Evaluation of palate-related factors of the effectiveness of microimplant-assisted rapid palatal expansion in late adolescents and adults

In-silico evaluation of orthodontic miniscrew-assisted rapid palatal expanders for patients with various stages of skeletal maturation

INTRODUCTION

This study aimed to use a finite element method to assess the stress on the miniscrews, skeletal and dental changes resulting from maxillary expansion using either a tooth-bone-borne (TBB) or a bone-borne (BB) device on patients with various skeletal maturation.

METHODS

Two types of expanders were modeled using SolidWorks. The design of the 2 expanders was similar, with the exception that the BB appliance lacked support for teeth (rods and bands). Both were placed on the palatal bones with the help of 4 miniscrews as bony anchorage. Five skeletal maturation stages were examined using suture maturation classification by Angelieri. A lateral displacement of 0.2 mm was applied to simulate 1 turn of jackscrew per day. The dental and skeletal changes from the treatment were quantified.

RESULTS

Stage A sutural maturation exhibited the greatest skeletal movement (0.13 mm/d) with a V-shaped displacement pattern. Stages B and C exhibited a more parallel expansion pattern. Stages D and E exhibited the least amount of skeletal movement with either device. Compared with the BB device, TBB demonstrated greater dental displacement. On average, the BB device exhibited a skeletal-to-dental expansion ratio of 70% from stage A to C compared with 49% with the TBB device.

CONCLUSIONS

BB device showed more skeletal displacement than TBB, and the latter showed more dental side effects, particularly during stages B and C. The miniscrew-assisted rapid palatal expansion appliance was effective with sutural maturation stages A to C using the classification by Angelieri with a more parallel separation of the midpalatal sutures in stages B and C.

Miniscrew-Assisted Rapid Palatal Expansion: A Scoping Review of Influencing Factors, Side Effects, and Soft Tissue Alterations

Background: Miniscrew-assisted rapid palatal expansion (MARPE) has gained attention as an effective alternative to traditional rapid palatal expansion, particularly in adult patients. This scoping review synthesizes recent evidence to assess the clinical efficacy and safety of MARPE, addressing a gap in comprehensive, up-to-date analyses in this area. Objective: To present the recent assessments concerning MARPE influencing factors, side effects, soft tissue alterations, and airway changes, focusing on comparisons with conventional devices. Methods: Using PRISMA guidelines, we conducted a search of the literature published in 2018-2023 using Medline, Scopus, and Embase databases. This review focused on randomized controlled trials, cohort studies, and other reviews that evaluated the outcomes of MARPE. Results: Our analysis included 75 studies and revealed that MARPE significantly improves suture expansion with fewer dental and skeletal side effects compared to traditional methods. The technique shows high efficacy in subjects up to 25 years of age, with reduced incidence of complications and improved stability of expansion. Conclusions: The results support MARPE as a viable and superior alternative for maxillary expansion in late adolescents and adults. Given its advantages over traditional methods, MARPE should be considered a standard procedure in orthodontic treatment plans. Future research should focus on long-term outcomes and optimization of patient-specific treatment protocols.

Automatic Segmentation of the Jaws Used in Guided Insertion of Orthodontic Mini Implants to Improve Their Stability and Precision

Background and Objectives: With the goal of identifying regions with bicortical bone and avoiding root contact, the present study proposes an innovative technique for the simulation of the insertion of mini orthodontic implants using automatic jaw segmentation. The simulation of mini implants takes place in 3D rendering visualization instead of Multi-Planar Reconstruction (MPR) sections. Materials and Methods: The procedure involves utilizing software that automatically segments the jaw, teeth, and implants, ensuring their visibility in 3D rendering images. These segmented files are utilized as study models to determine the optimum location for simulating orthodontic implants, in particular locations characterized by limited distances between the implant and the roots, as well as locations where the bicortical structures are present. Results: By using this method, we were able to simulate the insertion of mini implants in the maxilla by applying two cumulative requirements: the implant tip needs to be positioned in a bicortical area, and it needs to be situated more than 0.6 mm away from the neighboring teeth's roots along all of their axes. Additionally, it is possible to replicate the positioning of the mini implant in order to distalize the molars in the mandible while avoiding the mandibular canal and the path of molar migration. Conclusions: The utilization of automated segmentation and visualization techniques in 3D rendering enhances safety measures during the simulation and insertion of orthodontic mini implants, increasing the insertion precision and providing an advantage in the identification of bicortical structures, increasing their stability.

Evolution, current status, and future trends of maxillary skeletal expansion: a bibliometric analysis

OBJECTIVES

The study aims to conduct a bibliometric analysis on maxillary skeletal expansion to elucidate the evolution and current status and predict future research hotspots and trends.

MATERIAL AND METHODS

A search was conducted in the Web of Science Core Collection at the University of Hong Kong's electronic library using the query "(TS = maxillary expansion) AND (TS = skeletal expansion)." The resulting literature data were imported into CiteSpace 6.2.R4 and VOS viewer software to analyze authorship, countries, institutions, keywords, etc. RESULTS: A total of 923 articles were analyzed. The research in this field has shown a steady growth, with a significant increase since 2019. The USA and Italy have played prominent roles in contributing to the publication volume and strengthening collaborative exchanges. Clustering labels provide directions for in-depth analysis of the literature.

CONCLUSIONS

(1) MARPE (miniscrew-assisted rapid palatal expansion) and SARME (surgically assisted rapid maxillary expansion) have gained widespread attention and become research hotspots due to their applicability in adults whose growth and development have ceased, while still producing favorable skeletal effects. (2) In addition to widening the maxillary arch, maxillary expansion techniques have shown significant effects on increasing nasal cavity width and volume. However, there is still controversy regarding whether they can effectively improve the deviated nasal septum. (3) Maxillary skeletal expansion techniques have been shown to increase upper airway volume and improve breathing, making them potentially valuable in the treatment of obstructive sleep apnea (OSA).

CLINICAL RELEVANCE

This study can provide cutting-edge clinical recommendations for healthcare professionals to better formulate clinical strategies.