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Barone S, Bennardo F, Salviati M, Calabria E, Bocchino T, Michelotti A, Giudice A. Can different osteotomies have an influence on surgically assisted rapid maxillary expansion? A systematic review. Head Face Med 2024; 20:16. [PMID: 38459578 PMCID: PMC10921779 DOI: 10.1186/s13005-024-00415-3] [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: 11/27/2023] [Accepted: 02/10/2024] [Indexed: 03/10/2024] Open
Abstract
The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Francesco Bennardo
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Marianna Salviati
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Elena Calabria
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Tecla Bocchino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Amerigo Giudice
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy.
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Meazzini MC, Demonte LP, Cohen N, Battista VMA, Rabbiosi D, Autelitano L. The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case-Control Study in Cleft Lip and Palate and Skeletal Class III Patients. J Clin Med 2024; 13:1329. [PMID: 38592173 PMCID: PMC10931644 DOI: 10.3390/jcm13051329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign's software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach.
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Affiliation(s)
- Maria Costanza Meazzini
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Leonardo Paolo Demonte
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
- Department of Orthodontics, University Vita-Salute, San Raffaele Hospital, 20132 Milano, Italy
| | - Noah Cohen
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Valeria Marinella Augusta Battista
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Dimitri Rabbiosi
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
- Università degli Studi dell’Insubria, Circolo and Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Luca Autelitano
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
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Inchingolo AM, Patano A, Piras F, de Ruvo E, Ferrante L, Noia AD, Dongiovanni L, Palermo A, Inchingolo F, Inchingolo AD, Dipalma G. Orthognathic Surgery and Relapse: A Systematic Review. Bioengineering (Basel) 2023; 10:1071. [PMID: 37760172 PMCID: PMC10525849 DOI: 10.3390/bioengineering10091071] [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: 08/17/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This review aimed to analyze the relapse in orthognathic surgery. METHODS PubMed, Scopus, and Web of Science databases were used to find papers that matched our topic dating from 1 January 2012 up to November 2022. Inclusion criteria were (1) human studies, (2) open access studies, (3) studies concerning the correlation between orthognathic surgery and relapse. Exclusion criteria were: (1) in vitro or animal studies, (2) off-topic studies, (3) reviews, (4) other languages than English. RESULTS A total of 482 results were obtained resulting in 323 publications after duplicate removal (158). After screening and eligibility phases 247 records were excluded: 47 reviews, 5 in animals, 35 in vitro, 180 off-topic. The authors successfully retrieved the remaining 78 papers and evaluated their eligibility. A total of 14 studies from these were ultimately included in the review. CONCLUSION Using cephalometric examinations and digital study models, these studies reveal that the relapse after orthognathic surgery is an event that occurs in most of the cases. The limitation of our research is that most of the studies are retrospective and use small sample sizes. A future research goal should be to conduct long-term clinical trials with larger numbers of samples.
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Affiliation(s)
- Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Elisabetta de Ruvo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Angela Di Noia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Andrea Palermo
- Implant Dentistry College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.P.); (F.P.); (E.d.R.); (L.F.); (A.D.N.); (L.D.); (A.D.I.)
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Galli P, Foy JP, Le Roux MK, Goudot P, Lutz JC, Schouman T. Stability of maxillary expansion osteotomy using patient-specific fixation implants without necessitating removable appliances: a retrospective analysis. Clin Oral Investig 2023:10.1007/s00784-023-05082-3. [PMID: 37256431 DOI: 10.1007/s00784-023-05082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the long-term stability of surgical maxillary expansion using patient-specific fixation implants (PSFIs) without intraoral retention. MATERIALS AND METHODS Fifteen patients who had undergone segmented Le Fort I osteotomy and PSFIs with available preoperative (t0) early (t1) and 1-year follow-up computed tomography (CT) scans (t2) were evaluated. The early and 1-year 3D models were superimposed to transfer the bony landmarks; the distances between each pair of landmarks at the different time points were then measured. The distances between the canines and second molars were also measured directly on the CT scans. RESULTS The achieved maxillary expansions ranged from a median of 4.39 (2.00-6.27) mm at the greater palatine foramina to a median of 2.14 (1.56-2 > 83) mm at the canine level of the palatal bone. One year postoperatively, the changes in skeletal diameters ranged from a median of - 0.53 (- 1.65 to 0.41) mm at the greater palatine foramina (p = 0.12) to 0.17 (- 0.09 to 0.32) mm at the canine level of the palatal bone (p = 0.56). Changes in dental arch diameters ranged from a median of - 0.6 (- 2 to 0.00) mm between the second molars to - 1.3 (- 1.8 to - 0.25) mm between the canines (P < 0.05). CONCLUSION This study showed the stability of maxillary expansion osteotomy using PSFIs, even without postoperative intraoral retention. CLINICAL RELEVANCE PSFIs are a reliable method for the surgical treatment of transverse maxillary discrepancy. PFSIs are easy-to-use and improve surgical accuracy.
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Affiliation(s)
- Philippe Galli
- Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillo-Faciale, 75013, Paris, France.
| | - Jean-Philippe Foy
- Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillo-Faciale, 75013, Paris, France
| | - Marc-Kevin Le Roux
- Department of Oral and Maxillofacial Surgery, La Conception University Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, 13005, Marseille, France
| | - Patrick Goudot
- Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillo-Faciale, 75013, Paris, France
| | - Jean-Christophe Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital, and UFR Medicine, University of Strasbourg, 1, Avenue Molière, 67098, Strasbourg Cedex, France
| | - Thomas Schouman
- Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillo-Faciale, 75013, Paris, France
- Arts Et Métiers Sciences Et Technologies, Institut de Biomécanique Humaine Georges Charpak (IBHGC), 75013, Paris, France
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Mulier D, Gaitán Romero L, Führer A, Martin C, Shujaat S, Shaheen E, Politis C, Jacobs R. Long-term dental stability after orthognathic surgery: a systematic review. Eur J Orthod 2021; 43:104-112. [PMID: 32901268 DOI: 10.1093/ejo/cjaa022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Long-term dental stability is one of the main objectives following combined orthodontic and orthognathic surgical treatment. It is influenced by multiple factors such as surgical, patient-related, and orthodontic aspects. While recent reviews mainly focus on short-term dental changes (0.5-2 years), longer follow-up dental stability remains hardly reviewed. OBJECTIVES The aim of this study was to evaluate long-term stability of dental and dentolabial changes following combined orthodontic and orthognathic surgical treatment with a minimum follow-up period of 5 years. SEARCH METHODS A systematic search was conducted up to December 2019 using Pubmed, Embase, Web of Science, and Cochrane Central. SELECTION CRITERIA Randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case series with a minimum of 10 patients, which reported long-term dental stability following combined orthodontic and orthognathic treatment, were included. DATA COLLECTION AND ANALYSIS Long-term changes were assessed for overjet, overbite, maxillary, and mandibular incisors' position and relationship of lip position to maxillary and mandibular incisors. Risk of bias was assessed according to the Cochrane Handbook. RESULTS Following the screening of 3178 articles, 11 studies were included (2 RCT, 9 retrospective) with a postoperative follow-up period ranging from 5 to 15 years. A decrease in overjet was observed for patients with skeletal class III malocclusion, whereas overjet increased in class II patients at long-term follow-up. Overbite increased in class II patients, whereas class III showed variable results. The lower incisor position was more stable vertically than horizontally; the latter showing more outcome variability. Dentolabial changes corresponded to the normal ageing process and results were not clinically significant after long-term follow-up. CONCLUSION Current evidence suggests variability of dental and dentolabial stability in both skeletal class II and III patients. Further prospective studies are required to develop guidelines for long-term follow-up assessment using computer tomography or cone-beam computed tomography imaging, before final conclusions can be drawn. REGISTRATION The protocol for this systematic review (CRD42020133844) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).
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Affiliation(s)
- Delphine Mulier
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lesly Gaitán Romero
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alberto Führer
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Catalina Martin
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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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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