Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

Skeletal, dentoalveolar and soft tissue effects of different maxillary expansion appliances in cleft lip/palate patients: A systematic review and frequentist network meta-analysis

INTRODUCTION

This study aimed to assess the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of different maxillary expansion appliances in cleft lip/palate patients.

METHODS

We assessed the effects of different maxillary expansion appliances on skeletal and dentoalveolar structures and soft tissues in cleft lip/palate patients. We searched the PubMed, Science Direct, Web of Science, Cochrane, and LILACS databases through September 2024; that investigation was augmented by a manual search. We focused on clinical trials and longitudinal studies, either retrospective or prospective. The outcomes of interest included skeletal, dentoalveolar, and soft tissue changes obtained from study models, cephalometric radiographs, or cone beam computed tomography.

RESULTS

Of the 430 screened articles, only six satisfied our eligibility criteria and were included in the quantitative synthesis. These articles exhibited a moderate overall risk of bias. None of the appliances conferred better forward skeletal maxillary movement than the hyrax. The iMini-Molars (iMini-M) was the most effective appliance for increasing maxillary skeletal width (mean: 0.89 mm [range: 0.01-1.78]), with the hyrax following closely behind. The Haas appliance exhibited the largest inter-molar distance (mean: 4.76 mm [range: 2.53-6.99]), followed by the Differential opening appliance (EDO), iMini-M, and the hyrax. The fan-type appliance was the least effective at resisting maxillary premolar tipping (14.46° [2.60-26.32]), and the iMini-premolars (iMini-P) was the most effective at reducing molar tipping (-3.54° [-6.06- -1.02]).

CONCLUSIONS

Considering the limited number of studies and moderate risk of bias, the iMini-M was the most effective appliance at increasing maxillary skeletal width compared with the hyrax; the Haas achieved the largest inter-molar distance. The fan-type appliance excelled at resisting premolar tipping, and the iMini-P offered the best control for molar tipping.

REGISTRATION

The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42023489536).

Evaluation of pterygomaxillary disjunction on skeletal and dental changes after surgically assisted rapid maxillary expansion: A systematic review and meta-analysis

Background

Surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the pterygomaxillary disjunction (PD) procedure has often been deemed risky. The actual necessity and effectiveness of PD in SARME remain subjects of debate, with some studies suggesting that sufficient expansion can be achieved without it. This systematic review with meta-analysis aimed to evaluate the scientific literature regarding the effects of PD on skeletal and dental changes after SARME.

Methods

The systematic review followed the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant articles published in different databases. The study conducted a comprehensive literature search across seven databases: PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar. The selected studies evaluated the effect of the extent of expansion and the stability of SARME with PD, as well as the skeletal and dental changes associated with the treatment. The intervention cohorts within the sampled population chosen for incorporation into our analysis consisted of individuals who underwent SARME accompanied by PD, whereas the control group underwent SARME devoid of PD. Data were combined in a meta-analysis using the Review Manager 5.3.5. (RevMan) program. A systematic search was performed in seven databases (PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar).

Results

After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. Expansion in the previous region was slightly higher in the SARME with PD group compared to the PD-free group (95 % CI: 1.07 to 1.1 mm; p = 0.98). In the posterior region, expansion exceeding 0.11 mm was observed in the SARME with PD group compared to the PD-free group, but without statistical significance (95 % CI: 1.64 to 1.86 mm; p = 0.903).

Conclusion

SARME combined with PD proves to be an effective surgical procedure for correcting transverse maxillary deficiencies. However, no statistically significant differences were observed when SARME with and without PD was compared, indicating that SARME with PD can be used especially in cases that require expansion in the posterior region of the maxilla.

Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers

Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.

Dehiscence and buccal bone thickness after rapid maxillary expansion in young patients with unilateral cleft lip and palate

INTRODUCTION

The present study aimed to evaluate the consequences of rapid maxillary expansion in the buccal bone thickness and dehiscence of subjects with unilateral cleft lip and palate.

METHODS

This prospective cohort study consisted of 30 participants, 20 males and 10 females, between 8 and 15 years old. Participants were allocated into 3 groups, according to the type of maxillary constriction, and were treated with different types of expanders: G1, hyrax; G2, fan-type; G3, inverted mini-hyrax. Cone-beam computed tomography scans were performed immediately before treatment and after 90 days of retention. Linear measurements were obtained by the same calibrated and blinded examiner.

RESULTS

An average of 0.8 mm decrease in buccal bone thickness (P <0.001) and a 0.5 mm increase in dehiscence (P <0.001) were observed. There was no significant difference between the cleft and noncleft side for all variables (P >0.05), as there was no significant difference between groups (P >0.05).

CONCLUSION

The findings in this study allow the conclusion that the orthopedic forces of rapid maxillary expansion lead to a decrease in the posterior buccal bone volume in unilateral cleft lip and palate patients.

Comparative Assessment of Anxiety, Pain, and Discomfort During Rapid Maxillary Expansion Using Two Different Activation Protocols in Patients With Cleft Lip and Palate

OBJECTIVE

The aim of this study was to compare and assess the pain perception, anxiety, and discomfort between two different rapid maxillary expansion (RME) protocols in patients with unilateral cleft lip and palate (UCLP).

DESIGN

This is a prospective study.

SETTING

The study was done in a comprehensive cleft care center.

PATIEN AND PARTICIPANTS

The sample included 26 patients between ages 6 and 9 years with a history of repaired UCLP.

INTERVENTIONS

The patients were randomly allotted into 2 groups-Group A and Group B. Group A received 1 RME activation per day and Group B received 2 activations per day. The participants after RME activation completed a self-report questionnaire and ranked the pain and anxiety levels using Faces pain scale and Hamilton anxiety scale, respectively. The evaluation was done every day for 1 week.

MAIN OUTCOME MEASURE

The Faces Pain Scale, Hamilton Anxiety Scale, and self-report questionnaires assessed the pain, anxiety, and discomfort experienced by the patients after 2 different types of RME activation protocols.

RESULTS

Group B experienced significantly higher pain in the molars than Group A (P < .001). There was no significant difference between the 2 RME activation protocols regarding anxiety and jaw discomfort.

CONCLUSION

Patients who received 2 activations per day experienced significantly higher levels of pain in the molars compared to the patients who received a single activation per day. There were no significant differences between the 2 activation protocols in terms of pain in the palate, tongue, anxiety, and jaw discomfort.

Response to Pulp Vitality Tests in Teeth Submitted to Orthodontic Movement, Adjacent to the Cleft Area

OBJECTIVE

To evaluate the pulp vitality in teeth adjacent to the cleft area submitted to orthodontic movement into the alveolar graft area in individuals with complete unilateral cleft lip and palate (CUCLP).

DESIGN

Cold sensitivity, vertical, and horizontal percussion tests were conducted on the teeth adjacent to the cleft and the contralateral teeth.

SETTING

Endodontics Sector in the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP).

PATIENTS

One hundred patients with CUCLP and hypodontia of the upper lateral incisor in orthodontic movement and after successful alveolar bone graft in the cleft area.

MAIN OUTCOME MEASURES

The cleft study group (SG) was composed of 200 teeth, adjacent to the cleft area. The control group (CG) consisted of 200 contralateral teeth. Statistical analysis was performed using the chi-square test for comparisons between groups (P < .05).

RESULTS

In the SG, 82.0% of teeth presented positive response to the cold sensitivity testing, 13.5% had negative response, and 4.5% had marked response, with statistically significant difference in relation to the CG. The vertical and horizontal percussion tests on teeth in the SG revealed the same results, in which 95.0% presented negative response and 5.0% responded positively, without significant difference compared to teeth in the CG, for both tests.

CONCLUSIONS

Teeth adjacent to the cleft area presented changes in the physiological conditions of the pulp, which were observed by reduction of positive response to the cold sensitivity testing or presence of pulp hypersensitivity in cases of marked response.

Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics

Midpalatal corticotomy-assisted rapid maxillary expansion (MCRME) is a minimally invasive treatment of maxillary transverse deficiency (MTD) in young adults. However, the effect of MCRME on respiratory function still needs to be determined. In this study, we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics (CFD). Twenty patients with MTD (8 males, 12 females; mean age 20.55 years) had cone-beam computed tomography (CBCT) images taken before and after MCRME. The CBCT data were used to construct a three-dimensional (3D) upper airway model. The upper airway flow characteristics were simulated using CFD, and measurements were made based on the CBCT images and CFD. The results showed that the widths of the palatal bone and nasal cavity, and the intermolar width were increased significantly after MCRME. The volume of the nasal cavity and nasopharynx increased significantly, while there were no obvious changes in the volumes of the oropharynx and hypopharynx. CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment. Our results suggest that in these young adults with MTD, increasing the maxillary width, upper airway volume, and quantity of airflow by MCRME substantially improved upper airway ventilation.

Orthodontic treatment of unilateral cleft lip and palate associated with maxillary canine/premolar transposition: case report

Introduction:

The cleft lip and palate is the most frequent craniofacial anomaly and as a consequence of this malformation some inadequate occlusal relationship between the arches are observed. Furthermore, dental absences, individual positioning changes of teeth as rotations, and in more rare situations the transpositions may be found as well.

Description:

In this context, in this article is reported a case of a 9-year-old patient with unilateral cleft lip and palate, with anterior and posterior crossbite on the left side, absence of the maxillary left lateral incisor, and transposition of the maxillary left canine and first premolar. The patient was treated with slow maxillary expansion, secondary graft and fixed orthodontic appliance, transposition maintenance and closing of the lateral incisor space with the first premolar, by means of mesialization of the posterior teeth.

Results:

At the end of the treatment, good intercuspation and an important aesthetic gain for the patient were achieved. The analysis three years after treatment revealed a good stability of the results obtained.