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Colino-Gallardo P, Del Fresno-Aguilar I, Castillo-Montaño L, Colino-Paniagua C, Baptista-Sánchez H, Criado-Pérez L, Alvarado-Lorenzo A. Skeletal and Dentoalveolar Changes in Growing Patients Treated with Rapid Maxillary Expansion Measured in 3D Cone-Beam Computed Tomography. Biomedicines 2023; 11:3305. [PMID: 38137526 PMCID: PMC10740967 DOI: 10.3390/biomedicines11123305] [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: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The skeletal and dental effects of rapid maxillary expansion (RME) have been extensively studied, but high-quality research is still needed to determine the three-dimensional (3D) effects of RME. The aim of this study was to compare skeletal and dentoalveolar parameters through cone-beam computed tomography (CBCT) pre- (T1) and post-treatment (T2) with respect to RME. Twenty growing patients (mean age 10.7 years) were treated with a Hyrax-type expander. A 3D CBCT was performed at T1 and T2, measuring nasal width, maxillary width, palatal height, maxillary arch perimeter, angulation of the upper first molar, and intermolar width. The mean palatal suture opening was 2.85 ± 0.62 mm (p < 0.0001). Nasal width increased 1.28 ± 0.64 mm and maxillary width 2.79 ± 1.48 mm (p < 0.0001). In contrast, palatal height was reduced 0.65 ± 0.64 mm (p < 0.0001). Regarding arch perimeter, the radicular perimeter increased 2.89 ± 1.80 mm, while the coronal perimeter increased 3.42 ± 2.09 mm (p < 0.0001). Molar angulation increased 5.62 ± 3.20° for the right molar and 4.74 ± 2.22° for the left molar (p < 0.0001). Intermolar width increased 5.21 ± 1.55 mm (p < 0.0001). Treatment with Hyrax produced a significant opening in the mean palatal suture. Also, a significant increase in nasal width, maxillary width, arch perimeter, molar angulation, and intermolar width, and a decrease in palatal height, were observed.
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Affiliation(s)
- Peri Colino-Gallardo
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Irene Del Fresno-Aguilar
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Laura Castillo-Montaño
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Carlos Colino-Paniagua
- Department of Dentistry, Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.C.-G.); (I.D.F.-A.); (L.C.-M.); (C.C.-P.)
| | - Hugo Baptista-Sánchez
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
| | - Laura Criado-Pérez
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
| | - Alfonso Alvarado-Lorenzo
- Department of Oral Surgery, Universidad de Salamanca, 37007 Salamanca, Spain; (H.B.-S.); (A.A.-L.)
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Calandrelli R, Pilato F, Massimi L, D'Apolito G, Colosimo C. Facial skeleton dysmorphology in syndromic craniosynostosis: differences between FGFR2 and no-FGFR2-related syndromes and relationship with skull base and facial sutural patterns. Childs Nerv Syst 2023; 39:3235-3247. [PMID: 37195419 DOI: 10.1007/s00381-023-05962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/16/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To assess the role of FGFR2 mutations and sutural synostotic patterns on facial skeleton dysmorphology in children with syndromic craniosynostosis. METHODS Preoperative high-resolution CT images in 39 infants with syndromic craniosynostosis were evaluated. Patients were divided into infants with and without FGFR2 mutations; each group was split according to synostotic involvement of minor sutures/synchondroses: isolated or combined involvement of middle (MCF) and posterior cranial fossae (PCF). Quantitative analysis of the midface and mandible measures was performed. Each subgroup was compared with a group of age-matched healthy subjects. RESULTS Twenty-four patients with FGFR2 related syndromes were clustered in 3 subgroups: MCF + PCF (8 patients, 5.4 ± 1.75 months), MCF (8 patients, 3.62 ± 1.68 months), and PCF (8 patients, 2.75 ± 0.46 months). Fifteen no-FGFR2 patients were clustered in 2 subgroups: MCF + PCF (7 patients, 9.42 ± 0.78 months) and PCF (8 patients, 7.37 ± 2.92 months). Both FGFR2 and no-FGFR2 groups with involvement of minor sutures coursing in MCF showed more facial sutural synostoses. Children with minor suture/synchondrosis synostosis of MCF (MCF-PCF and MCF subgroups) showed altered position of glenoid fossa and mandibular inclination ([Formula: see text]), but children in the FGFR2 group had also reduced midfacial depth and maxillary length ([Formula: see text]). Children with minor suture/synchondrosis synostosis of PCF (PCF subgroups) had reduced posterior mandibular height, but those children in the FGFR2 group also showed reduced intergonion distance ([Formula: see text]). CONCLUSIONS In children with syndromic craniosynostosis, both skull base and facial suture synostosis affect facial dysmorphology/hypoplasia. FGFR2 mutations may worsen facial hypoplasia both acting on bone development and causing an earlier premature closure of facial sutures.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, Rome, 00168, Italy.
| | - Fabio Pilato
- Unit of Neurology, Department of Medicine, Neurophysiology, Università Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, Rome, 00168, Italy
| | - Gabriella D'Apolito
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, Rome, 00168, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, Rome, 00168, Italy
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Palomo JM, Piccoli VD, Menezes LMD. Obstructive sleep apnea: a review for the orthodontist. Dental Press J Orthod 2023; 28:e23spe1. [PMID: 37075419 PMCID: PMC10108585 DOI: 10.1590/2177-6709.28.1.e23spe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated. OBJECTIVE Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.
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Affiliation(s)
- Juan Martin Palomo
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
| | - Vicente Dias Piccoli
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
| | - Luciane Macedo de Menezes
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
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Almaqrami BS, Ngan P, Alhammadi MS, Al-Somairi MAA, Xiong H, Hong H. Three-dimensional craniofacial changes with maxillary expansion in young adult patients with different craniofacial morphology. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_177_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives:
Skeletally mature patients with transverse deficiency are best treated with surgically assisted rapid palatal expansion (RPE) procedure. Recent studies have shown that microimplant-assisted RPE (MARPE) appliances can be effective in achieving skeletal expansion in young adults. This retrospective study aimed to evaluate the skeletal and dental alveolar changes in response to treatment with MARPE appliances in three types of anteroposterior skeletal malocclusions using cone-beam computed tomography (CBCT) scans.
Material and Methods:
Seventy-eight subjects diagnosed with maxillary transverse deficiency and treated with the MARPE appliance (mean age of 22.9 ± 4.2 years) were divided into skeletal Class I, II, and III malocclusions with 26 subjects in each group. Pre- and post-treatment CBCT scans were used for superimposition to examine the skeletal and dentoalveolar changes following maxillary expansion treatment.
Results:
Significant lateral separation of the maxilla was found at the levels of the nasal floor, interzygomatic bones, and the inferior palatine margin of the alveolar process (P < 0.05) in the whole sample. Most of the sagittal and vertical variables change significantly in the whole sample and each studied group separately. Intergroup comparisons revealed no significant differences among the three skeletal classes except for the left frontozygomatic angle, left maxillary inclination angle, and torque in the first and second premolars. In Class III patients, the maxilla moved forward significantly in most of the cases (eight of 26 cases) (0.88°, P < 0.05) and the mandible moved downward and backward improving the anteroposterior skeletal relationship. Significant differences were also found in the vertical measurements (N-Me, MMP, and MP/SN, P < 0.05) in all three types of anteroposterior malocclusions.
Conclusion:
Maxillary expansion with the MARPE appliance in young adult patients induced different skeletal and dentoalveolar changes in the anteroposterior and vertical dimensions in each skeletal malocclusion with no significant difference among the three skeletal classes.
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Affiliation(s)
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, West Virginia, United States,
| | - Maged Sultan Alhammadi
- Department of Preventive Dental Sciences, Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia,
| | - Majedh Abdo Ali Al-Somairi
- Department of Orthodontic, Lanzhou University, School of Stomatology Lanzhou University, Lanzhou, China,
| | - Hui Xiong
- Department of Orthodontics, Wuhan University, Wuhan, Hubei, China,
| | - H. Hong
- Department of Orthodontics, Wuhan University, Wuhan, Hubei, China,
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Craniofacial morphology and growth in Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis. Clin Oral Investig 2021; 26:2927-2936. [PMID: 34904178 PMCID: PMC8898243 DOI: 10.1007/s00784-021-04275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
Objectives To determine whether the midface of patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis is hypoplastic compared to skeletal facial proportions of a Dutch control group. Material and methods We included seventy-four patients (43 patients with Muenke syndrome, 22 patients with Saethre-Chotzen syndrome, and 9 patients with TCF12-related craniosynostosis) who were referred between 1990 and 2020 (age range 4.84 to 16.83 years) and were treated at the Department of Oral Maxillofacial Surgery, Special Dental Care and Orthodontics, Children’s Hospital Erasmus University Medical Center, Sophia, Rotterdam, the Netherlands. The control group consisted of 208 healthy children. Results Cephalometric values comprising the midface were decreased in Muenke syndrome (ANB: β = –1.87, p = 0.001; and PC1: p < 0,001), Saethre-Chotzen syndrome (ANB: β = –1.76, p = 0.001; and PC1: p < 0.001), and TCF12-related craniosynostosis (ANB: β = –1.70, p = 0.015; and PC1: p < 0.033). Conclusions In this study, we showed that the midface is hypoplastic in Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis compared to the Dutch control group. Furthermore, the rotation of the maxilla and the typical craniofacial buildup is significantly different in these three craniosynostosis syndromes compared to the controls. Clinical relevance The maxillary growth in patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis is impaired, leading to a deviant dental development. Therefore, timely orthodontic follow-up is recommended. In order to increase expertise and support treatment planning by medical and dental specialists for these patients, and also because of the specific differences between the syndromes, we recommend the management of patients with Muenke syndrome, Saethre-Chotzen syndrome, or TCF12-related craniosynostosis in specialized multidisciplinary teams. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04275-y.
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Short-term effects of microimplant-assisted rapid palatal expansion on the circummaxillary sutures in skeletally mature patients: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2021; 161:e187-e197. [PMID: 34872829 DOI: 10.1016/j.ajodo.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study aimed to investigate the short-term effects on the circummaxillary sutures induced by microimplant-assisted rapid palatal expansion (MARPE) in skeletally mature patients. METHODS Cone-beam computed tomography (CBCT) images of preexpansion (T0) and postexpansion (T1) of 23 patients (mean age, 20.9 ± 3.65 years) treated with MARPE were evaluated. The T0 and T1 CBCT images were reoriented and superimposed on the basis of the anterior cranial base, using OnDemand3D software (Cybermed, Seoul, Korea). Then, width changes of 9 circummaxillary sutures (frontonasal, frontomaxillary, frontozygomatic, nasomaxillary, zygomaticomaxillary, intermaxillary, midpalatal, zygomaticotemporal, and pterygopalatine sutures) were measured on 1 section of each patient's T0 and T1 CBCT images. In addition, correlation coefficients between changes in the midpalatal sutures, the amount of appliance activation, age, and the changes in other circummaxillary sutural widths were also calculated. RESULTS Statistically significant (P <0.05) width increases were found in all 9 circummaxillary sutures. The changes in midpalatal suture at the maxillary central incisor level positively correlated with the intermaxillary sutures at the anterior nasal spine level, midpalatal sutures at the posterior nasal spine level, and frontomaxillary sutures (P <0.05). In addition, the changes in the midpalatal sutures at the posterior nasal spine level also positively correlated with the changes in the intermaxillary sutures at the anterior nasal spine level, frontomaxillary sutures, and medial pterygopalatine sutures (P <0.05). CONCLUSIONS All 9 circummaxillary sutural widths increased in skeletally mature patients immediately after MARPE. The greatest increases in width were measured in the midpalatal sutures and the intermaxillary sutures, followed by the frontomaxillary sutures.
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Three-dimensional zygomatic changes after rapid maxillary expansion in growing patients. J Orofac Orthop 2021; 84:147-156. [PMID: 34542641 DOI: 10.1007/s00056-021-00348-5] [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: 03/30/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the effects of rapid maxillary expansion (RME) treatment on the zygomatic bone complex (ZBC). METHODS In this single-center retrospective study, pre- and posttreatment cone-beam computed tomography (CBCT) images of 38 patients treated with RME were analyzed to investigate changes in the coordinates of the ZBC landmarks. At the start of treatment (T0), the patients' mean age was 11.1 ± 3.8 years (range 8.3-14.9 years). Cohen's d test was used to evaluate statistical differences. RESULTS There were statistically significant differences between T0 and T1 (P < 0.01) in the measurement values for the maxillary transverse width (ΔT: 3.18 ± 2.58, d: 1.23), frontozygomatic sutures (ΔT: 1.09 ± 0.56, d: 0.43), lowest point of the zygomaticomaxillary sutures (ΔT: 3.16 ± 1.78, d: 0.78), frontomaxillary angular parameter (right side ΔT: 2.81 ± 1.63, d: 1.73; left side ΔT: 2.52 ± 1.20, d: 2.10), frontozygomatic angular parameter (right side ΔT: 2.81 ± 1.63 d: 1.07; left side ΔT: 2.21 ± 2.79, d: 0.61), anterior intermaxillary distance (ΔT: 2.11 ± 1.42, d: 0.99), interzygomaticotemporal distance (ΔT: 2.00 ± 2.42, d: 0.99), and zygomatic angular parameter (right side ΔT: 2.06 ± 1.29, d: 1.6; left side ΔT: 2.02 ± 1.86, d: 1.09). CONCLUSIONS After RME in growing patients, the zygomatic bone showed pyramidal expansion in the coronal plane and parallel palatal expansion in the axial plane. In addition, significant lateral relocation of the zygomatic bone occurred. The zygomatic bone tended to rotate outward in conjunction with the maxilla, with a typical center of rotation close to the superior side of the frontozygomatic suture. These results shed light on the patterns of skeletal expansion in the zygomatic bone associated with RME in growing patients.
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Oliveira RDS, de Oliveira CJM, Panzarella FK, Cintra Junqueira JL. Maturation stages of the sutures in the median palatine evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021; 160:567-572. [PMID: 34274199 DOI: 10.1016/j.ajodo.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aimed to evaluate the influence of age, sex, and facial growth patterns on the maturation stage of midpalatal sutures. METHODS We selected 90 total skull cone-beam computed tomography scans and divided them into the following 3 groups: brachyfacial (n = 30), mesofacial (n = 30), and dolichofacial (n = 30). These groups were determined using Ricketts VERT 3-dimensional cephalometric analysis. All patients were aged ≥18 years and were divided into those aged ≥30 years and >30 years. The maturational stage of the median palatine sutures was determined by evaluating the central transverse axial dimension in the maxillary-mandibular palate. Maturational stages were classified as A, B, C, D, and E. RESULTS Of the 90 images reviewed, 55 (61.1%) were female patients, and 35 were male patients (38.9%). The age of patients ranged from 18 to 59 years, with 55 patients aged <30 years (61.1%) and 35 aged ≥30 years (38.9%). Regarding the maturational stages, 3.3% of brachyfacial, 6.7% of mesiofacial, and 16.7% of dolichofacial subjects (P = 0.032) were classified as stages B and C. CONCLUSIONS The patients' facial patterns were found to be a significant signal for the maturation stage of midpalatal sutures. Adult dolichofacial patients are the most likely to have stage B and C.
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Affiliation(s)
- Rudyard Dos Santos Oliveira
- Department of Dentistry, Postgraduate Program in Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil.
| | | | - Francine Kühl Panzarella
- Department of Dentistry, Postgraduate Program in Imaging and Oral Radiology, São Leopoldo Mandic College, Campinas, São Paulo, Brazil
| | - José Luiz Cintra Junqueira
- Department of Dentistry, Postgraduate Program in Imaging and Oral Radiology, São Leopoldo Mandic College, Campinas, São Paulo, Brazil
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Evaluation of the Soft Tissue Changes after Rapid Maxillary Expansion Using a Handheld Three-Dimensional Scanner: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073379. [PMID: 33805172 PMCID: PMC8036493 DOI: 10.3390/ijerph18073379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
Facial soft tissue esthetics is a priority in orthodontic treatment, and emerging of the digital technologies can offer new methods to help the orthodontist toward an esthetic outcome. This prospective study aimed to assess the soft tissue changes of the face after six months of retention following Rapid Maxillary Expansion (RME). The sample consisted of 25 patients (13 females, 12 males, mean age: 11.6 years) who presented with unilateral or bilateral posterior crossbite requiring RME, which was performed with a Hyrax expander. 3D facial images were obtained before treatment (T0) and at the end of a six-month retention period after the treatment (T1) using a structured-light 3D handheld scanner. Linear and angular measurements were performed and 3D deviation analyses were done for six morphological regions of the face. Significant changes in various areas of the nasal and the upper lip regions were observed. Based on the results of the study and within the limitations of the study, RME with a Hyrax expander results in significant morphological changes of the face after a six-month retention period.
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Coloccia G, Inchingolo AD, Inchingolo AM, Malcangi G, Montenegro V, Patano A, Marinelli G, Laudadio C, Limongelli L, Di Venere D, Hazballa D, D’Oria MT, Bordea IR, Xhajanka E, Scarano A, Lorusso F, Laforgia A, Inchingolo F, Dipalma G. Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57030288. [PMID: 33808680 PMCID: PMC8003431 DOI: 10.3390/medicina57030288] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Palatal expansion is a common orthodontic technique able to increase the transverse changes for subjects with constricted maxillary arches. The aim of the present investigation was to evaluate through a systematic review the tomography effectiveness of different palatal expander approaches. Materials and Methods: The database used to perform the screening and determine the eligibility of the clinical papers was PubMed (Medline). Results: The database search included a total of 284 results, while 271 articles were excluded. A total of 14 articles were included for the qualitative assessment. Conclusions: The effectiveness of the present studies reported that skeletal expansion was a useful approach to increase the transverse changes for subjects with constricted maxillary arches.
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Affiliation(s)
- Giovanni Coloccia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Valentina Montenegro
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Claudia Laudadio
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Denisa Hazballa
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Kongresi Elbasanit, Rruga: Aqif Pasha, 3001 Elbasan, Albania
| | - Maria Teresa D’Oria
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
- Department of Medical and Biological Sciences, University of Udine. Via delle Scienze, 206, 33100 Udine, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Edit Xhajanka
- Department of Dental Prosthesis, Medical University of Tirana, Rruga e Dibrës, 1001 Tirana, Albania;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence: (G.M.); (I.R.B.); (F.L.); Tel.: +39-3403348500 (G.M.); +40-7449-19319 (I.R.B.); +39-3282-132-586 (F.L.)
| | - Alessandra Laforgia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (G.C.); (A.D.I.); (A.M.I.); (V.M.); (A.P.); (G.M.); (C.L.); (L.L.); (D.D.V.); (D.H.); (M.T.D.); (A.L.); (F.I.); (G.D.)
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Caldas LD, Takeshita WM, Machado AW, Bittencourt MAV. Effect of rapid maxillary expansion on nasal cavity assessed with cone-beam computed tomography. Dental Press J Orthod 2020; 25:39-45. [PMID: 32844972 PMCID: PMC7437151 DOI: 10.1590/2177-6709.25.3.039-045.oar] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Rapid maxillary expansion (RME) is assumed as a well established procedure; although, some effects on facial complex are not yet fully understood. Objective: The aim of this research was to verify, using cone-beam computed tomography, the effect on linear dimensions of the nasal cavity. Methods: Sample consisted of twenty patients aged 7 to 16 years, with skeletal deformity that justified the use of CT scans, and who required the RME as part of the orthodontic treatment planning. Scans were taken before clinical procedures were performed (T0) and after stabilizing the expander screw (T1). Dolphin Imaging v. 11.5 3D software was used to measure six areas on nasal cavity: three at the anterior portion (upper, middle, and lower) and other three at the posterior portion (also upper, middle, and lower). Data were statistically treated using Shapiro-Wilk test to verify normality. Differences between T0 and T1 were calculated using the Spearman correlation and paired Student’s t-test, with a significance level of 5%. Results: All linear measurements presented a significant increase (p< 0.05) after RME, both in the anterior and posterior regions, suggesting some parallelism on the opening pattern, especially at the lower portion (p< 0.001). Conclusions: RME was able to significantly modify the internal dimensions of the nasal cavity.
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Affiliation(s)
| | - Wilton M Takeshita
- Departamento de Radiologia Oral, Faculdade de Odontologia, Universidade Federal do Sergipe, Aracaju, SE, Brazil
| | - André Wilson Machado
- Departamento de Ortodontia, Faculdade de Odontologia, Universidade Federal da Bahia, Salvador, BA, Brazil
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Colak O, Paredes NA, Elkenawy I, Torres M, Bui J, Jahangiri S, Moon W. Tomographic assessment of palatal suture opening pattern and pterygopalatine suture disarticulation in the axial plane after midfacial skeletal expansion. Prog Orthod 2020; 21:21. [PMID: 32686018 PMCID: PMC7370251 DOI: 10.1186/s40510-020-00321-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). MATERIALS AND METHODS Pre- and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. RESULTS After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (- 0.8° to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). CONCLUSIONS MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients.
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Affiliation(s)
- Ozge Colak
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA.
| | - Ney Alberto Paredes
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Islam Elkenawy
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Martha Torres
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Joseph Bui
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Sara Jahangiri
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Won Moon
- School of Dentistry, Center for Health Science, University of California at Los Angeles, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA, 90095-1668, USA.
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13
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Bruder C, Ortolani CLF, Lima TAD, Artese F, Faltin Junior K. Evaluation of palate area before and after rapid maxillary expansion, using cone-beam computed tomography. Dental Press J Orthod 2019; 24:40-45. [PMID: 31721945 PMCID: PMC6833936 DOI: 10.1590/2177-6709.24.5.040-045.oar] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to estimate the changes in the palate area after rapid maxillary expansion (RME) with the Hyrax expander in growing subjects, using cone beam computed tomography (CBCT). Methods: Fourteen patients (9 girls and 5 boys; mean age = 11.7 ± 2.4 years) who required RME as part of their orthodontic treatment were included in this study. CBCT records had been taken before RME treatment (T0), at the end of active expansion (T1) and after a 6-month retention period (T2). The CBCT scans were manipulated with Dolphin Imaging® version 11.7 Premium software, in which landmarks were positioned and measured in relation to sagittal, coronal and axial planes, to verify the palate surface area. In addition, linear measurements of the palatal depth and width were assessed. These measurements were compared by using analysis of variance (ANOVA) for repeated measures. A p-value smaller than 0.05 was considered statistically significant. Results: The palatal surface area and width significantly increased from T0 to T1, respectively by 9.27% and 9.71%, and both decreased in a non-significant manner from T1 to T2. The palatal depth had non-significant differences at T0, T1 and T2. Conclusions: RME promotes a significant gain in the surface area of the palate and an increase in intermolar width. The Hyrax appliance was effective for the treatment of maxillary atresia in growing patients. There was no vertical alteration of the palate. After a 6-month retention period, the maxilla transverse dimension and the surface area of the palate remained stable.
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Affiliation(s)
- Carolina Bruder
- Universidade Paulista, Programa de Pós-Graduação em Odontologia (São Paulo/SP, Brazil)
| | | | - Tatiana Araújo de Lima
- Universidade Veiga de Almeida, Curso de Graduação em Odontologia e Fonoaudiologia (Rio de Janeiro/RJ, Brazil)
| | - Flavia Artese
- Universidade do Estado do Rio de Janeiro, Departamento de Odontologia Preventiva e Comunitária (Rio de Janeiro/RJ, Brazil)
| | - Kurt Faltin Junior
- Universidade Paulista, Programa de Pós-Graduação em Odontologia (São Paulo/SP, Brazil)
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Abstract
As orthodontic treatment has advanced in complexity and in frequency, more recent techniques, using temporary skeletal anchorage, were developed to help correct more severe occlusal and dentofacial discrepancies that were treated with orthognathic surgery alone previously. These techniques have allowed the orthodontist to move teeth against a rigid fixation, allowing for more focused movements of teeth and for orthopedic growth modification. These types of treatments using rigid fixation have allowed for greater interaction between the orthodontist and the oral and maxillofacial surgeon, and have vastly enhanced the treatment planning for the orthodontist in today's society.
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Affiliation(s)
- Jason P Jones
- Department of Oral and Maxillofacial Surgery, UT Health San Antonio, 8210 Floyd Curl Drive, MC 8124, San Antonio, TX 78229, USA
| | - Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, M/C 841, Chicago, IL 60612-7211, USA.
| | - Daniel E Perez
- Department of Oral and Maxillofacial Surgery, UT Health San Antonio, 8210 Floyd Curl Drive, MC 8124, San Antonio, TX 78229, USA.
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15
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Deviating dental arch morphology in mild coronal craniosynostosis syndromes. Clin Oral Investig 2018; 23:2995-3003. [PMID: 30392078 PMCID: PMC7398388 DOI: 10.1007/s00784-018-2710-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/17/2018] [Indexed: 11/21/2022]
Abstract
Objectives To determine whether the intramaxillary relationship of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are systematically different than those of a control group. Material and methods Forty-eight patients (34 patients with Muenke syndrome, 8 patients with Saethre-Chotzen syndrome, and 6 patients with TCF12-related craniosynostosis) born between 1982 and 2010 (age range 4.84 to 16.83 years) that were treated at the Department of Oral Maxillofacial Surgery, Special Dental Care and Orthodontics, Children’s Hospital Erasmus University Medical Center, Sophia, Rotterdam, the Netherlands, were included. Forty-seven syndromic patients had undergone one craniofacial surgery according to the craniofacial team protocol. The dental arch measurements intercanine width (ICW), intermolar width (IMW), arch depth (AD), and arch length (AL) were calculated. The control group existed of 329 nonsyndromic children. Results All dental arch dimensions in Muenke (ICW, IMW, AL, p < 0.001, ADmax, p = 0.008; ADman, p = 0.002), Saethre-Chotzen syndrome, or TCF12-related craniosynostosis patients (ICWmax, p = 0.005; ICWman, IMWmax, AL, p < 0.001) were statistically significantly smaller than those of the control group. Conclusions In this study, we showed that the dental arches of the maxilla and the mandible of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are smaller compared to those of a control group. Clinical relevance To gain better understanding of the sutural involvement in the midface and support treatment capabilities of medical and dental specialists in these patients, we suggest the concentration of patients with Muenke and Saethre-Chotzen syndromes or TCF12-related craniosynostosis in specialized teams for a multi-disciplinary approach and treatment.
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Zygomaticomaxillary modifications in the horizontal plane induced by micro-implant-supported skeletal expander, analyzed with CBCT images. Prog Orthod 2018; 19:41. [PMID: 30345476 PMCID: PMC6196147 DOI: 10.1186/s40510-018-0240-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background Miniscrew-assisted rapid palatal expansion (MARPE) has been adopted in recent years to expand the maxilla in late adolescence and adult patients. Maxillary Skeletal Expander (MSE) is a device that exploits the principles of skeletal anchorage to transmit the expansion force directly to the maxillary bony structures and is characterized by the miniscrews’ engagement of the palatal and nasal cortical bone layers. In the literature, it has been reported that the zygomatic buttress is a major constraint that hampers the lateral movement of maxilla, since maxilla is located medially to the zygomatic arches. The objective of the present study is to analyze the changes in the zygomatic bone, maxillary bone, and zygomatic arches and to localize the center of rotation for the zygomaticomaxillary complex in the horizontal plane after treatment with MSE, using high-resolution cone-beam computed tomography (CBCT) images. Methods Fifteen subjects with a mean age of 17.2 (± 4.2) years were treated with MSE. CBCT records were taken before and after miniscrew-assisted maxillary expansion; three linear and four angular parameters were identified in the axial zygomatic section (AZS) and were compared from pre-treatment to post-treatment using the Wilcoxon signed rank test. Results Anterior inter-maxillary distance increased by 2.8 mm, posterior inter-zygomatic distance by 2.4 mm, angle of the zygomatic process of the temporal bone by 1.7° and 2.1° (right and left side) (P < 0.01). Changes in posterior inter-temporal distance and zygomaticotemporal angle were negligible (P > 0.05). Conclusions In the horizontal plane, the maxillary and zygomatic bones and the whole zygomatic arch were significantly displaced in a lateral direction after treatment with MSE. The center of rotation for the zygomaticomaxillary complex was located near the proximal portion of the zygomatic process of the temporal bone, more posteriorly and more laterally than what has been reported in the literature for tooth-borne expanders. Bone bending takes place in the zygomatic process of the temporal bone during miniscrew-supported maxillary expansion.
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LaBlonde B, Vich ML, Edwards P, Kula K, Ghoneima A. Three dimensional evaluation of alveolar bone changes in response to different rapid palatal expansion activation rates. Dental Press J Orthod 2018; 22:89-97. [PMID: 28444010 PMCID: PMC5398847 DOI: 10.1590/2177-6709.22.1.089-097.oar] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this multi-center retrospective study was to quantify the changes in alveolar bone height and thickness after using two different rapid palatal expansion (RPE) activation protocols, and to determine whether a more rapid rate of expansion is likely to cause more adverse effects, such as alveolar tipping, dental tipping, fenestration and dehiscence of anchorage teeth. METHODS The sample consisted of pre- and post-expansion records from 40 subjects (age 8-15 years) who underwent RPE using a 4-banded Hyrax appliance as part of their orthodontic treatment to correct posterior buccal crossbites. Subjects were divided into two groups according to their RPE activation rates (0.5 mm/day and 0.8 mm/day; n = 20 each group). Three-dimensional images for all included subjects were evaluated using Dolphin Imaging Software 11.7 Premium. Maxillary base width, buccal and palatal cortical bone thickness, alveolar bone height, and root angulation and length were measured. Significance of the changes in the measurements was evaluated using Wilcoxon signed-rank test and comparisons between groups were done using ANOVA. Significance was defined at p ≤ 0.05. RESULTS RPE activation rates of 0.5 mm per day (Group 1) and 0.8 mm per day (Group 2) caused significant increase in arch width following treatment; however, Group 2 showed greater increases compared to Group 1 (p < 0.01). Buccal alveolar height and width decreased significantly in both groups. Both treatment protocols resulted in significant increases in buccal-lingual angulation of teeth; however, Group 2 showed greater increases compared to Group 1 (p < 0.01). CONCLUSION Both activation rates are associated with significant increase in intra-arch widths. However, 0.8 mm/day resulted in greater increases. The 0.8 mm/day activation rate also resulted in more increased dental tipping and decreased buccal alveolar bone thickness over 0.5 mm/day.
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Affiliation(s)
- Brian LaBlonde
- School Dentistry, Indiana University, Indianapolis, IN, USA
| | | | - Paul Edwards
- School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - Katherine Kula
- School Dentistry, Indiana University, Indianapolis, IN, USA
| | - Ahmed Ghoneima
- School of Dentistry, Indiana University, Indianapolis, IN, USA
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Utreja A, Bain C, Turek B, Holland R, AlRasheed R, Sorkhdini P, Roberts WE. Maxillary expansion in an animal model with light, continuous force. Angle Orthod 2018; 88:306-313. [PMID: 29364697 DOI: 10.2319/070717-451.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Maxillary constriction is routinely addressed with rapid maxillary expansion (RME). However, the heavy forces delivered by most RME appliances to expand the palate may lead to deleterious effects on the teeth and supporting tissues. The objective of this study was to explore a more physiologic maxillary expansion with light continuous force. MATERIALS AND METHODS Twenty 6-week-old Sprague-Dawley rats were equally divided into experimental (EXPT) and control (CTRL) groups. A custom-fabricated archwire expansion appliance made from 0.014-inch copper-nickel-titanium wire was activated 5 mm and bonded to the maxillary molar segments of animals in the EXPT group for 21 days. The force applied to each maxillary segment was 5 cN. Microfocus x-ray computed tomography and histological analyses were used to compare the tooth movement and bone morphology in the midpalatal suture and buccal aspect of the alveolar process between the EXPT and CTRL groups. Descriptive statistics (mean ± standard error of the mean) and nonparametric statistical tests were used to compare the outcomes across groups. RESULTS Compared to the CTRL group, there was a statistically significant increase in buccal tooth movement and expansion of the midpalatal suture in the EXPT group. There was no difference in the bone morphologic parameters between groups. The mineral apposition rate was increased on the buccal surface of the alveolar process in the EXPT group. CONCLUSIONS Application of light, continuous force resulted in maxillary osseous expansion due to bilateral sutural apposition and buccal drift of the alveolar processes. This animal experiment provides a more physiologic basis for maxillary expansion.
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19
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Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J, Moon W. Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod 2017; 18:34. [PMID: 29090368 PMCID: PMC5663987 DOI: 10.1186/s40510-017-0188-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/03/2017] [Indexed: 12/05/2022] Open
Abstract
Background Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture. Methods Fifteen subjects (mean age of 17.2 years; range, 13.9–26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher’s exact test was used. Results Regarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture opening was negligible (R2 range, 0.3–4.2%). Conclusions Midpalatal suture was successfully split by MSE in late adolescents, and the opening was almost perfectly parallel in a sagittal direction. Regarding the extent of transverse asymmetry of the split, on average one half of ANS moved more than the contralateral one by 1.1 mm. Pterygopalatine suture was split in its lower region by MSE, as the pyramidal process was pulled out from the pterygoid process. Patient gender and age had a negligible influence on suture opening for the age group considered in the study.
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Affiliation(s)
- Daniele Cantarella
- Division of Oral Biology and Medicine, School of Dentistry, Center for Health Science, University of California, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Ramon Dominguez-Mompell
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Sanjay M Mallya
- Division of Diagnostic and Surgical Sciences, Section of Oral and Maxillofacial Radiology, School of Dentistry, Center for Health Science, University of California, Room 53-068 B CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Christoph Moschik
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Hsin Chuan Pan
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Joseph Miller
- Division of Integrative Anatomy, Department of Pathology and Laboratory Medicine, Geffen School of Medicine, Center for Health Science, University of California, Room 52-068 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA
| | - Won Moon
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Room 63-082 CHS, 10833 Le Conte Avenue, Box 951668, Los Angeles, CA, 90095-1668, USA.
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Saadeh M, Macari A, Haddad R, Ghafari J. Instability of palatal rugae following rapid maxillary expansion. Eur J Orthod 2017; 39:474-481. [PMID: 28379386 DOI: 10.1093/ejo/cjx016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Existing evidence on changes of the palatal rugae following rapid maxillary expansion (RME) is scarce and inconclusive, particularly immediate post-expansion changes in three-dimensional assessments. Objectives Our aims were to assess the dimensional stability of the palatal rugae in the antero-posterior and transverse dimensions following RME treatment, as well as the three-dimensional changes in palatal volume and area. Material and methods The sample consisted of the dental casts of 30 adolescents (16 males; 14 females, age 11.46 ± 1.42 years) who underwent RME. The models, available at T1 (pretreatment) and T2 (immediately after expansion) were scanned using a laser scanning system. Various parameters were recorded including individual ruga transverse and antero-posterior linear and angular measurements; palatal dimensions (width, length, volume, surface area, vault depth/height); and dental characteristics (interincisor, intercanine, interpremolar, and intermolar distances). Statistical analyses included paired t-tests for group comparisons, and Pearson moment product for associations among variables. Results Palatal rugae were altered by RME in all dimensions in both linear and angular measurements, almost equally on right and left sides, albeit the average linear changes were about 1 mm. Correlation coefficients among rugal and dental measures suggested an association between rugae changes and the underlying bony movements. Except for the first rugae that had higher correlations to the intercanine width, the correspondence of changes seems to be asymmetric, thus not precisely predictable. Conclusions The results suggest a variable trend in the rugae response to expansion, likely reflecting the constitutional asymmetric pattern or nature of pairs of rugae.
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Affiliation(s)
- Maria Saadeh
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Orthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Anthony Macari
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi Haddad
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Ghafari
- Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Orthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.,Department of Orthodontics, University of Pennsylvania, Philadelphia, PA, USA
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21
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Lombardo L, Sacchi E, Larosa M, Mollica F, Mazzanti V, Spedicato GA, Siciliani G. Evaluation of the stiffness characteristics of rapid palatal expander screws. Prog Orthod 2016; 17:36. [PMID: 27747528 PMCID: PMC5124561 DOI: 10.1186/s40510-016-0151-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study is to evaluate the mechanical properties of the screws used for rapid expansion of the upper jaw. Methods Ten types of expansion screw were assessed, seven with four arms: Lancer Philosophy 1, Dentaurum Hyrax Click Medium, Forestadent Anatomic Expander type “S”, Forestadent Anatomic Expander type “S” for narrow palates, Forestadent Memory, Leone A 2620-10 with telescopic guide, and Leone A 0630-10 with orthogonal arms; and three with two arms: Dentaurum Variety S.P., Target Baby REP Veltri, and Leone A 362113. A test expander with the mean dimensions taken from measurements on a sample of 100 expanders was constructed for each screw. The test expanders were connected to the supports of an Instron 4467 (Instron Corp., USA) mechanical testing machine equipped with a 500 N load cell, and the compression force exerted after each activation was measured. The mean forces expressed by the two- and four-arm expanders were then compared. Results After five activations, the forces expressed by the two-arm devices were double than those expressed by the four-arm devices on average (224 ± 59.9 N vs. 103 ± 32.9 N), and such values remained high after subsequent activations. Conclusions The expanders tested demonstrated stiffness characteristics compatible with opening of the palatine sutures in pre-adolescent patients. The stiffness of such devices can be further increased during the construction phase.
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Affiliation(s)
- Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy
| | | | - Maria Larosa
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy.
| | - Francesco Mollica
- Department of Engineering, University of Ferrara, Via Saragat 1, 44122, Ferrara, Italy
| | - Valentina Mazzanti
- Department of Engineering, University of Ferrara, Via Saragat 1, 44122, Ferrara, Italy
| | | | - Giuseppe Siciliani
- Postgraduate School of Orthodontics, University of Ferrara, Via Montebello 31, 44121, Ferrara, Italy
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22
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Tadinada A, Marczak A, Yadav S, Mukherjee PM. Applications of Cone Beam Computed Tomography in Orthodontics: A Review. Turk J Orthod 2016; 29:73-79. [PMID: 30112478 DOI: 10.5152/turkjorthod.2016.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/22/2016] [Indexed: 11/22/2022]
Abstract
Cone Beam Computed Tomography (CBCT) is being extensively used in orthodontics for diagnostic and treatment planning, especially in complex clinical conditions. The objective of this study was to review the English language literature for current applications and trends of CBCT in orthodontic diagnosis and treatment. Several electronic databases were searched with the primary words: "orthodontics and radiography" and "cone beam computed tomography" or "CBCT." Abstracts that appeared to fulfill our inclusion criteria were selected, and the complete articles were obtained. Twenty-eight abstracts initially met our search criteria, and 12 were selected for the review. Ten articles were later added to the list after hand searching the references. It was concluded that there is a need for prospective randomized clinical trials to evaluate the risk/benefit ratio of CBCT, such as higher cost, greater risk for radiation dose (compared to digital panoramic and cephalograms) versus superior diagnosis and treatment outcomes.
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Affiliation(s)
- Aditya Tadinada
- Division of Oral and Maxillofacial Radiology, University of Connecticut, School of Dental Medicine Farmington, Connecticut, USA
| | - Alana Marczak
- School of Dental Medicine, University of Connecticut, Farmington, Conn, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut, School of Dental Medicine Farmington, Connecticut, USA
| | - Padma M Mukherjee
- Division of Orthodontics, Rutgers School of Dental Medicine, Newark, NJ, USA
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23
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Effects of rapid maxillary expansion on facial soft tissues : Deviation analysis on three-dimensional images. J Orofac Orthop 2016; 77:242-50. [PMID: 27272054 DOI: 10.1007/s00056-016-0033-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Changes in soft tissue in various morphological regions of the face immediately after rapid maxillary expansion (RME) were examined using three-dimensional (3D) deviation analyses. PATIENTS AND METHODS A total of 50 patients were included in the study; 25 patients (11 female and 14 male) presented with a unilateral or bilateral posterior crossbite malocclusion requiring RME. In addition, 25 patients (13 female and 12 male) were included as a control group. The mean ages of the study group and control group were 9.8 years (range 8.1-12.6 years) and 9.6 years (range 8.3-12.2 years), respectively. The 3D stereophotogrammetric images acquired immediately before the appliance was cemented and after expansion had been completed in the treatment group were compared using Rapidform software. The 3D deviation analyses were made for the complete face and in the upper and lower face, upper and lower lips and nose regions. The amount of negative and positive deviations and the mean deviations were examined on the facial meshes for the 95th percentiles. RESULTS Immediately after RME, the mean absolute deviation over the complete face was 0.54 ± 0.16 mm. The mean change for the upper face was 0.42 ± 0.17 mm (mean positive deviation: 0.37 ± 0.17 mm; mean negative deviation: -0.48 ± 0.18 mm). The mean absolute deviation was 0.62 ± 0.28 mm in the upper lip and 0.60 ± 0.34 mm in the lower lip. In the nose area, the absolute deviation was 0.41 ± 0.21 mm (mean positive deviation: 0.39 ± 0.16 mm; mean negative deviation: -0.43 ± 0.26 mm). CONCLUSIONS Changes in facial soft tissues in the upper face, lower face, nasal soft tissues, and lower and upper lip regions were observed after RME.
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24
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Salgueiro DG, Rodrigues VHLDO, Tieghi Neto V, Menezes CCD, Gonçales ES, Ferreira Júnior O. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography. J Appl Oral Sci 2016; 23:397-404. [PMID: 26398512 PMCID: PMC4560500 DOI: 10.1590/1678-775720140486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients' age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).
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Affiliation(s)
- Daniel Gomes Salgueiro
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, BR
| | | | - Victor Tieghi Neto
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, BR
| | - Carolina Carmo de Menezes
- Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, BR
| | | | - Osny Ferreira Júnior
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, BR
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25
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Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes and indications for its use. Dentomaxillofac Radiol 2015; 44:20140282. [PMID: 25358833 DOI: 10.1259/dmfr.20140282] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics.
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Affiliation(s)
- S D Kapila
- Department of Orthodontics and Pediatric Dentistry, The University of Michigan, Ann Arbor, MI, USA
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26
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Motro M, Schauseil M, Ludwig B, Zorkun B, Mainusch S, Ateş M, Küçükkeleş N, Korbmacher-Steiner H. Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study. Eur Arch Otorhinolaryngol 2015; 273:679-87. [PMID: 25837986 DOI: 10.1007/s00405-015-3584-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal-dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm(3); P < 0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P < 0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P > 0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P > 0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient's age.
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Affiliation(s)
- Melih Motro
- Department of Orthodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Michael Schauseil
- Department of Orthodontics, Faculty of Dentistry, Marburg University, Marburg, Germany.
| | - Björn Ludwig
- Orthodontic praxis, Traben-Trarbach, Germany.,Department of Orthodontics, Faculty of Dentistry, Homburg University, Homburg, Germany
| | | | - Saskia Mainusch
- Department of Orthodontics, Faculty of Dentistry, Marburg University, Marburg, Germany
| | - Mustafa Ateş
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Nazan Küçükkeleş
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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