Clinical Insights Into Addressing Constricted Maxillary Arch in Angle's Class II Malocclusion: A Case Report

The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

Analysis of the Influence of Breastfeeding and Bottle-Feeding upon the Origin of Posterior Crossbites

(1) Introduction. An analysis was made of posterior crossbites in deciduous dentition and their relation to the type of feeding received by the child, with the objective of determining the influence of the way in which the child is fed in the early stages of life on the development of posterior crossbites. (2) Material and methods. A total of 1401 preschool children between 3 and 6 years of age from Seville (Spain) were included in the study. An intraoral exploration was carried out to assess the presence of crossbites (uni- or bilateral, and functional or not). The study was completed with a parent or legal guardian questionnaire exploring the type of feeding received by the child in the first stages of life, as well as the presence of bad oral habits and their duration. (3) Results. A total of 276 children (19.7%) presented posterior crossbite in occlusion. Uponn centering the midlines, 197 were maintained, indicating that 79 were due to premature contacts (functional crossbites). There were no significant differences in crossbites among the children who had received breastfeeding, though bottle-feeding was seen to favor crossbite. (4) Conclusions. No statistically significant relationship was found between posterior crossbites and breastfeeding, though an association between posterior crossbites and bottle-feeding was observed, with the number of crossbites increasing with the duration of bottle-feeding.

Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis

When treating posterior crossbite, the primary goal is to achieve long-term crossbite correction. The majority of studies however focus on relapse of the increase in the transverse dimension, but not relapse of the crossbite itself, which is an essential outcome. The aim of the present study was to determine long-term stability (2 years minimum post-treatment) of posterior crossbite correction, treated in mixed or early permanent dentitions of growing children. Following registration in PROSPERO (CRD42022348858), an electronic literature search including PubMed, Embase, Web of Science, the Cochrane Library, and a manual search were conducted up to January 2023, to identify longitudinal studies looking into the long-term stability of crossbite correction in growing children. Data extraction and risk of bias assessment were carried out, and subsequently, a random-effects meta-analyses models were used to calculate estimates for relapse of the crossbite and relapse at the transverse level. Twenty-two studies were included, of varying designs and quality, representing 1076 treated patients, with different expansion appliances and protocols. Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up. At the transverse level, 19.3% of the total expansion (including overexpansion) relapsed (95% CI: 13%; 27%) regardless of whether there a was relapse of the crossbite itself. Data from existing studies, with a moderate level of evidence, indicate that the long-term stability of posterior crossbite correction in growing children is unfavourable in roughly 1 in 5 growing children, with crossbite relapse long-term. On average, 19% of the maxillary expansion performed (including overexpansion) relapses long-term, which may occur in cases with or without relapse of the crossbite.

Osteochondroma of the Mandibular Condyle: A Rare Case Presentation With Literature Review

Osteochondromas (OCs) are benign bone tumors characterized by their growth with a cartilage cap and typically occurring at the ends of long bones. Their occurrence in the head and neck region is infrequent, accounting for only around 1% of head and neck tumors. Notably, the mandibular coronoid process and the mandibular condyle are the primary sites where an OC is reported. Patients often exhibit facial asymmetry, limited mouth opening, and malocclusion. Possible treatment options depending on the condition include partial or total condylectomy, vertical ramus osteotomy, and supplementary orthognathic surgery. The recurrence rate of under 1%- 2% is reported after local resection.  In this case report, we present a unique case of an OC in a 27-year-old woman. It involved the mandibular condyle, resulting in a left-sided mouth deviation while opening and closing her mouth. The purpose of this article is to detail the clinical and radiographic features, histopathological aspects, and treatment strategies and differentiate potential diagnoses, for such OCs.

The Facial Characteristics of Individuals with Posterior Crossbite: A Cross-Sectional Study

Facial morphology is known to be influenced by genetic and environmental factors. Scientific evidence regarding facial parameters in patients with posterior crossbite is lacking. This study aimed to investigate the association between posterior crossbite and facial parameters. This cross-sectional study included 34 adolescents with and 34 adolescents without posterior crossbite in the age range from 13 to 15 years. Facial surface scans were acquired with a 3dMD imaging system, and landmark-based analysis was performed. Data were analyzed using the Mann-Whitney U test and Spearman's correlations. Individuals in the control group had lower face heights (females: p = 0.003, r = 0.45; males: p = 0.005, r = 0.57). The control group females presented with smaller intercanthal width (p = 0.04; r = 0.31) and anatomical nose width (p = 0.004; r = 0.43) compared with the crossbite group females. The males in the control group had wider nostrils. In the control group, significant correlations among different facial parameters were more common, including the correlations between eye width and other transversal face measurements. On the contrary, the facial width was correlated with nasal protrusion (r = 0.657; p < 0.01) and the morphological width of the nose (r = 0.505; p < 0.05) in the crossbite group alone. In both groups, the philtrum width was linked with the anatomical and morphological widths of the nose. Conclusions: Patients with posterior crossbites have increased face height and different patterns of facial proportions compared with individuals without crossbites.

A Correlation Analysis between Arch Width and Molar Inclination Using Cone-Beam Computed Tomography Transverse Measurements: A Cross-Sectional Study

A new era in 3-dimensional analysis has begun with the use of cone-beam computed tomography (CBCT) in orthodontics, which promises to provide a more thorough understanding of the craniofacial skeletal architecture. This study aimed to investigate the correlation between the transverse basal arches discrepancy and dental compensation by utilizing CBCT width analysis. An observational study was conducted to retrospectively review 88 CBCT scans of patients presented to dental clinics from 2014 to 2020 obtained from the Planmeca Romexis x-ray system at three centers. Dental compensation data across normal and narrow maxillae were analyzed and a Pearson correlation was used to find the relationship between molar inclination and width difference. Significant maxillary molar compensation differences were observed between the normal maxilla and narrow maxilla group, where the amount of dental compensation (164.73 ± 10.15) was higher in the narrow maxilla group. A significant negative correlation (r = -0.37) was observed between width difference and maxillary molar inclination. Maxillary molars were tipped buccally to compensate for the reduced maxillary arch width. These findings are important to determine the amount of needed maxillary expansion taking into account the buccal inclination while treating cases.

Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial

Objective

This study aimed to evaluate and compare the levels of pain, discomfort, and functional impairments between slow and rapid maxillary expansion (RME) in treating skeletal maxillary constriction in the adolescence period (i.e., between 12 and 16 years).

Materials and methods

The study sample consisted of 52 patients (21 males and 31 females) with maxillary skeletal constriction in the posterior region. The patients were randomly distributed into either RME (26 patients, with a mean age of 13.87 (± 1.31) years) or slow maxillary expansion group (SME, 26 patients, with a mean age of 14.31 (± 1.19) years). The levels of pain, discomfort, and functional difficulties were assessed after 24 hours (T1), 7 days (T2), 15 days (T3), one month (T4), and four months (T5) following the onset of the expansion procedure.

Results

Patients in the RME group encountered significantly greater levels of pain and discomfort than those in the SME group at T1, T2, and T3 (p>0.001). Chewing and swallowing difficulties were significantly greater in the RME group at T1, T2, T3, and T4 (P≤0.001). The pressure on soft tissue was greater in the RME group at T2 and T3 (p>0.001). After four months (T5), the levels of pain and discomfort decreased to their lowest levels, as well as the difficulties of chewing and swallowing, and the pressure on soft tissue were almost non-existent in both groups.

Conclusion

Patients treated with the removable slow maxillary expander reported lower levels of pain and discomfort, fewer chewing and swallowing difficulties, and less pressure on soft tissues than those treated with the bonded rapid maxillary expander. These difficulties gradually decreased over time in both groups. The lower levels of pain and discomfort may make the SME an effective and comfortable treatment alternative for adolescents with skeletal maxillary constriction.

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study

INTRODUCTION

Children born very preterm have an immature sucking reflex at birth and are exposed to neonatal care that can impede proper palate growth.

OBJECTIVES

We aimed to describe the frequency of high-arched palate and posterior crossbite at the age of 5 in children born very preterm and to identify their respective risk factors.

METHODS

Our study was based on the data from EPIPAGE-2, a French national prospective cohort study, and included 2,594 children born between 24- and 31-week gestation. Outcomes were high-arched palate and posterior crossbite. Multivariable models estimated by generalized estimation equations with multiple imputation were used to study the association between the potential risk factors studied and each outcome.

RESULTS

Overall, 8% of children born very preterm had a high-arched palate and 15% posterior crossbite. The odds of high-arched palate were increased for children with low gestational age (24-29 vs. 30-31 weeks of gestation) [adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.17, 2.66], thumb-sucking habits at the age of 2 (aOR 1.53, 95% CI 1.03, 2.28), and cerebral palsy (aOR 2.18, 95% CI 1.28, 3.69). The odds of posterior crossbite were increased for children with pacifier-sucking habits at the age of 2 (aOR 1.75, 95% CI 1.30, 2.36).

CONCLUSIONS

Among very preterm children, low gestational age and cerebral palsy are the specific risk factors for a high-arched palate. High-arched palate and posterior crossbite share non-nutritive sucking habits as a common risk factor. The oro-facial growth of these children should be monitored.

Three-dimensional morphological and positional analysis of the temporomandibular joint in adults with posterior crossbite: A cross-sectional comparative study

OBJECTIVES

The purpose of this study was to three-dimensionally (3D) evaluate the morphological and positional features of the temporomandibular joint (TMJ) in adults with unilateral and bilateral posterior crossbite compared with aligned control subjects.

MATERIALS AND METHODS

This cross-sectional comparative study analysed cone beam computed tomography (CBCT) images of 90 adult subjects' divided into three equal groups: bilateral posterior crossbite (BCG), unilateral posterior crossbite (UCG) and control group (CG). 3D measurements of the TMJ included the following: (a) position, angulation and inclination of the mandibular condyles; (b) centralisation of the condyles in their respective mandibular fossae; and (c) volumetric measurements of the TMJ spaces. Intra- and intergroup differences were identified using the paired Student's t test and an analysis of variance (ANOVA) followed by Tukey's post hoc test, respectively.

RESULTS

Regarding the intra-group side-based comparisons, there were significant differences in the anterior and superior joint spaces and the anteroposterior condylar joint position in the UCG. Intergroup comparisons revealed significant differences in the vertical condylar inclination, medial condylar position, condylar width and height, and volumetric joint space between the unaffected side of the UCG and left sides of the other groups. There were significant differences in the anteroposterior condylar inclination, medial condylar position, condylar width and height, anterior, posterior, superior and volumetric joint spaces, and anteroposterior condylar joint position between the crossbite side of the UCG and the right sides of the other groups.

CONCLUSION

Skeletal crossbite accompanied with characteristic morphological and positional TMJ features associated with unilateral posterior crossbite and are associated with side-specific TMJ asymmetry.

Oral findings and craniofacial morphology in a patient with Schwartz-Jampel syndrome and severe obstructive sleep apnea: A case report

We reported dental and craniofacial characteristics of an SJS patient with severe OSA. Not only does the syndrome cause skeletal abnormalities and myotonia, but it also affects the craniofacial development resulting in a severe constriction of maxillary arch and bimaxillary retrognathia which may increase a risk to develop pediatric OSA.

Effects of Rapid Palatal Expansion on Chewing Biomechanics in Children with Malocclusion: A Surface Electromyography Study

Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles' activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope's peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle's activation patterns comparable to healthy subjects for both T and M.

Modified Haas Expander for the Treatment of Anterior Openbite and Posterior Crossbite Associated with Thumb Sucking-A Case Report: 3-Years Follow-Up

Thumb sucking is an abnormal habit that occurs in childhood and can cause several malocclusions if it persists for a long time. Malocclusions caused by oral habits require proper treatment timing to maintain a normal growth and should be treated at an early age. This case report shows the management of thumb sucking and early correction of anterior open bite and posterior crossbite by a modified Haas expander. Three-year follow-up results showed the effectiveness of this special designed appliance.

Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta-analyses

BACKGROUND

Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue.

OBJECTIVES

This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs.

METHODS

Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2).

RESULTS

Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function.

CONCLUSION

Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.

Comparison of effectiveness of quad helix appliance with other slow maxillary expanders in children with posterior crossbite: A systematic review

OBJECTIVE

The present review was conducted to compare the effectiveness of Quad Helix (QH) appliance with other slow maxillary expanders in children with posterior crossbite.

MATERIALS AND METHODS

Randomized controlled clinical trials and retrospective studies published between January 1, 1995, and December 31, 2016, were identified from MEDLINE, the Cochrane Central Register of Controlled Trials, the National Institutes of Health Trials, Clinical Trials Registry India, Google Scholar and major journals. After a comprehensive search, the articles were independently screened for eligibility by two reviewers. All cross-reference lists of the selected studies were screened for any additional papers.

RESULTS

The preliminary screening consisted of 608 articles, of which 33 articles were selected. A final total of only 9 articles were included as they met the inclusion and exclusion criteria. Of the nine papers, four articles clearly state that QH appliance was a more effective appliance, while the remaining five studies suggest that the maxillary expansion caused by QH is comparable to other slow maxillary expansion appliances. Of the nine included articles, four articles also describe the complications of QH in comparison to other slow maxillary expansion devices.

CONCLUSION

The QH appliance is a viable alternative for the correction of posterior crossbite. The QH appliance is comparable to or even better than other slow maxillary expanders in terms of maxillary expansion while being cost-effective with very few complications.

Simultaneous correction of functional posterior cross bite and midline shift

The most frequent cause of functional posterior crossbite is the reduction in width of the maxillary dental arch. This posterior crossbite is associated with anterior crowding which is presented as an infrapositioned canine or a palatally positioned lateral incisor on one side; this leads to an upper midline shift toward the crowded side. The present case report shows the management of posterior crossbite with functional shift and upper midline shift simultaneously without adverse side effects. In this case, rapid maxillary expansion along with fixed appliance is used to correct posterior crossbite with the upper dental midline shift using reciprocal action of elastic transseptal fibers.