1
|
Alqahtani KA, Jacobs R, Da Costa Senior O, Politis C, Shaheen E. Recommendations to minimize tooth root remodeling in patients undergoing maxillary osteotomies. Sci Rep 2024; 14:13686. [PMID: 38871741 DOI: 10.1038/s41598-024-62059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.
Collapse
Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Oliver Da Costa Senior
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of 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, Leuven, Belgium
- Department of 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, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Hoang TH, Nguyen KCT, Kaipatur NR, Alexiou M, La TG, Lagravère Vich MO, Major PW, Punithakumar K, Lou EH, Le LH. Ultrasonic mapping of midpalatal suture - An ex-vivo study. J Dent 2024; 145:105024. [PMID: 38670332 DOI: 10.1016/j.jdent.2024.105024] [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: 08/10/2023] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Rapid maxillary expansion is a common orthodontic procedure to correct maxillary constriction. Assessing the midpalatal suture (MPS) expansion plays a crucial role in treatment planning to determine its effectiveness. The objectives of this preliminary investigation are to demonstrate a proof of concept that the palatal bone underlying the rugae can be clearly imaged by ultrasound (US) and the reconstructed axial view of the US image accurately maps the MPS patency. METHODS An ex-vivo US scanning was conducted on the upper jawbones of two piglet's carcasses before and after the creation of bone defects, which simulated the suture opening. The planar images were processed to enhance bone intensity distribution before being orderly stacked to fuse into a volume. Graph-cut segmentation was applied to delineate the palatal bone to generate a bone volume. The accuracy of the reconstructed bone volume and the suture opening was validated by the micro-computed tomography (µCT) data used as the ground truth and compared with cone beam computed tomography (CBCT) data as the clinical standard. Also included in the comparison is the rugae thickness. Correlation and Bland-Altman plots were used to test the agreement between the two methods: US versus µCT/CBCT. RESULTS The reconstruction of the US palatal bone volumes was accurate based on surface topography comparison with a mean error of 0.19 mm for pre-defect and 0.15 mm and 0.09 mm for post-defect models of the two samples, respectively when compared with µCT volumes. A strong correlation (R2 ≥ 0.99) in measuring MPS expansion was found between US and µCT/CBCT with MADs of less than 0.05 mm, 0.11 mm and 0.23 mm for US, µCT and CBCT, respectively. CONCLUSIONS It was possible to axially image the MPS opening and rugae thickness accurately using high-frequency ultrasound. CLINICAL SIGNIFICANCE This study introduces an ionizing radiation-free, low-cost, and portable technique to accurately image a difficult part of oral cavity anatomy. The advantages of conceivable visualization could promise a successful clinical examination of MPS to support the predictable treatment outcome of maxillary transverse deficiency.
Collapse
Affiliation(s)
- Trang H Hoang
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kim-Cuong T Nguyen
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | | | - Maria Alexiou
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Thanh-Giang La
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | | | - Paul W Major
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Edmond H Lou
- Department of Electrical and Computing Engineering, University of Alberta, Edmonton, AB, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; School of Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada; Department of Physics, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
3
|
Tepedino M, Montaruli G, Esposito R, Akhilanand C, Lorusso M, Laurenziello M, Ciavarella D. Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls. Orthod Craniofac Res 2024; 27:455-464. [PMID: 38180289 DOI: 10.1111/ocr.12754] [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: 12/23/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.
Collapse
Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chaurasia Akhilanand
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| |
Collapse
|
4
|
Verplanken T, Vanroose R, Ureel M, Coopman R, Van Paepegem W. Numerical study of the impact of osteotomies and distractor location in surgically assisted rapid palatal expansion for transverse maxillary deficiency. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101916. [PMID: 38763267 DOI: 10.1016/j.jormas.2024.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION This paper employs finite element analysis to assess the biomechanical behavior of surgically assisted rapid palatal expansion (SARPE) with a bone-borne transpalatal distractor (TPD) by varying surgical parameters. MATERIAL AND METHODS Nine models were constructed to scrutinize the effects of pterygomaxillary disjunction (PMD), lateral osteotomy positioning, and TPD placement on displacement profiles and Von Mises stresses. These models encompassed variations such as no, unilateral or bilateral PMD, asymmetrical lateral osteotomy, and five TPD locations. RESULTS Performing a PMD reduces posterior resistance to transverse expansion, resulting in 10-20 % stress reduction around the maxillofacial complex. No significant changes in horizontal tipping were observed post-PMD. The asymmetric lateral osteotomy model exhibited larger displacements on the side with a more superiorly positioned osteotomy. Reduced stresses were observed at the maxillary body and medial pterygoid plate (superiorly), while increased stresses were observed at the medial (inferiorly) and lateral pterygoid plates. More posterior TPD placement facilitated more parallel expansion thus less horizontal tipping, albeit with increased vertical tipping. DISCUSSION SARPE procedures (distractor and osteotomy positions) can be tailored based on desired outcomes. PMD reduces stress within the maxillofacial complex but doesn't significantly affect tipping. Higher lateral osteotomies lead to increased displacements, more posterior distractors to more parallel expansion.
Collapse
Affiliation(s)
- Tomas Verplanken
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Robin Vanroose
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium.
| | - Matthias Ureel
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Wim Van Paepegem
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| |
Collapse
|
5
|
Jara SM, Thuler ER, Hutz MJ, Yu JL, Cheong CS, Boucher N, Evans M, Dedhia RC. Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study. Laryngoscope 2024; 134:1970-1977. [PMID: 37772955 PMCID: PMC10947985 DOI: 10.1002/lary.31060] [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: 10/07/2022] [Revised: 05/01/2023] [Accepted: 06/28/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. METHODS This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). RESULTS The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. CONCLUSION 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1970-1977, 2024.
Collapse
Affiliation(s)
- Sebastian M Jara
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Eric R Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael J Hutz
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jason L Yu
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Crystal S Cheong
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Normand Boucher
- Department of Orthodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Marianna Evans
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|
6
|
Bruni A, Abate A, Maspero C, Castroflorio T. Comparison of Mechanical Behavior of Clear Aligner and Rapid Palatal Expander on Transverse Plane: An In Vitro Study. Bioengineering (Basel) 2024; 11:103. [PMID: 38391589 PMCID: PMC10886082 DOI: 10.3390/bioengineering11020103] [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: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: This study aims to investigate, within a controlled laboratory environment, the magnitude of the transversal load and the force decay over time produced by clear aligners in comparison to a Rapid Palatal Expander (RPE). (2) Methods: Resin models of a dental maxillary arch, additively manufactured from an intraoral scan, were inserted in a testing machine with uniaxial load cells to measure the force trend over time expressed by RPE and clear aligners. The mechanical load was recorded during a certain timeframe for both appliances. (3) Results: The force expressed by the RPE ranged from 30 to 50 N for each activation, decreasing with a nonlinear pattern over time. The force expressed by the clear aligner ranged from 3 to 5 N, decreasing with a linear pattern over time. In contrast, the force generated by the clear aligner fell within the range of 3 to 5 N, showing a linear reduction in force magnitude over the observed period of time. (4) Conclusions: The RPE exerted a force magnitude approximately ten times greater than that generated by clear aligners. Nevertheless, it is essential to acknowledge that the oral environment can significantly influence these results. These limitations underscore the need for caution when applying these findings to clinical settings.
Collapse
Affiliation(s)
- Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16126 Genova, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | |
Collapse
|
7
|
Lim YN, Baharin F, Lin GSS, Hassan R, Tsai MH, Wei LC, Yeoh S, Ping MKX. Evaluation of the Changes of the Intercanine and Intermolar Widths Following Palatal Expansion in the Mixed Dentition Patients with Bilateral Posterior Crossbite: A Systematic Review. Dent J (Basel) 2023; 11:dj11020052. [PMID: 36826197 PMCID: PMC9955097 DOI: 10.3390/dj11020052] [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: 10/26/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
This systematic review aimed to identify the intercanine and intermolar width changes following palatal expansion in bilateral posterior crossbite (PXB) in mixed dentition. This review was registered in the PROSPERO database (CRD42021275833). All randomized controlled trials (RCT) and non-RCT articles between 1980 and August 2022 on the palatal expansion of bilateral PXB in mixed dentition were searched in seven online databases (Google Scholar, Ovid, Web of Science, Scopus, EBSCOHost, Cochrane Library and PubMed). The risk of bias (RoB) of the articles included was analyzed using the Joanna Briggs Institute (JBI) critical appraisal tool. Three non-RCT studies were included and showed a low risk of bias. Meta-analysis on the changes in intercanine and intermolar widths was not performed due to study design heterogeneity. One study reported an over-correction of the bilateral PXB. There is a need for more RCT studies with standardized landmark measurements, outcome assessment methods and retention periods to investigate the interdental changes following palatal expansion.
Collapse
Affiliation(s)
- Yen Nie Lim
- Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Malaysia
| | - Fadzlinda Baharin
- Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Malaysia
- Correspondence: ; Tel.: +60-9-767-5853
| | - Galvin Sim Siang Lin
- Department of Dental Materials, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Bedong 08100, Malaysia
| | - Rozita Hassan
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Malaysia
| | - Milton Hongli Tsai
- Discipline of Orthodontics, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
| | - Lim Chia Wei
- Taman Intan Dental Clinic, Ministry of Health Malaysia, Sungai Petani 08000, Malaysia
| | - Suzanne Yeoh
- Tudan Dental Clinic, Tudan Health Clinic, Ministry of Health Malaysia, Miri 98000, Malaysia
| | - Mark Ko Xiang Ping
- RTC Sibuti Dental Clinic, Bangunan RTC Sibuti, Ministry of Health Malaysia, Bekenu 98150, Malaysia
| |
Collapse
|
8
|
Alqahtani KA, Shaheen E, Morgan N, Shujaat S, Politis C, Jacobs R. Impact of orthognathic surgery on root resorption: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e260-e267. [PMID: 35477011 DOI: 10.1016/j.jormas.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR). MATERIAL AND METHODS An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools. RESULTS The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy. CONCLUSIONS The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.
Collapse
Affiliation(s)
- Khalid Ayidh Alqahtani
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Sattam bin Abdulaziz University, AlKharj, Saudi Arabia.
| | - Eman Shaheen
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nermin Morgan
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective. J Clin Med 2022; 11:jcm11175243. [PMID: 36079172 PMCID: PMC9457357 DOI: 10.3390/jcm11175243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.
Collapse
|
10
|
Ngan P, Song J, Xiang J, He H, Martin CA, Weaver B. Changes in the nasal and pharyngeal airway volume with miniscrew-assisted rapid palatal expansion appliances. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_175_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The purpose of this study was to assess the volumetric changes in the nasal and pharyngeal airway volume in patients with maxillary transverse deficiency treated with miniscrew-assisted rapid palatal expansion (MARPE) appliances.
Material and Methods:
The pre- and post-treatment cone-beam computed tomography scans of 20 subjects who underwent treatment with the MARPE appliance as part of their orthodontic treatment were included in the study. Pre- and post-expansion airway volume measurements of the nasal cavity, nasopharynx, and oropharynx were measured. Linear measurements of the skeletal structures surrounding the nasal cavity were taken to assess the pattern of airway expansion. Paired t-tests were used to evaluate nasal and pharyngeal airway volume changes with expansion. Pearson correlation test was utilized to assess the relationship between nasal and pharyngeal volume changes.
Results:
A total of 17 out of 20 samples had a successful split of the mid-palatal sutures. A significant increase in nasal airway volume (12.0%) was found post-expansion. In addition, a significant increase in linear measurements of the nasal cavity base width in the frontal plane (7.1%) and both the anterior and posterior widths in the transverse dimension (9.4% and 3.4%, respectively) were found. Significant positive correlations were found between airway volumes and increase in width of the maxillary expansion appliance.
Conclusion:
The effects of maxillary expansion with a MARPE appliance include an increase in nasal cavity volume, but not the nasopharyngeal and the oropharyngeal airway volume. The nasal cavity expands in a triangular pattern in both the frontal and transverse dimensions following orthopedic expansion with the MARPE appliance. Increase in airway volume is a result of the increase in width of the maxillary expansion appliance.
Collapse
Affiliation(s)
- Peter Ngan
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Joanna Song
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Jun Xiang
- Department of Family Medicine, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Hong He
- Department of Stomatology, Wuhan University School of Stomatology, Wuhan, China,
| | - Chris A. Martin
- Department of Orthodontics, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| | - Bryan Weaver
- Department of Oral and Maxillofacial Surgery, Health Sciences Center, West Virginia University, Morgantown, West Virginia, United States,
| |
Collapse
|
11
|
Farzan A, Khaleghi K, Pirayesh Z. Effect of Low-Level Laser Therapy on Bone Formation in Rapid Palatal Expansion: A Systematic Review. J Lasers Med Sci 2022; 13:e13. [PMID: 35996494 PMCID: PMC9392875 DOI: 10.34172/jlms.2022.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/02/2022] [Indexed: 11/09/2023]
Abstract
Introduction: Crossbite is a common malocclusion with a 7-23% prevalence rate. Treatment is based on the expansion of the mid-palatal suture (MPS) with Rapid Palatal Expansion(RPE) followed by a retention period to reach new bone maturation, enough to maintain the results stable. This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in increasing bone formation in MPS. Methods: This article was written by the PRISMA checklist. Electronically, 3 databases, namely PubMed, Scopus, and Embase, were searched with the keywords selected based on PICO. Time (2010-2021) and language restrictions were performed. Results: 528 articles, out of which 374 studies were screened, were found, and 9 full-text articles were subsequently included considering these inclusion criteria: randomized clinical trial (RCT) that examines the efficacy of LLLT in rapid palatal expansion (RPE), age under 15 years, non-surgical RPE with a tooth-supported appliance, and low-intensity laser application. Finally, 4 articles were appraised by Cochrane version 5.2.0 with 7 domains. 3 of 4 articles showed LLLT has a significant impact on bone formation. One of them showed no significant difference in pain perception and bone density between the laser and non-laser groups. Conclusion: While many studies have assessed the effect of LLLT on bone formation in animal models, high-quality clinical trials are missing in this regard. The available clinical trials suggest a positive effect of LLLT on sutural bone formation after RPE.
Collapse
Affiliation(s)
- Arash Farzan
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Katayoon Khaleghi
- School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zeynab Pirayesh
- Dental Student, Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
12
|
Rabah N, Al-Ibrahim HM, Hajeer MY, Ajaj MA, Mahmoud G. Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial. Cureus 2022; 14:e22793. [PMID: 35261839 PMCID: PMC8893008 DOI: 10.7759/cureus.22793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to evaluate and compare the levels of pain, discomfort, and functional impairments between slow and rapid maxillary expansion (RME) in treating skeletal maxillary constriction in the adolescence period (i.e., between 12 and 16 years). Materials and methods The study sample consisted of 52 patients (21 males and 31 females) with maxillary skeletal constriction in the posterior region. The patients were randomly distributed into either RME (26 patients, with a mean age of 13.87 (± 1.31) years) or slow maxillary expansion group (SME, 26 patients, with a mean age of 14.31 (± 1.19) years). The levels of pain, discomfort, and functional difficulties were assessed after 24 hours (T1), 7 days (T2), 15 days (T3), one month (T4), and four months (T5) following the onset of the expansion procedure. Results Patients in the RME group encountered significantly greater levels of pain and discomfort than those in the SME group at T1, T2, and T3 (p>0.001). Chewing and swallowing difficulties were significantly greater in the RME group at T1, T2, T3, and T4 (P≤0.001). The pressure on soft tissue was greater in the RME group at T2 and T3 (p>0.001). After four months (T5), the levels of pain and discomfort decreased to their lowest levels, as well as the difficulties of chewing and swallowing, and the pressure on soft tissue were almost non-existent in both groups. Conclusion Patients treated with the removable slow maxillary expander reported lower levels of pain and discomfort, fewer chewing and swallowing difficulties, and less pressure on soft tissues than those treated with the bonded rapid maxillary expander. These difficulties gradually decreased over time in both groups. The lower levels of pain and discomfort may make the SME an effective and comfortable treatment alternative for adolescents with skeletal maxillary constriction.
Collapse
Affiliation(s)
- Nancy Rabah
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Heba M Al-Ibrahim
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Mohammad Y Hajeer
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Mowaffak A Ajaj
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| | - Ghiath Mahmoud
- Department of Orthodontics, University of Damascus Faculty of Dentistry, Damascus, SYR
| |
Collapse
|
13
|
Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:4509-4523. [PMID: 35211817 DOI: 10.1007/s00784-022-04415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency. MATERIALS AND METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99). CONCLUSIONS MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination. REGISTRATION This study is registered with PROSPERO, CRD42021256750. CLINICAL RELEVANCE MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.
Collapse
|
14
|
Rapid maxillary expansion supplementary methods: A scoping review of animal studies. Int Orthod 2022; 20:100614. [PMID: 35153159 DOI: 10.1016/j.ortho.2022.100614] [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: 10/24/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Maxillary constriction is a relatively common condition. Various treatment modalities have been proposed for this condition such as rapid maxillary expansion (RME). Although RME can significantly expand the suture in a relatively short period of time, it has a number of drawbacks, mainly a lengthy retention period. The primary objective of this study was to assess the efficacy of the supplementary methods used in conjunction with RME for new bone formation (NBF) at the midpalatal suture (MPS). Relapse, bone healing, and root resorption were also studied as the secondary outcomes. MATERIALS AND METHODS The PubMed, Embase, and Cochrane library online databases were searched according to the PRISMA-ScR guideline. Animal studies on the effects of non-surgical supplementary methods other than laser therapy on NBF in RME were included and reviewed. RESULT Thirty-eight articles met the inclusion criteria. The supplementary methods were categorized into 6 groups: hormones, chemical agents, drugs, vitamins, proteins, and some other substances, which could not be assigned to any group. All the aforementioned substances enhanced NBF. Drugs such as bisphosphonates also increased bone resorption. The oestrogen hormone was shown to reduce treatment relapse. Lastly, stem cell application accelerated bone healing at the expanded MPS. CONCLUSION Administration of hormones, chemical agents, drugs, vitamins, herbs, and proteins may improve the outcomes of RME, shorten the retention period and consequently, reduce relapse in animals. However, the generalizability of these findings is limited due to the insubstantial number of studies published on each substance.
Collapse
|
15
|
Feştilă D, Enache AM, Nagy EB, Hedeşiu M, Ghergie M. Testing the Accuracy of Pont’s Index in Diagnosing Maxillary Transverse Discrepancy as Compared to the University of Pennsylvania CBCT Analysis. Dent J (Basel) 2022; 10:dj10020023. [PMID: 35200248 PMCID: PMC8871275 DOI: 10.3390/dj10020023] [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: 11/20/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Assessment of maxillary transverse discrepancy requires an accurate tool in order to implement the appropriate treatment plan. Aim: To evaluate the accuracy of Pont’s Index in confirming a transverse maxillary deficiency by comparing its results with the corresponding results yielded by the University of Pennsylvania CBCT analysis. Material and methods: The study was performed on dental casts and CBCT’s of 60 randomly selected patients by adopting a cluster sampling method. The results of Pont’s Index and University of Pennsylvania CBCT analysis were analyzed through McNemar’s test using Excel Data Analysis, and the accuracy indicators for Pont’s Index were computed using MedCalc Ltd. Results: Mc Nemar’s test revealed a p-value of 0.85. The accuracy indicators of Pont’s Index were: sensitivity: 69%; specificity: 16.6%; positive predictive value: 65%; negative predictive value: 18.75%; positive likelihood ratio: 0.83; negative likelihood ratio: 1.86; and accuracy: 53.28%. Conclusion: Due to the fact that CBCT is not used on a daily basis and Pont’s Index has a relatively high sensitivity (69%) making it suitable to detect patients with a narrow maxilla, assessment of the maxillary deficiency on CBCT can be recommended for cases were the midpalatal suture maturation should be evaluated.
Collapse
Affiliation(s)
- Dana Feştilă
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
| | - Aurelia Magdalena Enache
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, “C. Davilla” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (A.M.E.); (E.B.N.)
| | - Evelyn Beatrix Nagy
- B-Line Dent, Str. Observatorului nr. 7 ap. 35, 400500 Cluj-Napoca, Romania
- Correspondence: (A.M.E.); (E.B.N.)
| | - Mihaela Hedeşiu
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
| | - Mircea Ghergie
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Medicine, University of Medicine and Pharmacy “Iuliu Haţieganu”, 400349 Cluj-Napoca, Romania; (D.F.); (M.H.); (M.G.)
| |
Collapse
|
16
|
Bin Dakhil N, Bin Salamah F. The Diagnosis Methods and Management Modalities of Maxillary Transverse Discrepancy. Cureus 2021; 13:e20482. [PMID: 35047300 PMCID: PMC8760022 DOI: 10.7759/cureus.20482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/15/2022] Open
Abstract
Transverse deficiency of the maxilla (TDM) is the most common skeletal change that involves the maxilla. The craniofacial skeletal assessment as early as possible is critical, as the early diagnosis of TDM influences the effectiveness of treatment. Methods for treating TDM have been reported since the mid-19th century and continue to evolve. This article puts forward a literature review on the topic, investigating the diagnosis and management of TDM, as well as stability after surgical and nonsurgical interventions. We conducted a literature search using a logical combination of the terms “palatal extension,” “maxillary transverse deficiency,” “diagnosis,” and “management.” More recent approaches include three-dimensional imaging, which has allowed for accurate depictions of the craniofacial region to be examined, allowing for evaluation of the spatial relationships between the jaw elements. The success of nonsurgical management compared to surgical management depends on the growth stage of the patient. Unfortunately, data comparing the stability of surgical and nonsurgical management is still lacking. However, for surgical intervention, surgically assisted palatal expansion (SARPE) appears to be the appropriate choice, especially when a large expansion is needed.
Collapse
|
17
|
Lopponi G, Maino BG, Dalessandri D. Rapid Palatal Expansion Should Not Be Trivialized: Two Case Reports of Unexpected Complications. Eur J Dent 2021; 15:599-605. [PMID: 34171932 PMCID: PMC8382503 DOI: 10.1055/s-0041-1728840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Rapid maxillary expansion is one of the most common orthodontic procedures performed in the pediatric population, easy to accomplish and compliance free, therefore really effective. Nevertheless, a careful diagnosis and frequent clinical follow-up appointments are necessary during the first weeks of active treatment. The purpose of this article was to report two cases of unexpected complications during orthopaedic maxillary expansion, involving two 7-year-old female patients, one presenting a saddle nose with suborbital hematoma and the other one an asymmetric palatal expansion. In both cases, the clinical situation progressively relapsed during the months following expansion appliance removal.
Collapse
Affiliation(s)
- Gaia Lopponi
- Department of Endodontics, University of Florence, Firenze, Italy.,Department of Orthodontics, University of Cagliari, Cagliari, Italy
| | - Bortolo Giuliano Maino
- Postgraduate Orthodontic School, Ferrara University, Ferrara, Italy.,Private Practice of Orthodontics, Vicenza, Italy
| | - Domenico Dalessandri
- School of Dentistry, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
18
|
Barillas AP, Michelogiannakis D, Rossouw PE, Javed F. Maxillary expansion in grafted alveolar arches in patients with cleft lip and palate: A literature review. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
Collapse
Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|
20
|
Nowak R, Olejnik A, Gerber H, Frątczak R, Zawiślak E. Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion-A Finite Element Analysis (FEA) Study. MATERIALS 2021; 14:ma14051152. [PMID: 33804454 PMCID: PMC7957660 DOI: 10.3390/ma14051152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
The aim of this study was to compare the reduced stresses according to Huber’s hypothesis and the displacement pattern in the region of the facial skeleton using a tooth- or bone-borne appliance in surgically assisted rapid maxillary expansion (SARME). In the current literature, the lack of updated reports about biomechanical effects in bone-borne appliances used in SARME is noticeable. Finite element analysis (FEA) was used for this study. Six facial skeleton models were created, five with various variants of osteotomy and one without osteotomy. Two different appliances for maxillary expansion were used for each model. The three-dimensional (3D) model of the facial skeleton was created on the basis of spiral computed tomography (CT) scans of a 32-year-old patient with maxillary constriction. The finite element model was built using ANSYS 15.0 software, in which the computations were carried out. Stress distributions and displacement values along the 3D axes were found for each osteotomy variant with the expansion of the tooth- and the bone-borne devices at a level of 0.5 mm. The investigation showed that in the case of a full osteotomy of the maxilla, as described by Bell and Epker in 1976, the method of fixing the appliance for maxillary expansion had no impact on the distribution of the reduced stresses according to Huber’s hypothesis in the facial skeleton. In the case of the bone-borne appliance, the load on the teeth, which may lead to periodontal and orthodontic complications, was eliminated. In the case of a full osteotomy of the maxilla, displacements in the buccolingual direction for all the variables of the bone-borne appliance were slightly bigger than for the tooth-borne appliance.
Collapse
Affiliation(s)
- Rafał Nowak
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
- Correspondence: ; Tel.: +48-71-734-3600
| | - Anna Olejnik
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
| | - Hanna Gerber
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
| | - Roman Frątczak
- NOBO Solutions S.A., Al. Kasztanowa 3A-5, 53-125 Wrocław, Poland;
| | - Ewa Zawiślak
- Department of Maxillofacial Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (A.O.); (H.G.); (E.Z.)
| |
Collapse
|
21
|
Pirmoradian M, Safiaghdam H, Nokhbatolfoghahaei H, Ashnagar S, Fekrazad R. Effect of Photobiomodulation on Relapse in an Experimental Rapid Maxillary Expansion Model in Rat. Photochem Photobiol 2020; 97:634-640. [PMID: 33294968 DOI: 10.1111/php.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
Rapid maxillary expansion (RME) is performed on transversely deficient maxilla. As all orthodontic treatments, retention is important in maintaining therapeutic outcomes. Fixed /removable retainers are used post-RME causing hygiene and compliance problems. Given photobiomodulation's positive effects on the quantity and quality of bone regeneration, its effect on post-RME relapse was studied. Thirty Sprague Dawley rats were randomly divided into group R, non-irradiated RME-treated (n = 12), group P, irradiated RME-treated (n = 12) and group C, non-RME non-irradiated (n = 6). A 1.5 mm metal ring inserted between maxillary incisors at days 0 and 15 was expanded until 1.5 mm space was obtained at day 30. In group P, Ga-Al-As diode laser (810 nm, 100 mW, 4J/cm2 , 30 secs) was applied on days 0, 2, 4, 6, 8, 10, 12 and 14 as predictor variable. The relapse was measured as the space lost between incisors for 30 days after appliance removal (primary outcome variable) and compared with t-test. In week 2, space loss in group P was significantly lower (P < 0.05) than all other groups. The relapse during weeks 2 and 3 was significantly lower in group P than group R. However, no significant difference in relapse amount was found between groups during first and fourth week. There was a significant difference (P < 0.05) between groups in relapse rates (secondary outcome variable) but not in total relapse after 4 weeks. Photobiomodulation proved beneficial in resisting relapse in our study, and it is suggested to be continued until the end of expansion.
Collapse
Affiliation(s)
- Maryam Pirmoradian
- Department of Dental Biomaterials, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hannaneh Safiaghdam
- Student Research Commitee, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Nokhbatolfoghahaei
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, Aja University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| |
Collapse
|
22
|
Sun J, Eleniste PP, Utreja A, Turkkahraman H, Liu SSY, Bruzzaniti A. Pyk2 deficiency enhances bone mass during midpalatal suture expansion. Orthod Craniofac Res 2020; 23:501-508. [PMID: 32562339 DOI: 10.1111/ocr.12402] [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: 03/07/2020] [Revised: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine if Pyk2 deficiency increases midpalatal suture bone mass and preserves sutural integrity after maxillary expansion. SETTING AND SAMPLE Thirty-six male Pyk2 knockout (KO) and control (WT) mice at 6 weeks of age. MATERIALS AND METHODS Mice received nickel-titanium spring expanders delivering 0 g (no intervention control), 10 or 20 g force for 14 days. High-resolution micro-CT was used to determine bone volume/tissue volume (BV/TV), sutural width and intermolar width. Effects on osteoclasts, chondrocytes and suture morphology were determined by histomorphometry. RESULTS Pyk2-KO controls (0 g) had 7% higher BV/TV compared with WT controls. Expanded Pyk2-KO maxillae also exhibited 12% (10 g) and 18% (20 g) higher BV/TV than WT mice. Although bone loss following expansion occurred in both genotypes, BV/TV was decreased to a greater extent in WT maxillae (-10% at 10g; -22% at 20 g) compared with Pyk2-KO maxillae (-11% only at 20 g). Expanded WT maxillae also showed a greater increase in sutural width, intermolar width and fibrous connective tissue width compared with expanded Pyk2-KO maxillae. Moreover, osteoclast number was increased 77% (10 g) and 132% (20 g) in expanded WT maxillae, but remained unchanged in expanded Pyk2-KO, compared to their respective controls. Cartilage area and chondrocyte number were increased to the same extent in expanded WT and Pyk2-KO sutures. CONCLUSIONS These findings suggest that midpalatal suture expansion increases osteoclast formation in WT but not Pyk2-KO mice, leading to higher BV/TV in expanded Pyk2-KO maxillae. These studies suggest Pyk2-targeted strategies may be beneficial to increase bone density and preserve sutural integrity during maxillary expansion.
Collapse
Affiliation(s)
- Jun Sun
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Pierre P Eleniste
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Achint Utreja
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Hakan Turkkahraman
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Sean Shih-Yao Liu
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Angela Bruzzaniti
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| |
Collapse
|
23
|
Fox GC, Jones TA, Wilson JM, Claro WI, Williams RA, Trojan TM, Al Dayeh A. Sutural loading in bone‐ versus dental‐borne rapid palatal expansion: An ex vivo study. Orthod Craniofac Res 2020; 23:419-426. [DOI: 10.1111/ocr.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Gavin C. Fox
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Thomas A. Jones
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - John M. Wilson
- College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Wanda I. Claro
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Richard A. Williams
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Terry M. Trojan
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| | - Ayman Al Dayeh
- Department of Orthodontics College of Dentistry University of Tennessee Health Science Center Memphis TN USA
| |
Collapse
|
24
|
Alyessary AS, Othman SA, Yap AUJ, Radzi Z, Rahman MT. Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review. Int Orthod 2019; 17:12-19. [PMID: 30732977 DOI: 10.1016/j.ortho.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. MATERIALS AND METHODS An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. RESULTS The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. CONCLUSIONS Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.
Collapse
Affiliation(s)
- Akram S Alyessary
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia; Karbala University, College of dentistry, Department of Orthodontics, Karbala, Iraq.
| | - Siti A Othman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Adrian U J Yap
- National University Health System, Ng Teng Fong General Hospital, Department of Dentistry, Singapore, Singapore; University of Malaya, Faculty of Dentistry, Department of Restorative Dentistry, Kuala Lumpur, Malaysia
| | - Zamri Radzi
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| | - Mohammad T Rahman
- University of Malaya, Faculty of Dentistry, Department of Paediatric Dentistry and Orthodontics, Kuala Lumpur, Malaysia
| |
Collapse
|
25
|
Pattanaviriyapisan C, Charoemratrote C, Thongudomporn U. Controlled Molar Inclination during Maxillary Dental Expansion Using a Straight Rectangular Archwire. APOS TRENDS IN ORTHODONTICS 2018. [DOI: 10.4103/apos.apos_70_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose
The purpose of this study was to examine whether the amount of transversal dental expansion, controlled using a straight rectangular beta-titanium alloy (TMA®) wire, has an influence on changes in maxillary first molar inclination.
Materials and Methods
Twenty patients requiring bilateral maxillary dental arch expansion were treated using a 0.018”-slot preadjusted edge-wise fixed appliance. Once leveled and aligned, the maxillary dental arches were expanded using a 0.016” × 0.022” straight TMA® wire. Changes in arch width and maxillary first molar inclination were assessed before (T0) and after (T1) expansion using three-dimensional scanned models. Mann–Whitney U-test, Wilcoxon signed-rank test, and Kruskal–Wallis test were used, where appropriate, to compare changes between and within groups.
Results
Intermolar width expanded at a rate of 0.8 ± 0.3 mm/month, and first molar buccal crown tipping occurred at 2.1° ± 1.2° (P < 0.05). Changes in inclination between minor expansion (1.0–2.5 mm) and moderate expansion (2.6–4.0 mm) groups were not statistically significant (1.8 ± 0.5 vs. 2.2 ± 1.2; P > 0.05).
Conclusions
Use of a straight rectangular TMA® wire in conjunction with a fixed orthodontic appliance successfully expanded the maxillary dental arch. The amount of expansion had no effect on molar inclination.
Collapse
Affiliation(s)
- Chanchai Pattanaviriyapisan
- Department of Preventive Dentistry, Faculty of Dentistry, Orthodontic Section, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chairat Charoemratrote
- Department of Preventive Dentistry, Faculty of Dentistry, Orthodontic Section, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Udom Thongudomporn
- Department of Preventive Dentistry, Faculty of Dentistry, Orthodontic Section, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|