demonstrate the possibility of solving the contraction in the posterior segments and anterior crossbite in a few months with maximum control of the applied forces, despite the objective difficulties related to the specificity of the case.
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Solano Mendoza P, Aceytuno Poch P, Solano Reina E, Solano Mendoza B. Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography. J Clin Med 2022; 11:jcm11164652. [PMID: 36012886 PMCID: PMC9410327 DOI: 10.3390/jcm11164652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.
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Huang X, Han Y, Yang S. Effect and stability of miniscrew-assisted rapid palatal expansion: A systematic review and meta-analysis. Korean J Orthod 2022; 52:334-344. [PMID: 35844097 PMCID: PMC9512629 DOI: 10.4041/kjod21.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to systematically analyze the effect and stability of miniscrew-assisted rapid palatal expansion (MARPE) to provide a reference for the clinical treatment of patients with maxillary transverse deficiency (MTD). Methods We searched PubMed, Science Direct, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Database for relevant studies published before February 18, 2021 and selected them according to the eligibility criteria. The Cochrane Handbook for Systematic Reviews (version 5.1.0) criteria were used for the quality assessment of randomized controlled trials, while the scoring protocol of the methodological index for non-randomized studies was used for non-randomized controlled trials. Statistical analysis was performed using the RevMan5.3 software. Results All the included studies showed a relatively high success rate of expansion. The changes in both the intermolar and alveolar widths after MARPE were statistically significant. MARPE exhibited greater skeletal expansion effects than did conventional RPE. The midpalatal suture was opened in parallel after MARPE. A small amount of relapse was observed 1 year after expansion. MARPE caused tooth inclination and a decrease in alveolar height, but it was less significant than in conventional RPE. Conclusions MARPE may be an effective treatment modality for patients with MTD. It causes great transverse skeletal expansion in late adolescence. In comparison to conventional RPE, MARPE has lower detrimental periodontal effects and has certain clinical advantages.
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Affiliation(s)
- Xinyi Huang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jin
| | - Yu Han
- Department of Orthodontics, Hangzhou Dental Hospital, Hangzhou, China
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Alsayegh E, Balut N, Ferguson DJ, Makki L, Wilcko T, Hansa I, Vaid NR. Maxillary Expansion: A Comparison of Damon Self-Ligating Bracket Therapy with MARPE and PAOO. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1974467. [PMID: 35586819 PMCID: PMC9110185 DOI: 10.1155/2022/1974467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area. Conclusions All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.
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Affiliation(s)
- Eman Alsayegh
- Department of Orthodontics, European University College, Dubai, UAE
| | - Nasib Balut
- Universidad Autónoma de Baja California, Mexicali, Mexico
- Universidad Del Valle, Cali, Colombia
| | | | - Laith Makki
- Department of Orthodontics, European University College, Dubai, UAE
| | - Thomas Wilcko
- Department of Periodontology, Case Western Reserve University, Cleveland, USA
| | - Ismaeel Hansa
- Department of Orthodontics, European University College, Dubai, UAE
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McMullen C, Al Turkestani NN, Ruellas ACO, Massaro C, Rego MVNN, Yatabe MS, Kim-Berman H, McNamara JA, Angelieri F, Franchi L, Ngan P, He H, Cevidanes LHS. Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2022; 161:666-678. [PMID: 34980520 PMCID: PMC9050833 DOI: 10.1016/j.ajodo.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. METHODS The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P <0.05). RESULTS Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P = 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P = 0.004). CONCLUSIONS Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.
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Affiliation(s)
- Craig McMullen
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Antonio C O Ruellas
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Marcus V N N Rego
- Department of Orthodontics, Centero Universitário Uninovafapi, Teresina, Brazil
| | - Marilia S Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Fernanda Angelieri
- Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Peter Ngan
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, W Va
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Siddhisaributr P, Khlongwanitchakul K, Anuwongnukroh N, Manopatanakul S, Viwattanatipa N. Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis. Korean J Orthod 2022; 52:182-200. [PMID: 35418520 PMCID: PMC9117794 DOI: 10.4041/kjod21.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT). Methods Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed. Results Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows 1) Skeletal expansion zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion inter-canine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%. Conclusions In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.
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Affiliation(s)
| | | | - Niwat Anuwongnukroh
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Somchai Manopatanakul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nita Viwattanatipa
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Ventura V, Botelho J, Machado V, Mascarenhas P, Pereira FD, Mendes JJ, Delgado AS, Pereira PM. Miniscrew-Assisted Rapid Palatal Expansion (MARPE): An Umbrella Review. J Clin Med 2022; 11:jcm11051287. [PMID: 35268377 PMCID: PMC8911209 DOI: 10.3390/jcm11051287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
In postpubertal patients, maxillary transverse discrepancy is a common condition often requiring surgical approaches. To overcome the excess morbidity and discomfort, maxillary expansion through miniscrew-assisted rapid palatal expansion (MARPE) was proposed and studied in the last few years. This umbrella review aims to critically appraise the quality of evidence and the main clinical outcomes of available systematic reviews (SRs) on MARPE. An extensive search was carried out in five electronic databases (PubMed-Medline, Cochrane Database of SRs, Scielo, Web of Science, and LILACS) until December 2021. The methodological quality was appraised using the A Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality of SRs. Overall, four SRs were included and analyzed, one of high methodological quality, one of low and two of critically low. Despite the verified methodological constraints, MARPE seems to present significant clinical changes when compared to conventional RPE, SARPE or controls and less adverse clinical outcomes. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better clarify the clinical protocols and outcomes success of MARPE.
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Affiliation(s)
- Vanda Ventura
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Correspondence:
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Paulo Mascarenhas
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - François Durand Pereira
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
| | - Ana Sintra Delgado
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
| | - Pedro Mariano Pereira
- Orthodontic Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal; (F.D.P.); (A.S.D.); (P.M.P.)
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior CRL, 2829-511 Almada, Portugal; (J.B.); (V.M.); (P.M.); (J.J.M.)
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Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: a prospective clinical cohort study. Clin Oral Investig 2022; 26:6253-6263. [PMID: 35731323 PMCID: PMC9525423 DOI: 10.1007/s00784-022-04577-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED). MATERIALS AND METHODS D-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed. RESULTS Thirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (- 0.31 ± 0.49 mm M1; - 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated. CONCLUSIONS MARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults. CLINICAL RELEVANCE Higher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.
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Success and complication rate of miniscrew assisted non-surgical palatal expansion in adults - a consecutive study using a novel force-controlled polycyclic activation protocol. Head Face Med 2021; 17:50. [PMID: 34895287 PMCID: PMC8665552 DOI: 10.1186/s13005-021-00301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Bone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents. Adult patients usually present a challenge, as they often require additional surgical assisted maxillary expansion (SARPE). There is still no clear statement about non-surgical expansion in adult patients using this technique. The aim of this study was to evaluate the success and complication rate of non-surgical palatal expansion in adults utilizing MAPE with a novel force-controlled polycyclic expansion protocol (FCPC). Methods This consecutive study consisted of 33 adult patients with an average age of 29.1 ± 10.2 years (min. 18 years, max. 58 years), including one dropout patient. First, four miniscrews were inserted and after 12-weeks latency, the expander was placed and the FCPC protocol was applied (MAPE group). In case of missing expansion, a SARPE was performed (SARPE group). After maximum expansion, a cone beam CT was made and widening of the midpalatal suture was measured. The outcome variables were successful non-surgical expansion and, with sample size power above 80%, the odds of failed non-surgical expansion and associated complications were evaluated. The primary predictor variable was age. Statistical analysis was performed using R (Version 3.1) to calculate power, to construct various models for measuring the odds of requiring surgical intervention/complications, and others. Results Successful non-surgical expansion was achieved in 27 patients (84.4%), ranging from 18 to 49 years. Mean age differed significantly between both groups (26.8 ± 8.2 years vs. 41.3 ± 9.9 years; p < 0.001). Mean expansion at the anterior and posterior palate for the MAPE group was 5.4 ± 1.5 mm and 2.5 ± 1.1 mm, respectively. Among these subjects’ complications were observed in 18.5%. Age significantly increased the odds of complications (p = 0.019). Conclusions 1. The success rate of MAPE among individuals aged 18 to 49 years was 84.4%. 2. A V-shaped expansion pattern in the antero-posterior dimension was mostly observed. 3. Complications were significantly associated with age. 4. A careful expansion protocol seems to be beneficial to prevent unfavorable results in adult patients. Trial registration Consecutive cohort study, Review Board No. EK-2-2014/0016.
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Salmoria I, de Souza EC, Furtado A, Franzini CM, Custodio W. Dentoskeletal changes and their correlations after micro-implant-assisted palatal expansion (MARPE) in adults with advanced midpalatal suture ossification. Clin Oral Investig 2021; 26:3021-3031. [PMID: 34773143 DOI: 10.1007/s00784-021-04284-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate and correlate the dentoskeletal changes of adult patients after miniscrew-assisted rapid palatal expander (MARPE) in the two final stages of midpalatal suture ossification. MATERIALS AND METHODS This interventional pre-post clinical study consisted of 20 adults (24.9±1.8 years), with transverse maxillary atresia, divided into two subgroups (n=10) based on the ossification degree of the midpalatal suture: stage D, fusion completed in the palatine bone; and stage E, fusion anteriorly in the maxilla. Cone beam computed tomography (CBCT) in the pre- (T0) and post-treatment (T1) time intervals were used to evaluate the anterior and posterior sutural opening, activation of the expander screw, vestibular-lingual inclinations, and widths of first premolars and first molars. Maxillary interincisor diastema was measured on patients' plaster models in the same timepoints. The Wilcoxon-Mann-Whitney test, generalized linear models (GLM), and chi-square (χ2) test were employed. RESULTS All variables significantly increased after MARPE therapy regardless of the ossification degree (P<0.05). Patients with stage D suture presented wider interincisal diastema and maxillary suture opening (on both regions, anterior and posterior) when compared with patients with stage E (P<0.05). Maxillary interincisor diastema was positively associated with anterior and posterior suture opening for all subjects (P<0.05). MARPE therapy was unsuccessful in six patients, mostly presented by individuals with E maturation stage of the midpalatal suture. CONCLUSIONS After MARPE, a significant correction in the transverse defect of the maxillary basal bone was achieved for adults in the last two midpalatal suture maturation stages. CLINICAL RELEVANCE Adult patients in stage D of maxillary suture ossification are more susceptible to dentoskeletal changes following MARPE therapy as compared to patients with stage E.
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Affiliation(s)
- Igor Salmoria
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation-FHO, Avenida Dr Maximiliano Baruto, 500, Araras, SP, Zip Code 13607-339, Brazil
| | - Evaldo Chaves de Souza
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation-FHO, Avenida Dr Maximiliano Baruto, 500, Araras, SP, Zip Code 13607-339, Brazil
| | - Alvaro Furtado
- Department of Orthodontics, Centro Universitário Unifacvest: Centro Universitario Unifacvest, Florianópolis, SC, Brazil
| | - Cristina Maria Franzini
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation-FHO, Avenida Dr Maximiliano Baruto, 500, Araras, SP, Zip Code 13607-339, Brazil
| | - William Custodio
- Department of Orthodontics, University Center of the Hermínio Ometto Foundation-FHO, Avenida Dr Maximiliano Baruto, 500, Araras, SP, Zip Code 13607-339, Brazil.
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Vidalón JA, Loú-Gómez I, Quiñe A, Diaz KT, Liñan Duran C, Lagravère MO. Periodontal effects of maxillary expansion in adults using non-surgical expanders with skeletal anchorage vs. surgically assisted maxillary expansion: a systematic review. Head Face Med 2021; 17:47. [PMID: 34753493 PMCID: PMC8579525 DOI: 10.1186/s13005-021-00299-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Describe and compare harmful periodontal effects as a consequence of maxillary expansion in adult patients with different types of anchorage devices in non-surgical expanders with skeletal anchorage and surgically assisted maxillary expansion. MATERIALS AND METHODS An exhaustive search was carried out on the electronic databases PubMed (MEDLINE), Embase, Cochrane and LILACS. Additionally, journal references and grey literature were searched without any restrictions. After the selection and extraction process; risk of bias was assessed by the ROB-1 Cochrane tool and Newcastle-Ottawa Scale (NOS) for randomized trials and cohort studies, respectively. RESULTS Of 621 studies retrieved from the searches, six were finally included in this review. One of them presented a low risk bias, while five were excellent respective to selection, comparability and outcomes. Results showed that maxillary expansion in adults using non-surgical expanders (bone-borne or tooth-bone-borne with bicortical skeletal anchorage) produce less harmful periodontal effects, such as: alveolar bending with an average range from 0.92° to 2.32°, compared to surgically assisted maxillary expansion (tooth-borne) of 6.4°; dental inclination with an average range from 0.07° to 2.4°, compared to surgically assisted maxillary expansion (tooth-borne) with a range from 2.01° to 5.56°. CONCLUSIONS Although limited, the current evidence seems to show that the bone-borne or tooth-bone-borne with bicortical skeletal anchorage produces fewer undesirable periodontal effects.
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Affiliation(s)
- José Antonio Vidalón
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ismael Loú-Gómez
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Aldo Quiñe
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karla T Diaz
- Stomatology Second Speciality, Universidad Privada San Juan Bautista, Lima, Peru
| | - Carlos Liñan Duran
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuel O Lagravère
- University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
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Facio-Umaña JA, Chaurand J, Gonzalez-Luna PIV. Early class III treatment with maxillary protraction-miniscrew-assisted rapid palatal expansion (MARPE) and mandibular miniplates. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Mehta S, Chen PJ, Upadhyay M, Yadav S. Intermaxillary elastics on skeletal anchorage and MARPE to treat a class III maxillary retrognathic open bite adolescent: A case report. Int Orthod 2021; 19:707-715. [PMID: 34452857 DOI: 10.1016/j.ortho.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Class III malocclusion when accompanied with transverse and vertical maxillomandibular discrepancies such as posterior crossbite and vertical open bite leads to complicated orthodontic treatment. Proper diagnosis and treatment planning are important in such patients for a successful orthodontic outcome. A common treatment approach for patients with class III malocclusion is to wait for the completion of growth and plan orthognathic surgery in conjunction with orthodontic treatment. However, performing no treatment and waiting for growth to be completed during teen years could lead to negative effects on the patient's self-esteem. In such cases, a non-surgical option with skeletal anchorage could be used to correct the malocclusion without surgical intervention. This case report shows that in patients with severe class III malocclusion, skeletal anchorage can be used for the correction of anterior crossbite with intermaxillary elastics.
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Affiliation(s)
- Shivam Mehta
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA.
| | - Po-Jung Chen
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Madhur Upadhyay
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut Health, Farmington, CT, USA
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Suresh S, Sundareswaran S, Sathyanadhan S. Effect of microimplant assisted rapid palatal expansion on bone-anchored maxillary protraction: A finite element analysis. Am J Orthod Dentofacial Orthop 2021; 160:523-532. [PMID: 34215468 DOI: 10.1016/j.ajodo.2020.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 02/01/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate the craniofacial effects of microimplant assisted rapid palatal expansion (MARPE) on bone-anchored maxillary protraction (BAMP) through a finite element analysis. METHODS A 3-dimensional finite element model of the skull with associated sutures was created from the computed tomography image of a 12-year-old male patient. Two protraction protocols: BAMP without MARPE (protocol 1) and BAMP with MARPE (protocol 2), were analyzed using Ansys software (Ansys, Canonsburg, Pa). Stress distribution in the sutures and displacement pattern of craniofacial structures were analyzed in the 2 protocols using finite element analysis. RESULTS Both protocols produced changes in craniofacial structures in all the 3 planes. Displacement of the maxilla was more pronounced in protocol 2 in all directions with mild clockwise rotation. Protocol 1 displayed a translatory movement of the maxilla without any rotation and mild constriction in the anterior region. In protocol 2, an expansion of the maxilla, which increased in the superoinferior direction, was also observed. Von Mises stress in circummaxillary sutures was significantly more in protocol 2, indicating an increased displacement of craniomaxillary structures. CONCLUSIONS The use of MARPE during BAMP enhanced maxillary protraction and reduced the counterclockwise rotation tendency of the maxilla. Hence, it may be inferred that incorporation of MARPE during BAMP protocol may prove beneficial in the treatment of patients with skeletal Class III malocclusion with open bite tendency or hyperdivergent growth pattern.
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Affiliation(s)
- Sugitha Suresh
- Department of Orthodontics, Government Dental College, Calicut, Kerala, India
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Kapetanović A, Theodorou CI, Bergé SJ, Schols JGJH, Xi T. Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis. Eur J Orthod 2021; 43:313-323. [PMID: 33882127 PMCID: PMC8186837 DOI: 10.1093/ejo/cjab005] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. Objectives This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. Search methods Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. Selection criteria Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. Data collection and analysis Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. Results Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. Limitations One of the main drawbacks was the lack of high-quality prospective studies in the literature. Conclusions and implications MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. Registration PROSPERO (CRD42020176618). Funding No grants or any other support funding were received.
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Affiliation(s)
- Aldin Kapetanović
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Orthodontics and Craniofacial Biology, Nijmegen, The Netherlands
| | | | - Stefaan J Bergé
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Oral and Maxillofacial Surgery, Nijmegen, The Netherlands
| | - Jan G J H Schols
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Orthodontics and Craniofacial Biology, Nijmegen, The Netherlands
| | - Tong Xi
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Oral and Maxillofacial Surgery, Nijmegen, The Netherlands
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Stress distribution and displacement of three different types of micro-implant assisted rapid maxillary expansion (MARME): a three-dimensional finite element study. Prog Orthod 2021; 22:20. [PMID: 34152492 PMCID: PMC8217479 DOI: 10.1186/s40510-021-00357-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract Background/objective Until 2010, adults underwent surgical treatment for maxillary expansion; however, with the advent of micro-implant-assisted rapid maxillary expansion (MARME), the availability of less invasive treatment options has increased. Nevertheless, individuals with severe transverse maxillary deficiency do not benefit from this therapy. This has aroused interest in creating a new device that allows the benefit of maxillary expansion for these individuals. The aim of this study was to evaluate the efficacy of three MARME models according to tension points, force distribution, and areas of concentration in the craniofacial complex when transverse forces are applied using finite element analysis. Materials and methods Digital modeling of the three MARME models was performed. Model A comprised five components: one body screw expander and four adjustable arms with rings for mini-implant insertion. These arms have an individualized height adjustment that allows MARME positioning according to the patient’s palatal anatomy, thereby preventing body screw expander collision with the lateral mucosa in severe cases of maxillary deficiency. Model B was a maxillary expander with screw rings joined to the body, and model C was similar to model B, except that model C had open rings for the insertion of the mini-implants. Through the MEF (Ansys software), the stresses, distribution, and area of concentration of the stresses were evaluated when transverse forces of 7.85 N were applied. Results The three models maintained the following pattern: model C presented weak stress peaks with limited distribution and lower concentration area, model B obtained median stress peaks with better distribution when compared to that of model C, and model A showed better stress distribution and larger concentration area. In model A, tensions were located in the lateral lamina of the pterygoid process, which is an important site for maxillary expansion. The limitation of the present study was that it did not include the periodontal tissues and muscles in the finite element method evaluation. Conclusions Model A showed the best stress distribution conditions. In cases of severe atresia, model A seems to be an excellent option. Supplementary Information The online version contains supplementary material available at 10.1186/s40510-021-00357-5.
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Tang H, Liu P, Liu X, Hou Y, Chen W, Zhang L, Guo J. Skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) in young adults. Angle Orthod 2021; 91:301-306. [PMID: 33492395 DOI: 10.2319/052920-491.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To observe skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) and determine the possible factors that may affect the postexpansion changes using cone-beam computed tomography (CBCT) in young adults. MATERIALS AND METHODS Thirty-one patients (mean age 22.14 ± 4.76 years) who were treated with MARME over 1 year were enrolled. Four mini-implants were inserted in the midpalatal region, and the number of activations ranged from 40 to 60 turns (0.13 per turn). CBCT was performed before MARME (T0), after activation (T1), and after 1 year of retention (T2). The mean period between T1 and T0 was 6 ± 1.9 months and between T2 and T1 was 13 ± 2.18 months. A paired t-test was performed to compare T0, T1, and T2. The correlations between the postexpansion changes and possible contributing factors were analyzed by Pearson correlation analysis. RESULTS The widths increased significantly after T1. After T2, the palatal suture width decreased from 2.50 mm to 0.75 mm. From T1 to T2, decreases recorded among skeletal variables varied from 0.13 mm to 0.41 mm. This decrease accounted for 5.75% of the total expansion (2.26 mm) in nasal width (N-N) and 19.75% at the lateral pterygoid plate. A significant correlation was found between postexpansion change and palatal cortical bone thickness and inclination of the palatal plane (ANS-PNS/SN; P < .05). CONCLUSIONS Expanded skeletal width was generally stable after MARME. However, some amount of relapse occurred over time. Patients with thicker cortical bone of the palate and/or flatter palatal planes seemed to demonstrate better stability.
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de Oliveira CB, Ayub P, Ledra IM, Murata WH, Suzuki SS, Ravelli DB, Santos-Pinto A. Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment. Am J Orthod Dentofacial Orthop 2021; 159:733-742. [PMID: 33931257 DOI: 10.1016/j.ajodo.2020.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. METHODS The sample comprised 17 patients (mean age, 26 ± 11 years) selected for the MARPE group and 15 (mean age, 28.5 ± 10.5 years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. RESULTS MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. CONCLUSIONS The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.
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Affiliation(s)
- Cibele Braga de Oliveira
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil.
| | - Priscila Ayub
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ingrid Müller Ledra
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Wilson Humio Murata
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Dirceu Barnabé Ravelli
- Department of Pediatric Dentistry, Area of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ary Santos-Pinto
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
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Palatal bone thickness at the implantation area of maxillary skeletal expander in adult patients with skeletal Class III malocclusion: a cone-beam computed tomography study. BMC Oral Health 2021; 21:144. [PMID: 33752663 PMCID: PMC7986252 DOI: 10.1186/s12903-021-01489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Maxillary skeletal expanders (MSE) is effective for the treatment of maxillary transverse deformity. The purpose of the study was to analyse the palatal bone thickness in the of MSE implantation in patients with skeletal class III malocclusion.
Methods A total of 80 adult patients (40 males, 40 females) with an average angle before treatment were divided into two groups, the skeletal class III malocclusion group and the skeletal I malocclusion group, based on sagittal facial type. Each group consisted of 40 patients, with a male to female ratio of 1:1. A cone-beam computed tomography scanner was employed to obtain DICOM data for all patients. The palatal bone thickness was measured at 45 sites with MIMICS 21.0 software, and SPSS 22.0 software was employed for statistical analysis. The bone thickness at different regions of the palate in the same group was analysed with one-way repeated measures ANOVA. Fisher’s least significant difference-t method was used for the comparison of pairs, and independent sample t test was employed to determine the significance of differences in the bone thickness at the same sites between the two groups. Results Palatal bone thickness was greater in the middle region of the midline area (P < 0.01), while the thickness in the middle and lateral areas in both groups was generally lower (P < 0.001). The bone in the anterior, middle, and posterior regions of the two groups became increasingly thin from the middle area toward the parapalatine region. The palatal bone was significantly thinner in the area 9.0 mm before the transverse palatine suture in the midline area, 9.0 mm before and after the transverse palatine suture in the middle area, and 9.0 mm after the transverse palatine suture in the lateral area. Conclusion The palatal bone was thinner in patients with class III malocclusion than in patients with class I malocclusion, with significant differences in some areas. The differences in bone thickness should be considered when MSE miniscrews are implanted. The anterior and middle palatal areas are safer for the implantation of miniscrews, while the thinness of the posterior palatal bone increases the risk of the miniscrews falling off and perforating.
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Choi JY, Choo H, Oh SH, Park JH, Chung KR, Kim SH. Finite element analysis of C-expanders with different vertical vectors of anchor screws. Am J Orthod Dentofacial Orthop 2021; 159:799-807. [PMID: 33762139 DOI: 10.1016/j.ajodo.2020.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION C-expanders are tissue- and bone-borne maxillary expanders that are anchored by 6 orthodontic miniscrews, 3 on each side of the palate. The purpose of the study was to investigate the effect of C-expanders on the circummaxillary sutures and bucco-palatal axis of teeth in 3-dimensional finite element analyses when anchor screw vectors are different. METHODS Five expansion models were studied on the basis of the vertical positions of anchor screws on the palate. Anchor screws for models A, B, and C were placed symmetrically at 4 mm, 7 mm, and 15 mm below the cementoenamel junction (CEJ), respectively. Anchor screws for models D and E were placed asymmetrically at 4 mm and 15 mm below CEJ and 7 mm and 15 mm below CEJ, respectively. Stress, displacement, and angular changes of the bone and teeth were measured in elastoplastic behavior models using a static-nonlinear simulation in an implicit method. RESULTS Symmetrical and asymmetrical anchor screw placement with different vertical vectors were compared using finite element analyses on 5 models. CONCLUSIONS Using different vectors of anchor screws for C-expanders does change the pattern of palatal expansion (null hypothesis was rejected). The current investigation presents a promising future of controlled asymmetric skeletal maxillary expansion when asymmetric maxillary architecture needs to be corrected for successful orthodontic outcomes without involving orthognathic surgeries.
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Affiliation(s)
- Jin-Young Choi
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea
| | - HyeRan Choo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Craniofacial and Airway Orthodontic Clinic, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, Calif
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jae-Hyun Park
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Kyu-Rhim Chung
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea.
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Coloccia G, Inchingolo AD, Inchingolo AM, Malcangi G, Montenegro V, Patano A, Marinelli G, Laudadio C, Limongelli L, Di Venere D, Hazballa D, D’Oria MT, Bordea IR, Xhajanka E, Scarano A, Lorusso F, Laforgia A, Inchingolo F, Dipalma G. Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57030288. [PMID: 33808680 PMCID: PMC8003431 DOI: 10.3390/medicina57030288] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander approaches. Materials and Methods: The database used to perform the screening and determine the eligibility of the clinical papers was PubMed (Medline). Results: The database search included a total of 284 results, while 271 articles were excluded. A total of 14 articles were included for the qualitative assessment. Conclusions: The effectiveness of the present studies reported that skeletal expansion was a useful approach to increase the transverse changes for subjects with constricted maxillary arches.
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Affiliation(s)
- Giovanni Coloccia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Valentina Montenegro
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Claudia Laudadio
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Denisa Hazballa
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Kongresi Elbasanit, Rruga: Aqif Pasha, 3001 Elbasan, Albania
| | - Maria Teresa D’Oria
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Department of Medical and Biological Sciences, University of Udine. Via delle Scienze, 206, 33100 Udine, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Edit Xhajanka
- Department of Dental Prosthesis, Medical University of Tirana, Rruga e Dibrës, 1001 Tirana, Albania;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Alessandra Laforgia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
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Choi JY, Cho J, Oh SH, Kim SH, Chung KR, Nelson G. Effect of Different Surface Designs on the Rotational Resistance and Stability of Orthodontic Miniscrews: A Three-Dimensional Finite Element Study. SENSORS 2021; 21:s21061964. [PMID: 33799632 PMCID: PMC8001794 DOI: 10.3390/s21061964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/03/2023]
Abstract
High orthodontic forces and various directions of applied forces can be associated with loosening of the screw anchorage in the bone. Screw designs have been modified to increase the stability of the miniscrews. This research evaluates the influence of three-designs on the stability of orthodontic miniscrews. A conventionally cylinder-type miniscrew design (Bio-Action screw, Jin-Biomed co., Bucheon, Korea) was set as a control, and three conditions were studied based on modifications of this control design. Condition-1 has narrowed threads in the upper part of the screw; Condition-2 has a notch at the middle part; and Condition-3 has the combination of Condition-1 and Condition-2. The moment required to unwind the miniscrew to five degrees is tested, and the moment generated at the cortical bone and the trabecular bone were calculated with finite element analysis. Compared to the control, all three conditions showed a higher moment required to unwind the miniscrew and a higher moment generated at the cortical bone. At the trabecular bone, condition-2 and -3 showed higher moment than the control, and condition-1 showed similar moment to the control. Condition-3 required a higher overall moment to unwind the miniscrew. These findings validate the design modifications used to increase the rotational resistance.
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Affiliation(s)
- Jin-Young Choi
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
| | - Jaehee Cho
- Department of Orthodontics, Graduate School of Medicine, Korea University, Seoul 02841, Korea;
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea;
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
- Correspondence:
| | - Kyu-Rhim Chung
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
| | - Gerald Nelson
- Division of Orthodontics, Department of Orofacial Science, University of California, San Francisco, CA 94143, USA;
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Xia K, Sun WT, Yu LY, Liu J. Influence of different types of rapid maxillary expansion on root resorption: a systematic review. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:38-47. [PMID: 33723935 DOI: 10.7518/hxkq.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to assess the influence of different types of rapid maxillary expansion on root resorption (RR). METHODS Literature searches were carried out electronically in five English and two Chinese databases. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, and case-control studies were included. The data were extracted by three authors. The risk of bias in the RCTs and nonrandomized studies were assessed in accordance with corresponding scales. RESULTS Among the 400 articles identified, seven were included for the final analysis. Three studies were graded as high value of evidence, while two and another two studies were graded as moderate value and low value, respectively. According to the available evidence, the tooth-borne maxillary expansion caused more obvious RR of anchorage teeth than the bone-borne one. In addition, the Haas-type palatal acrylic pads could not effectively reduce the degree of RR. The difference in the design of the retainer between the tooth-borne maxillary expansion (the use of a band or wire framework to connect the anchorage tooth) did not cause the difference in the incidence and degree of RR. CONCLUSIONS Clinical evidence suggested that bone-borne maxillary expansion may decrease the amount of RR, while the amounts of resorption did not significantly differ between Haas and Hyrax and between different retainer types of Hyrax.
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Affiliation(s)
- Kai Xia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wen-Tian Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li-Yuan Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jun Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Chuang YH, Chen JH, Ho KH, Wang KL, Hsieh SC, Chang HM. The role of micro-implant-assisted rapid palatal expansion (MARPE) in clinical orthodontics — a literature review. AUSTRALASIAN ORTHODONTIC JOURNAL 2021. [DOI: 10.21307/aoj-2021.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
A maxillary transverse deficiency is a common craniofacial problem. Rapid palatal expansion (RPE) has been traditionally considered for the treatment of children and young adolescents, but this is not applicable in late adolescents or adults due to the ossification of facial sutures. A surgically assisted rapid palatal expansion (SARPE) was initially advocated for this group of patients, but the surgical procedure is associated with morbidity. As temporary anchorage devices (TADs) have been recently and popularly applied in clinical orthodontics, micro-implant-assisted rapid palatal expansion (MARPE) has been employed to facilitate maxillary expansion in skeletally mature patients. There have been various proposed MARPE designs and the outcomes appear promising. The aim of the present article is to discuss the role of MARPE in clinical orthodontics by reviewing its background, design, indications, treatment effects, stability, and limitations in the current literature. The treatment effects of two types of MARPE, bone-borne and tooth-bone-borne (hybrid), will be individually assessed.
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Affiliation(s)
- Yun-Hsuan Chuang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Jen-Hsuan Chen
- DDS, Oromaxillofacial Department, Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kwok-Hing Ho
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kai-Long Wang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Shun-Chu Hsieh
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Heng-Ming Chang
- Chang Bing Show Chwan Memorial Hospital Changhua County , Changhua , Taiwan
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Calil RC, Marin Ramirez CM, Otazu A, Torres DM, Gurgel JDA, Oliveira RC, de Oliveira RCG, Valarelli FP, Freitas KMS. Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2020; 159:e93-e101. [PMID: 33288357 DOI: 10.1016/j.ajodo.2020.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The objective of the present study was to compare the maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion (MARPE). METHODS The sample comprised 37 patients with Class I malocclusion treated without tooth extraction, divided into 2 groups: group 1 comprises 21 patients with a mean age of 19.55 years (standard deviation = 1.31), submitted to orthodontic treatment with Damon self-ligating appliance, and evaluated until the end of the alignment and leveling stage. Group 2 comprises 16 patients with a mean age of 24.92 years (standard deviation = 7.60), with maxillary atresia, who underwent MARPE, and were evaluated after the removal of the expander. Buccal bone thickness; dental inclinations; and transverse distances of the maxillary arch, nasal base, and jugula widths were measured on cone-beam computed tomography scans before and after treatment. The intergroup comparison was performed with the independent t test. RESULTS With treatment, there was a significantly greater decrease in buccal bone thickness of canines and premolars in the self-ligating group, the premolars presented a greater buccal inclination in the self-ligating group, and the intercanine and intermolar distances and nasal base and jugula widths showed significantly greater increases in the MARPE group than in the self-ligating group. CONCLUSIONS MARPE treated more severe skeletal transverse maxillary discrepancies and obtained better results than self-ligating appliances in terms of buccal bone loss, tooth inclination, and transverse skeletal increase of the maxilla. MARPE presented more skeletal effects and self-ligating appliances, more dental effects.
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Affiliation(s)
| | | | - Aldo Otazu
- Department of Orthodontics, Advanced Dentistry Institute IOA, Asunción, Paraguay
| | - Dino Marcelo Torres
- Department of Orthodontics, Advanced Dentistry Institute IOA, Asunción, Paraguay
| | - Júlio de Araújo Gurgel
- Department of Speech Language, São Paulo State University UNESP, Marília, São Paulo, Brazil
| | | | | | | | - Karina Maria Salvatore Freitas
- Department of Orthodontics, Ingá University Center Uningá, Maringá, Paraná, Brazil; Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
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Baik HS, Kang YG, Choi YJ. Miniscrew-assisted rapid palatal expansion: A review of recent reports. J World Fed Orthod 2020; 9:S54-S58. [PMID: 33023733 DOI: 10.1016/j.ejwf.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
The miniscrew-assisted rapid palatal expander (MARPE) has extended not only skeletal effects with fewer dental changes and but also the age limit of nonsurgical maxillary expansion treatment. Amid its gaining popularity in clinical orthodontics, our current understanding of treatment effectiveness, efficiency, and stability needs to be reassessed. In this review article, the authors have attempted to evaluate MARPE from various aspects with a focus on recent studies.
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Affiliation(s)
- Hyoung-Seon Baik
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon-Goo Kang
- Department of Orthodontics, Kyung Hee University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
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Ahn YS, Choi SH, Lee KJ, Jung YS, Baik HS, Yu HS. Stability of bimaxillary surgery involving intraoral vertical ramus osteotomy with or without presurgical miniscrew-assisted rapid palatal expansion in adult patients with skeletal Class III malocclusion. Korean J Orthod 2020; 50:304-313. [PMID: 32938823 PMCID: PMC7500573 DOI: 10.4041/kjod.2020.50.5.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/03/2020] [Accepted: 04/25/2020] [Indexed: 01/02/2023] Open
Abstract
Objective The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion. Methods A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery. Results Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant (p < 0.001). Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased (p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group; these widths were maintained or decreased in the control group. However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement. Conclusions MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery.
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Affiliation(s)
- Yoon-Soo Ahn
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.,BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyoung-Seon Baik
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
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Differential assessment of skeletal, alveolar, and dental components induced by microimplant-supported midfacial skeletal expander (MSE), utilizing novel angular measurements from the fulcrum. Prog Orthod 2020; 21:18. [PMID: 32656601 PMCID: PMC7355053 DOI: 10.1186/s40510-020-00320-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background In order to assess skeletal expansion, alveolar bone bending, and dental tipping after maxillary expansion, linear and angular measurements have been performed utilizing different craniofacial references. Since the expansion with midfacial skeletal expander (MSE) is archial in nature, the aim of this paper is to quantify the differential components of MSE expansion by calculating the fulcrum locations and applying a novel angular measurement system. Methods Thirty-nine subjects with a mean age of 18.2 ± 4.2 years were treated with MSE. Pre- and post-expansion CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified by localizing the interfrontal distance and modified interfrontal distance. Based on the fulcrum, a novel angular measurement method is presented and compared with a conventional linear method to assess changes of the zygomaticomaxillary complex, dentoalveolar bone, and maxillary first molars. Results From 39 patients, 20 subjects have the rotational fulcrum of the zygomaticomaxillary complex at the most distant points of the interfrontal distance (101.6 ± 4.7 mm) and 19 subjects at the most distant points of the modified interfrontal distance (98.9 ± 5.7 mm). Linear measurements accounted for 60.16% and 56.83% of skeletal expansion, 16.15% and 16.55% of alveolar bone bending, and 23.69% and 26.62% of dental tipping for right and left side. Angular measurements showed 96.58% and 95.44% of skeletal expansion, 0.34% and 0.33% alveolar bone bending, and 3.08% and 4.23% of dental tipping for the right and left sides. The frontozygomatic, frontoalveolar, and frontodental angles were not significant different (P > 0.05). Conclusions In the coronal plane, the center of rotation for the zygomaticomaxillary complex was located at the most external and inferior point of the zygomatic process of the frontal bone or slightly above and parallel to the interfrontal distance. Due to the rotational displacement of the zygomaticomaxillary complex, angular measurements should be a preferred method for assessing the expansion effects, instead of the traditional linear measurement method.
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Parizotto JOL, Borsato KT, Peixoto AP, Bianchi J, Cassano DS, Gonçalves JR. Can palatal splint improve stability of segmental Le Fort I osteotomies? Orthod Craniofac Res 2020; 23:486-492. [PMID: 32533749 DOI: 10.1111/ocr.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. SETTING AND SAMPLE POPULATION Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). MATERIALS AND METHODS Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. RESULTS Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm. CONCLUSIONS The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.
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Affiliation(s)
| | | | - Adriano Porto Peixoto
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), Bauru, Brazil
| | - Jonas Bianchi
- School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
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Li Q, Tang H, Liu X, Luo Q, Jiang Z, Martin D, Guo J. Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion. Angle Orthod 2020; 90:432-441. [PMID: 33378437 PMCID: PMC8032299 DOI: 10.2319/080919-522.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate changes in dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion (MARME) and observe correlations between changes of upper airway and vertical skeletal pattern in young adults. MATERIALS AND METHODS In this retrospective study, 22 patients (mean age, 22.6 ± 4.5 years; 4 male 18 female) with transverse discrepancy underwent MARME. Cone beam computed tomography was taken before and 3 months after expansion. Vertical and horizontal dimensions and volume of the nasal cavity, nasopharyngeal, retropalatal, retroglossal and hypopharyngeal airway were compared before and after MARME. Correlations between changed volume and dimensions were explored, as well as the vertical skeletal pattern. RESULTS Nasal osseous width, maxillary width, volume of the nasal cavity and nasopharynx increased significantly (P < .05). Enlarged nasopharyngeal volume correlated with increased nasal width at the PNS plane (P < .05). There were no correlations between expanded volume and maxillary width. No measurements except nasal cavity volume had a correlation with Sum angle. Increased maxillary width correlated negatively with hard palate thickness (P < .05). CONCLUSIONS (1) MARME caused an increase in volume of the nasal cavity and nasopharynx, with expansion of nasal osseous width and maxillary width. (2) Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed no direct relation with increased volume. (3) In this study, it was unclear about the association between changes of the upper airway and vertical skeletal pattern because of complex structures. (4) Palate thickness affected skeletal expansion of the maxilla in MARME.
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