1
|
Dominguez-Mompell R, Zhang B, Paredes N, Combs A, Elkenawy I, Sfogliano L, Fijany L, Colak O, Romero-Maroto M, Moon W. Breathing changes following mini-implant-supported maxillary skeletal expander treatment in late adolescent or adult patients : Assessment of objective and subjective functional breathing changes. J Orofac Orthop 2024:10.1007/s00056-024-00521-6. [PMID: 38466417 DOI: 10.1007/s00056-024-00521-6] [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: 11/09/2022] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim of this study was to assess objective and subjective breathing changes in adult patients who underwent maxillary skeletal expansion with the mini-implant-supported maxillary skeletal expander (MSE). METHODS Twenty-nine patients (mean age 18.1 ± 4.3 years) who underwent expansion using the MSE were compared pre- and posttreatment and with a control group (mean age 19.9 ± 2.6 years) to assess objective and subjective functional breathing changes. Objective measurements of the airway including peak nasal inspiratory flow (PNIF) and peak oral inspiratory flow (POIF) were measured utilizing the In-Check medical device (Clement Clarke, Harlow, United Kingdom). Patients reported subjective breathing assessment utilizing the visual analog scale (VAS). Intragroup comparisons were performed with Wilcoxon tests and intergroup comparison with Mann-Whitney U tests. Spearman correlation coefficients were calculated among the studied variables (P < 0.05). RESULTS Following MSE treatment, there were significantly higher values for PNIF total (P < 0.0001), PNIF right (P < 0.0001), PNIF left (P < 0.0001), and POIF (P < 0.01) compared to pretreatment and control group results. Also, patients reported a significant decrease in troubled breathing as measured by the VAS for breathing through the right nostril (P < 0.01), left nostril (P < 0.001), and both nostrils (P < 0.01). Comparing the objective and subjective variables for both the pre-MSE or post-MSE groups, the results indicated no significant correlation between total PNIF and total VAS. However, the values had significant correlations between PNIF and VAS on each side when the patients were asked to block one nostril. CONCLUSIONS Objective functional breathing measurements were increased immediately after treatment with MSE. Subjective functional breathing measurements changes were significantly higher after MSE treatment and compared with the control group. MSE presents a nonsurgical alternative to achieving orthopedic expansion in adult patients which may provide a benefit for patients with nasal airway obstruction.
Collapse
Affiliation(s)
| | - Boshi Zhang
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ney Paredes
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA.
| | - Andrew Combs
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Islam Elkenawy
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Luca Sfogliano
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Layla Fijany
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ozge Colak
- Orthodontics Department, State University of New York, 320 Hayes Rd, 14215, Buffalo, NY, USA
| | | | - Won Moon
- Orthodontics and Craniofacial Development Research Forsyth Institute, 245 First Street, 02142, Cambridge, MA, USA.
- Orthodontics Department, AJOU University, Suwon, Korea (Republic of).
| |
Collapse
|
2
|
Benetti M, Montresor L, Cantarella D, Zerman N, Spinas E. Does Miniscrew-Assisted Rapid Palatal Expansion Influence Upper Airway in Adult Patients? A Scoping Review. Dent J (Basel) 2024; 12:60. [PMID: 38534284 DOI: 10.3390/dj12030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Objective: This scoping review evaluates the effects of miniscrew-assisted rapid palatal expansion (MARPE) on different regions of the upper airway in adult patients and investigates various methods of measurement. (2) Methods: The search encompassed Pubmed, Cochrane Library, Scopus and Web of Science. This review was conducted following the PRISMA_ScR guidelines, and the inclusion criteria for examined studies were chosen in accordance with the PICOS framework. (3) Results: Seven studies were included in this review, comprising four retrospective studies, one prospective and two case reports. All studies involved the use of Cone Beam Computed Tomography (CBCT) for measurements of the areas of interest. The percentage of increase in the volume of the nasal cavity varied between 31% and 9.9%, depending on the study. Volumetric variations in the nasopharynx were reported as increases between T0 (before expansion) and T1 (immediately after expansion) of 6.4%, 20.7% and 14.1%. All studies considered T0 before expansion and T1 immediately after expansion. Only one study evaluated remote follow-up to assess if the results were maintained after one year. (4) Conclusions: MARPE appears to lead to a statistically significant increase in the upper airway, especially in the nasal cavity and nasopharynx immediately after expansion. However, further prospective and retrospective trails with long-term controls are required to verify the effects of MARPE on the upper airway.
Collapse
Affiliation(s)
- Mariachiara Benetti
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Luca Montresor
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| | - Daniele Cantarella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, 20122 Milan, Italy
| | - Nicoletta Zerman
- Department of Pediatric Dentistry and Dental Hygiene, University of Verona, Via San Marco 121, 37138 Verona, Italy
| | - Enrico Spinas
- Department of Surgical Science, Post Graduate School of Orthodontics, University of Cagliari, Via Ospedale, 01924 Cagliari, Italy
| |
Collapse
|
3
|
Liu C, Wang K, Jiang C, Zhao Y, Zhang Y, Zhang Q, Fan C, Liu Y. The short- and long-term changes of upper airway and alar in nongrowing patients treated with Mini-Implant Assisted Rapid Palatal Expansion (MARPE): a systematic review and meta-analysis. BMC Oral Health 2023; 23:820. [PMID: 37899429 PMCID: PMC10613376 DOI: 10.1186/s12903-023-03344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/22/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study aims to assess the short- and long-term changes in the upper airway and alar width after mini-implant -assisted rapid palatal expansion (MARPE) in nongrowing patients. METHODS Five electronic databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched up to 2 August, 2023 based on the PICOS principles. The main outcomes were classified into three groups: 1) nasal cavity changes, 2) upper airway changes and 3) alar changes. The mean difference (MD) and 95% confidence intervals (CI) were used to assess these changes. Heterogeneity tests, subgroup analyses, sensitivity analyses, and publication bias were also analyzed. RESULT Overall, 22 articles were included for data analysis. Nasal cavity width (WMD: 2.05 mm; 95% CI: 1.10, 3.00) and nasal floor width (WMD: 2.13 mm; 95% CI: 1.16, 3.11) increased significantly. While palatopharyngeal volume (WMD: 0.29 cm3, 95% CI: -0.44, 1.01), glossopharyngeal volume (WMD: 0.30 cm3, 95% CI: -0.29, 0.89) and hypopharyngeal volume (WMD: -0.90 cm3; 95% CI: -1.86, 0.06) remained unchanged, nasal cavity volume (WMD: 1.24 cm3, 95% CI: 0.68, 1.81), nasopharyngeal volume (MD: 0.75 cm3, 95% CI: 0.44, 1.06), oropharyngeal volume (WMD: 0.61 cm3, 95% CI: 0.35, 0.87), and total volume of the upper airway (WMD: 1.67 cm3, 95% CI: 0.68, 2.66) increased significantly. Alar width (WMD: 1.47 mm; 95% CI: 0.40, 2.55) and alar base width (WMD: 1.54 mm; 95% CI: 1.21, 1.87) also increased. CONCLUSION MARPE can increase nasal cavity width, nasal cavity volume, nasopharyngeal volume and oropharyngeal volume for nongrowing patients, but has no significant effect on hypopharyngeal volume. In addition, the alar width also increased. However, the studies included in this meta-analysis were mainly retrospective, nonrandomized and small in number, so the findings should be interpreted with caution and high-quality RCTs need to be studied.
Collapse
Affiliation(s)
- Cuiyu Liu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Kaixin Wang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266023, China
| | - Yang Zhao
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266023, China
| | - Yiyan Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Qianwen Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Cunhui Fan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
- School of Stomatology, Qingdao University, Qingdao, 266023, China.
| | - Yang Liu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
- School of Stomatology, Qingdao University, Qingdao, 266023, China.
| |
Collapse
|
4
|
Echarri-Nicolás J, González-Olmo MJ, Echarri-Labiondo P, Romero M. Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders. BMC Oral Health 2023; 23:714. [PMID: 37794400 PMCID: PMC10552363 DOI: 10.1186/s12903-023-03461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.
Collapse
Affiliation(s)
- Javier Echarri-Nicolás
- Doctoral Program in Health Sciences, International PhD School, Rey Juan Carlos University (URJC), Madrid, Spain
| | - María José González-Olmo
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain.
| | | | - Martin Romero
- Department of Orthodontics, University Rey Juan Carlos, Avda de Atenas S/N 28922, Alcorcón, Madrid, Spain
| |
Collapse
|
5
|
Steegman RM, Renkema AM, Schoeman A, Kuijpers-Jagtman AM, Ren Y. Volumetric changes in the upper airway on CBCT after dentofacial orthopedic interventions - a systematic review. Clin Oral Investig 2023; 27:5737-5754. [PMID: 37723313 PMCID: PMC10560168 DOI: 10.1007/s00784-023-05207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To provide a critical overview of the effect of various orthodontic and/or dentofacial orthopedic interventions on three-dimensional volumetric changes in the upper airway. MATERIALS AND METHODS Four databases were searched for clinical studies concerning 3D volumetric assessments based on CBCT before and after orthodontics interventions. The quality of the studies was assessed using the quality assessment tool of the National Heart, Lung and Blood Institute. After the use of inclusion and exclusion criteria, the pre-and post-treatment volumes were used to visualize the effect of various orthodontics interventions. RESULTS A total of 48 studies were included in this review and none of which were RCTs. The quality of all included studies was assessed as medium. Overall, there is a tendency for an increase in airway volumes after various orthodontic interventions, except for studies concerning extraction therapy with fixed appliances in adults, in which both increases and decreases in airway volumes have been reported. CONCLUSION Orthodontic treatment by growth modification and non-extraction therapy with fixed appliances, regardless of the malocclusion, generally showed positive effects on the airway volume. Orthodontic treatment in combination with extractions does not provide an unambiguous insight. A consensus on the methodology of the airway measurement and nomenclature is urgently needed in order to gain insight into the effect of different interventions on three-dimensional airway changes. CLINICAL RELEVANCE Various orthodontic treatments do not negatively influence the upper airway volume. However, extraction therapy in adults should be chosen with caution, especially in subjects belonging to a group susceptible to airway obstruction.
Collapse
Affiliation(s)
- Ralph M. Steegman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
- Zijlweg Orthodontie, Orthodontic Private Practice, Haarlem, The Netherlands
| | - Anne-Marie Renkema
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Adriaan Schoeman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, BB72 300001, Hanzeplein 1, Groningen, 9700RB The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430 Indonesia
| | - Yijin Ren
- Department of Orthodontics, W.J. Kolff Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Anéris FF, El Haje O, Rosário HD, de Menezes CC, Franzini CM, Custodio W. The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification. J World Fed Orthod 2023; 12:150-155. [PMID: 37344294 DOI: 10.1016/j.ejwf.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. METHODS This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n = 10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α = 0.05). RESULTS Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increase for all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P = 0.3356). CONCLUSIONS MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.
Collapse
Affiliation(s)
- Fábio Ferreira Anéris
- Graduate student, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Ossam El Haje
- Professor, Departament of Oral Biology, Univeristy Center UNIFACVEST, Lages, Santa Catarina, Brazil
| | - Henrique Damian Rosário
- Professor, Departament of Dentistry, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Carolina Carmo de Menezes
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - Cristina Maria Franzini
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil
| | - William Custodio
- Associate Professor, Department of Orthodontics, University Center of Hermínio Ometto Foundation-FHO, Araras, Sao Paulo, Brazil.
| |
Collapse
|
7
|
Hupp LC, Verius M, Kolk A, Steinbichler TB, Heppt H, Giotakis AI. The long-term effect of maxillary advancement and impaction on subjective and objective nasal patency: A retrospective case-control study. J Craniomaxillofac Surg 2023:S1010-5182(23)00081-1. [PMID: 37355368 DOI: 10.1016/j.jcms.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to investigate the change of nasal patency after maxillary advancement and impaction (MAXADV + IMP) in subjects with skeletal class III malocclusion (cases) and after removal of maxillary cysts in close proximity to the nasal floor in subjects that served as controls. NOSE score, volume derived by computed tomography (VOL), and acoustic rhinometry and rhinomanometry were retrospectively evaluated, before and one year after surgery. The movement of specific landmarks was also measured. NOSE score did not change after surgery, neither in 17 cases (p = 0.10) nor in 17 controls (p = 0.14). In cases, VOLpostop (10088 ± 4200 mm3) was significantly higher than VOLpreop (7807 ± 3721 mm3; p = 0.036). Maxillary advancement and inferior displacement of the ventral maxilla were noted by the movement of incisive foramen in the coronal (3.9 ± 5.4; p = 0.011) and Frankfurt Horizontal plane (2.2 ± 2.0; p = 0.001), respectively. In controls, VOLpostop (9749 ± 3654 mm3) was also significantly higher than VOLpreop (8473 ± 2624 mm3; p = 0.050). Cross-sectional areas, nasal flow and nasal resistance changed significantly after surgery in cases (6/30 pairs; p < 0.018), but not in controls (all p > 0.066). MAXADV + IMP increased nasal patency, but did not change the feeling of nasal breathing. Physicians should proceed with caution when informing patients about improvement of nasal breathing after MAXADV + IMP.
Collapse
Affiliation(s)
- Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
8
|
Three-Dimensional Evaluation Effects of Microimplant-Assisted Rapid Palatal Expansion on the Upper Airway Volume: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051790. [PMID: 36902577 PMCID: PMC10003187 DOI: 10.3390/jcm12051790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Microimplant-assisted rapid palatal expansion is increasingly used clinically; however, the effect on the upper airway volume in patients with maxillary transverse deficiency has not been thoroughly evaluated yet. The following electronic databases were searched up to August 2022: Medline via Ovid, Scopus, Embase, Web of Science, Cochrane Library, Google Scholar, and ProQuest. The reference lists of related articles were also reviewed by manual search. The Revised Cochrane Risk of Bias Tool for randomized trials (ROB2) and the Risk of Bias in non-randomized Studies of Interventions (ROBINS-I) tool were used to evaluate the risks of bias of the included studies. The mean differences (MD) and 95% confidence intervals (CI) of changes in nasal cavity and upper airway volume were analyzed using a random-effects model, and subgroup and sensitivity analyses were also performed. Two reviewers independently completed the process of screening studies, extracting data, and assessing the quality of studies. In total, twenty-one studies met the inclusion criteria. After assessing the full texts, only thirteen studies were included, with nine studies selected for quantitative synthesis. Oropharynx volume increased significantly after immediate expansion (WMD: 3156.84; 95% CI: 83.63, 6230.06); however, there was no significant change in nasal volume (WMD: 2527.23; 95% CI: -92.53, 5147.00) and nasopharynx volume (WMD: 1138.29; 95% CI: -52.04, 2328.61). After retention a period, significant increases were found in nasal volume (WMD: 3646.27; 95% CI: 1082.77, 6209.77) and nasopharynx volume (WMD: 1021.10; 95% CI: 597.11, 1445.08). However, there was no significant change after retention in oropharynx volume (WMD: 789.26; 95% CI: -171.25, 1749.76), palatopharynx volume (WMD: 795.13; 95% CI: -583.97, 2174.22), glossopharynx volume (WMD: 184.50; 95% CI: -1745.97, 2114.96), and hypopharynx volume (WMD: 39.85; 95% CI: -809.77, 889.46). MARPE appears to be linked with long-term increases in nasal and nasopharyngeal volume. However, high-quality clinical trials are required to further verify the effects of MARPE treatment on the upper airway.
Collapse
|
9
|
Karaman A, Güdük Z, Genc E. Evaluation of pharyngeal airway dimensions and cephalometric changes after premolar extraction and nonextraction orthodontic treatment in adolescent and adult patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101275. [PMID: 36064145 DOI: 10.1016/j.jormas.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/24/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of premolar extraction and non-extraction for orthodontic treatment on the skeletal, dentoalveolar and pharyngeal airway. MATERIAL AND METHOD The study was carried out with the radiographs of a total of 130 patients at the ages of 14 to 25, including 59 male and 71 female patients. The cases were divided into two groups as the "extraction" group(2 upper premolar teeth) (n = 66) and the "non extraction" group (n = 64). RESULTS Extraction Group:In both age groups, there was a statistically significant increase in the mean interincisal angle (U1xL1) and lower anterior facial height (ANS-Me) values(p < 0.05). In the 14-18 age group, there was a significant increase in the mean upper airway thickness, inferior airway space, hyoid position, soft palate length(PNSP) and upper pharynx values(p < 0.05). In both sexes, while the mean U1xL1 and ANS-Me values significantly increased, the mean upper incisors inclination values decreased significantly(p < 0.05). Non Extraction Group:In both age groups, the mean ANS-Me values increased significantly from T0 to T1(p < 0.05). In the 14-18 age group, the increase in the mean upper adenoid thickness, tongue length,PNSP, softpalate thickness and vertical airway length values was significant(p < 0.05). In the male patients, the mean U1xL1 value decreased significantly(p < 0.05). CONCLUSION The premolar teeth extraction performed in the patients receiving orthodontic treatment did not affect airway dimensions to a high extent.It was determined that the position of the hyoid bone and tongue length was not affected in the patients with premolar extraction and non extraction.
Collapse
Affiliation(s)
- Ahmet Karaman
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey.
| | - Zekeriya Güdük
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey
| | - Esra Genc
- Orthodontic private practice, Kayseri, Turkey
| |
Collapse
|
10
|
Muacevic A, Adler JR. Effects of Rapid Maxillary Expansion on Upper Airway Volume in Growing Children: A Three-Dimensional Cone-Beam Computed Tomography Study. Cureus 2023; 15:e34274. [PMID: 36855483 PMCID: PMC9968479 DOI: 10.7759/cureus.34274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Background: Rapid maxillary expansion (RME) is a common orthodontic procedure that widens the maxillary arch to treat moderate to mild overcrowding and transverse skeletal and dental abnormalities. Orthodontic equipment applies lateral tension on posterior maxilla teeth or palate mucosa to the mid-palatal suture. The maxilla may grow transversely when force is applied at right angles to the mid-palatal suture, which is usually inactive in children and adolescents. This study used cone-beam computed tomography (CBCT) and an authorized upper respiratory airway volume measurement approach to compare RME cohort pharyngeal airway volume changes to healthy controls. Materials and Methods: This retrospective analysis included 52 RME patients and 52 healthy controls. The RME category's expansion regimen entailed twisting the screw of expansion on a tooth-attached Hyrax-type expansion equipment by 0.25 mm daily for at least 14 days. After six months, a few RME participants used fixed orthodontic gear. The comparison group used fixed orthodontic appliances for minor malocclusions without extractions (without RME). CBCT scans from 1021 orthodontic patients who visited a dental hospital between 2012 and 2022 were examined. The registry comprised only anonymized photographs. Volume, minimum cross-sectional area (MCA), molar width, and inter-molar width were measured before and after therapy. Results: The control group had 12227.12 mm3 at T0 and 15805.54 mm3 at T1. The control group's T0-T1 volume difference was statistically significant (p = 0.007). The RME group has 12884.84 mm3 at T0 and 17471.08 mm3 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The volume RME effect was ±1011.92 and statistically insignificant. (p > 0.05). MCA in the control group was 126.04 mm2 at T0 and 170.61 mm2 at T1. MCA at T0 and T1 in the control group was statistically significant (p = 0.041). RME group MCA was 126.53 mm3 at T0 and 164.69 mm2 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The MCA, RME effect was 5.92 and statistically insignificant (p > 0.05). Both the control and RME groups had statistically significant volume and MCA differences at T0 and T1. However, the intergroup analysis showed no significant differences across the groups. Conclusion: Tooth-borne RME does not affect upper airway or MCA volume in children compared to controls. Upper airway changes were better with younger skeletal ages before treatment. The findings may aid RME for young children.
Collapse
Affiliation(s)
- Alexander Muacevic
- Orthodontics Department of Preventive Dental Sciences, Albaha University College of Dentistry, Albaha, SAU
| | - John R Adler
- Orthodontics Department of Preventive Dental Sciences, Albaha University College of Dentistry, Albaha, SAU
| |
Collapse
|
11
|
Yacout YM, El-Harouni NM, Madian AM. Dimensional changes of upper airway after slow vs rapid miniscrew-supported maxillary expansion in adolescents: a cone-beam computed tomography study. BMC Oral Health 2022; 22:529. [PMID: 36424571 PMCID: PMC9686034 DOI: 10.1186/s12903-022-02581-9] [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: 07/13/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To date, the effects of different activation rates of miniscrew-supported expanders on the airway have not been compared. Hence, the purpose of this retrospective study was to evaluate and compare the effects of slow and rapid miniscrew-supported maxillary expansion on the upper airway dimensions using cone-beam computed tomography (CBCT). METHODS Data of 20 patients (Age 12 to 16 years old) treated using miniscrew-supported expanders at the Faculty of Dentistry, Alexandria University was collected. The patients were equally divided into two groups according to the activation protocol; slow maxillary expansion (SME): activation once every other day, and rapid maxillary expansion (RME): activation twice daily. CBCT scans obtained pre-expansion and 5 months post-expansion were used to evaluate the changes in the upper airway dimensions. Comparisons between the two time points within each group were done using paired samples t-test. SME and RME groups were compared using independent samples t-test. Significance level was set at p < 0.05. RESULTS Both groups showed a significant increase in anterior, middle, and posterior nasal cavity width. SME resulted in significantly greater increase of the anterior nasal cavity width than RME (Mean difference between the groups, 2.64 mm; 95% CI, 0.83, 4.45; p = 0.007). The dimensions of the retropalatal and retroglossal airways did not change significantly in either group. Both groups resulted in a significant increase of maxillary width, palatal width, and inter-molar width. RME showed a significantly larger increase of inter-molar width than SME (Mean difference between the groups, - 2.44 mm; 95% CI, - 3.88, - 1.00; p = 0.002). CONCLUSIONS The use of either a slow or rapid activation protocol is effective in expanding the nasomaxillary complex, with greater expansion achieved in the anterior section of the nasal cavity using the slow rate. However, the expander design employed in the current study does not affect the dimensions of the retropalatal or retroglossal airways.
Collapse
Affiliation(s)
- Yomna M. Yacout
- grid.7155.60000 0001 2260 6941Department of Orthodontics, Faculty of Dentistry, Alexandria University, P. O. Box: 21521, Alexandria, Egypt
| | - Nadia M. El-Harouni
- grid.7155.60000 0001 2260 6941Department of Orthodontics, Faculty of Dentistry, Alexandria University, P. O. Box: 21521, Alexandria, Egypt
| | - Ahmed M. Madian
- grid.7155.60000 0001 2260 6941Department of Orthodontics, Faculty of Dentistry, Alexandria University, P. O. Box: 21521, Alexandria, Egypt
| |
Collapse
|
12
|
Effect of Maxillary Skeletal Expansion on Airflow Dynamics of the Upper Airway. J Craniofac Surg 2022; 33:1684-1689. [DOI: 10.1097/scs.0000000000008442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
|
13
|
Management of Class III Malocclusion and Maxillary Transverse Deficiency with Microimplant-Assisted Rapid Palatal Expansion (MARPE): A Case Report. Medicina (B Aires) 2022; 58:medicina58081052. [PMID: 36013519 PMCID: PMC9415682 DOI: 10.3390/medicina58081052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Microimplant-assisted rapid palatal expansion (MARPE) has been demonstrated successfully in maxillary expansion in late adolescence and adulthood. The maxillary advancement accompanied by expansion is frequently anticipated, which is beneficial for the treatment of class III malocclusion. Airway volume increase can also be noted in some cases from the measurement of cone beam computerized tomography (CBCT) after expansion. The objective of this case report is to demonstrate the feasibility of applying MARPE on late adolescence patients with maxillary transverse deficiency and to present the changes in transverse and anteroposterior dimensions as well as the volume increase in velopharyngeal airway after MARPE. A 15-year-old female presented class III skeletal pattern. She had maxillary transverse deficiency with moderate crowding and posterior/anterior crossbites. Maxillary Skeletal Expander (MSE; Biomaterials Korea Inc.) type-2 was used as a MARPE device in this case. After four weeks of maxillary expansion, a significant amount of expansion was achieved and the anterior crossbite was spontaneously corrected. Fixed appliance treatment was commenced four weeks after MARPE with 0.022-slot preadjusted brackets (MBT prescription). Temporary anchorage devices (TADs) were placed over the mandibular buccal shelves for posterior teeth distalization and crowding relief. After 25 months of treatment, the facial profile was improved with maxillary advancement (SNA: 83° to 83.5°) and mandibular backward rotation (SNB: 83° to 82°; SN-MP: 34.5° to 35°). In this case, MARPE not only engenders significant transverse correction but also aids in anteroposterior change. The treatment effects of maxillary advancement and mandibular backward rotation can lead to a more esthetic profile in skeletal class III cases.
Collapse
|
14
|
Kim A, Cho HJ, Choi EK, Choi YJ. Improvement of obstructive sleep apnea in a child with Down syndrome with rapid palatal expansion. J Clin Sleep Med 2022; 18:1885-1888. [PMID: 35332867 DOI: 10.5664/jcsm.9968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Children with Down syndrome (DS) have distinct orofacial structures that predispose them to sleep-disordered breathing. The management options for obstructive sleep apnea (OSA) include continuous positive airway pressure, adenotonsillectomy, mandibular advancement, and maxillary expansion. However, most of these treatment options are less effective or less viable for children with DS. Rapid maxillary expansion (RPE) with a fixed orthodontic appliance is a viable alternative for DS patients because it separates the mid-palatal suture and dilates the airway, regardless of the patient's adherence. We present a case of a 15-year-old boy with DS and severe OSA, which dramatically improved with RPE and subsequent orthodontic treatment. Although only the short-term changes have been presented in this report, this case emphasizes the need for further discussions on the viability of RPE for treating OSA in children with DS.
Collapse
Affiliation(s)
- Ahhyeon Kim
- Department of Orthodnotics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Kyoung Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Yoon Jeong Choi
- Department of Orthodnotics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| |
Collapse
|
15
|
Badreddine FR, Yamamoto LH, Besen A, Hoppe DPMR, Fujita RR, Cappellette Junior M. Three-dimensional image study of accelerated maxillary expansion in oral breathing kids. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S100-S107. [PMID: 35241386 PMCID: PMC9801038 DOI: 10.1016/j.bjorl.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/30/2021] [Accepted: 01/29/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved. METHODS 120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software. RESULTS The experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change. CONCLUSION Rapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood. LEVEL OF EVIDENCE The soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.
Collapse
Affiliation(s)
- Fauze Ramez Badreddine
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, São Paulo, SP, Brazil,Corresponding author.
| | - Lucia Hatsue Yamamoto
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, São Paulo, SP, Brazil
| | - Andre Besen
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, Especialista em Ortodontia e Ortopedia Facial, São Paulo, SP, Brazil
| | - Daniela Pimentel Machado Renófio Hoppe
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, São Paulo, SP, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, São Paulo, SP, Brazil
| | - Mario Cappellette Junior
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Disciplina de Otorrinolaringologia Pediátrica, São Paulo, SP, Brazil
| |
Collapse
|
16
|
Upper Airway Changes in Diverse Orthodontic Looms: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Upper airway assessment is particularly important in the daily work of orthodontists, because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Three-dimensional cone-beam computed tomography images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements. However, the association between upper airway dimensions and skeletal malocclusion is unclear. Therefore, the current systematic review evaluates the effects of different surgical movements on the upper airway. Materials and Methods: Medline (PubMed, OVID Medline, and EBSCO), Cochrane Library (Cochrane Review and Trails), Web of Knowledge (social science, and conference abstracts), Embase (European studies, pharmacological literature, and conference abstracts), CINAHL (nursing and allied health), PsycInfo (psychology and psychiatry), SCOPUS (conference abstracts, and scientific web pages), and ERIC (education) databases were searched. Two authors independently performed the literature search, selection, quality assessment, and data extraction. Inclusion criteria encompassed computed tomography evaluations of the upper airway spaces with retrospective, prospective, and randomised clinical trial study designs. To grade the methodological quality of the included studies a GRADE risk of bias tool was used. Results and conclusion: In total, 29 studies were included. Among these, 17 studies had a low risk of bias, whereas 10 studies had a moderate risk of bias. A meta-analysis was performed with the mean differences using a fixed-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (p ≤ 0.001, 95% confidence interval) increases in upper airway volume after rapid maxillary expansion and surgical advancement for the correction of Class II.
Collapse
|
17
|
An effective simulation- and measurement-based workflow for enhanced diagnostics in rhinology. Med Biol Eng Comput 2021; 60:365-391. [PMID: 34950998 PMCID: PMC8766630 DOI: 10.1007/s11517-021-02446-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 08/20/2021] [Indexed: 11/02/2022]
Abstract
Physics-based analyses have the potential to consolidate and substantiate medical diagnoses in rhinology. Such methods are frequently subject to intense investigations in research. However, they are not used in clinical applications, yet. One issue preventing their direct integration is that these methods are commonly developed as isolated solutions which do not consider the whole chain of data processing from initial medical to higher valued data. This manuscript presents a workflow that incorporates the whole data processing pipeline based on a Jupyter environment. Therefore, medical image data are fully automatically pre-processed by machine learning algorithms. The resulting geometries employed for the simulations on high-performance computing systems reach an accuracy of up to 99.5% compared to manually segmented geometries. Additionally, the user is enabled to upload and visualize 4-phase rhinomanometry data. Subsequent analysis and visualization of the simulation outcome extend the results of standardized diagnostic methods by a physically sound interpretation. Along with a detailed presentation of the methodologies, the capabilities of the workflow are demonstrated by evaluating an exemplary medical case. The pipeline output is compared to 4-phase rhinomanometry data. The comparison underlines the functionality of the pipeline. However, it also illustrates the influence of mucosa swelling on the simulation. Graphical Abstract Workflow for enhanced diagnostics in rhinology.
Collapse
|
18
|
Jia H, Zhuang L, Zhang N, Bian Y, Li S. Age-dependent effects of transverse maxillary deficiency treated by microimplant-assisted rapid palatal expansion: A prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2021; 161:557-573. [PMID: 34903419 DOI: 10.1016/j.ajodo.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study investigated the results of maxillary discrepancy treated by microimplant-assisted rapid palatal expansion (MARPE) at different ages. METHODS Sixty patients (aged 11.0-34.1 years; 23 male and 37 female) were treated by MARPE. Cone-beam computed tomography scans and dental casts were taken before and after expansion. The data were compared among 4 age groups: early adolescents (aged 11-14 years), late adolescents (aged 15-19 years), young adults (aged 20-24 years), and old adults (aged 25-34.1 years). RESULTS The success rates of midpalatal suture separation were 100%, 100%, 88.2%, and 85.7% for early adolescents, late adolescents, young adults, and old adults, respectively. Palatal sutures at the level of the first molar were expanded by 4.02 mm, 3.48 mm, 2.63 mm, and 2.10 mm, corresponding to 66.7%, 58.1%, 42.0%, and 37.9% of the total dental expansion. Significant differences were found in the amounts of palatal suture expansion and the ratio of skeletal dental expansion between patients aged <20 years and patients aged ≥20 years (P <0.05). Skeletal expansion constituted 69.4%, 51.3%, 39.0%, and 29.8% of the total screw expansion. Except for the comparison between young adults and old adults, there were significant differences between groups for the ratio of skeletal screw expansion (P <0.05). CONCLUSIONS The midpalatal suture can be expanded by MARPE more easily in patients <20 years of age than in patients ≥20 years of age. The ratio of skeletal screw expansion decreases as age increases.
Collapse
Affiliation(s)
- Haichao Jia
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China.
| | - Li Zhuang
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Yuanyuan Bian
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Song Li
- Department of Orthodontics, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China.
| |
Collapse
|
19
|
Cone beam CT evaluation of skeletal and nasomaxillary complex volume changes after rapid maxillary expansion in OSA children. Sleep Med 2021; 86:81-89. [PMID: 34479051 DOI: 10.1016/j.sleep.2021.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). METHODS 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). RESULTS In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. CONCLUSION RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.
Collapse
|
20
|
Cheung GC, Dalci O, Mustac S, Papageorgiou SN, Hammond S, Darendeliler MA, Papadopoulou AK. The upper airway volume effects produced by Hyrax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial. Eur J Orthod 2021; 43:254-264. [PMID: 32377675 DOI: 10.1093/ejo/cjaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six patients, 10-16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. RESULTS Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1-3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). CONCLUSIONS RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. LIMITATIONS Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. HARMS Keles expanders blocked during activations and required substitution for completion of treatment. PROTOCOL The protocol was not published before trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).
Collapse
Affiliation(s)
- Gordon C Cheung
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Simone Mustac
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shanya Hammond
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney; Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, Australia
| |
Collapse
|
21
|
Computational Fluid Dynamics Analysis of Nasal Airway Changes after Treatment with C-Expander. Appl Bionics Biomech 2021; 2021:8874833. [PMID: 33868456 PMCID: PMC8032540 DOI: 10.1155/2021/8874833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
The use of the C-expander is an effective treatment modality for maxillary skeletal deficiencies which can cause ailments and significantly reduce life expectancy in late adolescents and young adults. However, the morphological and dynamic effects on the nasal airway have not been reported. The main goal of this study was to evaluate the nasal airway changes after the implementation of a C-expander. A sample of nine patients (8 females, 1 male, age range from 15 to 29 years) was included. The morphology parameters and nasal airway ventilation parameters of pretreatment and posttreatment were measured. All study data were normally distributed. A paired t-test was used to evaluate the changes before and after treatment. After expansion, the mean and standard deviation values of intercanine maxillary width (CMW) and intermolar maxillary width (MMW) increased from 35.75 ± 2.48 mm and 54.20 ± 3.17 mm to 37.87 ± 2.26 mm (P < 0.05) and 56.65 ± 3.10 mm (P < 0.05), respectively. The nasal cavity volume increased from 20320.00 ± 3468.25 mm3 to 23134.70 ± 3918.84 mm3 (P < 0.05). The nasal pressure drop decreased from 36.34 ± 3.99 Pa to 30.70 ± 3.17 Pa (P < 0.05), while the value of the maximum velocity decreased from 6.50 ± 0.31 m/s to 5.85 ± 0.37 m/s (P < 0.05). Nasal resistance dropped remarkably from 0.16 ± 0.14 Pa/ml/s to 0.08 ± 0.06 Pa/ml/s (P < 0.05). The use of C-expander can effectively broaden the area and volume of the nasal airway, having a positive effect in the reduction of nasal resistance and improvement of nasal airway ventilation. For patients suffering from maxillary width deficiency and respiratory disorders, a C-expander may be an alternative method to treat the disease.
Collapse
|
22
|
Mehta S, Wang D, Kuo CL, Mu J, Vich ML, Allareddy V, Tadinada A, Yadav S. Long-term effects of mini-screw-assisted rapid palatal expansion on airway. Angle Orthod 2021; 91:195-205. [PMID: 33315060 DOI: 10.2319/062520-586.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate the long-term effects on airway in patients with mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis. MATERIALS AND METHODS A total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated. RESULTS Both MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume. CONCLUSIONS There was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.
Collapse
|
23
|
Does Mini Screw Assisted Rapid Palatal Expansion (MARPE) have an influence on airway and breathing in middle-aged children and adolescents? A systematic review. Int Orthod 2021; 19:37-50. [DOI: 10.1016/j.ortho.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 12/20/2022]
|
24
|
Li J, Shi L, Zhang X, Weng L, Chen H, Lin J. Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics. J Zhejiang Univ Sci B 2021; 22:146-155. [PMID: 33615755 DOI: 10.1631/jzus.b2000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Juan Li
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lingfang Shi
- Department of Stomatology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China
| | - Xiayao Zhang
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luxi Weng
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong Chen
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Jun Lin
- Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| |
Collapse
|
25
|
Tang H, Liu P, Xu Q, Hou Y, Guo J. A comparative analysis of aerodynamic and anatomic characteristics of upper airway before and after mini-implant-assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2021; 159:e301-e310. [PMID: 33541787 DOI: 10.1016/j.ajodo.2020.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective of this research was to observe changes in aerodynamics and anatomic characteristics of the upper airway after mini-implants assisted rapid maxillary expansion and to evaluate the correlation between the 2 changes of the upper airway in young adults. METHODS Thirty consecutive patients (mean age, 23.82 ± 3.90 years; median, 24.5 years; 9 males, 21 females) were involved. Cone-beam computed tomography was taken before activation and over 3 months. Three-dimensional models of the upper airway were reconstructed on the basis of cone-beam computed tomography. The anatomic characteristics of the upper airway, including volume, area, transverse, and sagittal diameter, were measured. The aerodynamic characteristics of the upper airway were calculated on the basis of 3-dimensional models using computational fluid dynamics. The correlation between the changes in aerodynamics and anatomic characteristics of the upper airway was explored. RESULTS The enlargements of the volume of the total pharynx, nasopharynx, and oropharynx were found (9.99%, 20.7%, and 8.84%, respectively). The minimum cross-sectional area increased significantly (13.6%). The airway resistance (R) and maximum velocity (Vmax) decreased significantly in both the inspiration and expiration phase (inspiration: R, -26.8%, Vmax, -15.7%; expiration: R, -24.7%, Vmax, -16.5%). The minimum wall shear stress reduced significantly only in the inspiration phase (-26.3%). The correlations between decreased R and increased volume and minimum cross-sectional area were observed. CONCLUSIONS Mini-implants assisted rapid maxillary expansion is an effective device for improving anatomic characteristics represented by the total volume of the upper airway and minimum cross-sectional area, which contributed to the respiratory function depending on the favorable changes of aerodynamic characteristics including resistance, velocity, and minimum wall shear stress.
Collapse
Affiliation(s)
- Hongyi Tang
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - Panpan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - Qiuping Xu
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - Yingyue Hou
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Shandong Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China.
| |
Collapse
|
26
|
Chuang YH, Chen JH, Ho KH, Wang KL, Hsieh SC, Chang HM. The role of micro-implant-assisted rapid palatal expansion (MARPE) in clinical orthodontics — a literature review. AUSTRALASIAN ORTHODONTIC JOURNAL 2021. [DOI: 10.21307/aoj-2021.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
A maxillary transverse deficiency is a common craniofacial problem. Rapid palatal expansion (RPE) has been traditionally considered for the treatment of children and young adolescents, but this is not applicable in late adolescents or adults due to the ossification of facial sutures. A surgically assisted rapid palatal expansion (SARPE) was initially advocated for this group of patients, but the surgical procedure is associated with morbidity. As temporary anchorage devices (TADs) have been recently and popularly applied in clinical orthodontics, micro-implant-assisted rapid palatal expansion (MARPE) has been employed to facilitate maxillary expansion in skeletally mature patients. There have been various proposed MARPE designs and the outcomes appear promising. The aim of the present article is to discuss the role of MARPE in clinical orthodontics by reviewing its background, design, indications, treatment effects, stability, and limitations in the current literature. The treatment effects of two types of MARPE, bone-borne and tooth-bone-borne (hybrid), will be individually assessed.
Collapse
Affiliation(s)
- Yun-Hsuan Chuang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Jen-Hsuan Chen
- DDS, Oromaxillofacial Department, Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kwok-Hing Ho
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Kai-Long Wang
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Shun-Chu Hsieh
- DDS, Orthodontic Department, Chang Bing Show Chwan Memorial Hospital , Changhua , Taiwan
| | - Heng-Ming Chang
- Chang Bing Show Chwan Memorial Hospital Changhua County , Changhua , Taiwan
| |
Collapse
|
27
|
Ahn HW, Kang YG, Jeong HJ, Park YG. Palatal temporary skeletal anchorage devices (TSADs): What to know and how to do? Orthod Craniofac Res 2020; 24 Suppl 1:66-74. [PMID: 33278057 DOI: 10.1111/ocr.12451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/09/2020] [Accepted: 11/29/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Since palatal temporary skeletal anchorage devices (TSADs) have become important tools for orthodontic treatment, this narrative review was aimed to provide an updated and integrated guidelines for the clinical application of palatal TSADs. SETTING AND SAMPLE POPULATION A narrative review article including researches on palatal TSADs in orthodontics related to anatomy, success rate and clinical application. MATERIALS AND METHODS The anatomical characteristics, success rate and its consideration factors and clinical application of palatal TSADs based on the direction of tooth movement were evaluated. RESULTS To improve the stability of TSADs, hard tissue factors such as bone depth, cortical bone thickness, bone density and soft tissue thickness were evaluated. Anatomically risky structures, including the nasopalatine foramen, canal and the greater palatine foramen, nerve, vessel need to be identified before placement. The success rate of palatal TSADs was greater than that of the buccal inter-radicular space. Palatal TSADs have been used for various purposes because they can control tooth movement in all directions and, three-dimensionally; their applications include the retraction of anterior teeth, protraction of posterior teeth, distalization, intrusion, expansion and constriction. They can be applied directly or indirectly to the lingual arch or transpalatal arch. Design modifications using splinted 2 miniscrews have been suggested. CONCLUSION Palatal TSADs allow clinicians to perform minimally invasive and easy placement with good stability by understanding the anatomical characteristics of the palatal region, and they show good control over 3-dimensional tooth movements in various clinical cases.
Collapse
Affiliation(s)
- Hyo-Won Ahn
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Yoon-Goo Kang
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Hyun-Joo Jeong
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Young-Guk Park
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
28
|
Sánchez-Riofrío D, Viñas MJ, Ustrell-Torrent JM. CBCT and CAD-CAM technology to design a minimally invasive maxillary expander. BMC Oral Health 2020; 20:303. [PMID: 33148234 PMCID: PMC7641819 DOI: 10.1186/s12903-020-01292-3] [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: 06/19/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background A large number of articles in recent years studying the effects of non-surgically assisted tooth- versus bone-borne maxillary expanders in growing patients have found no significant differences in mid-palatal suture disjunction or even dentoalveolar changes. This suggests the need for new criteria and better use of current technology to make more effective devices and enhance the benefits of conventional treatments. This article describes a titanium grade V computer-aided design/computer-aided manufacturing (CAD/CAM) maxillary expander supported by two miniscrews, along with a 3D printed surgical guide. Methods The first step was to obtain a digitized model of the patient’s upper maxilla. To simplify the process and ensure the placement of the device in a high-quality bone area, the patients’ digital dental cast was superimposed with a cone beam computed tomography (CBCT) scan. Improved resistance to expansion forces was secured through the use of 2 mm-wide miniscrews, long enough for bicortical anchorage. Placement site and direction were assessed individually in order to achieve primary stability. We chose a site between the second premolars and first molars, while the inclination followed the natural contour of the palate vault. A 3D-printed, polyamide surgical guide was designed to ensure the correct placement of the device with a manual straight driver.
Results Favorable clinical results were presented with 3D images. We confirmed a mid-palatal suture parallel separation of 3.63 mm, along with a higher palatal volume, as well as increased intercanine and intermolar distance. Segmentation of the facial soft tissue showed an expansion of nasal airways and changes in nasal morphology. Conclusions Digital models, CBCT and CAD/CAM technology, are essential to accomplish the goals proposed in this article. Further studies are necessary to establish safer miniscrew placement sites and insertion angles so as to achieve greater in-treatment stability. Both the clinician and the patient can benefit from the use of current technology, creating new devices and updating traditional orthodontic procedures.
Collapse
Affiliation(s)
- Diego Sánchez-Riofrío
- Universitat de Barcelona, Feixa Llarga s/n. Pavelló de Govern 2ª pl. Office 2.7, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Universidad Espíritu Santo, Samborondón Campus, Km. 2.5 vía La Puntilla, Samborondón, Ecuador.
| | - María J Viñas
- Faculty of Dentistry, Universidad Complutense de Madrid, Ciudad Universitaria, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Josep M Ustrell-Torrent
- Director Master of Orthodontics, Dental School, Universitat de Barcelona, Feixa Llarga s/n. Pavelló de Govern 2ª pl. Office 2.7, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| |
Collapse
|
29
|
Baik HS, Kang YG, Choi YJ. Miniscrew-assisted rapid palatal expansion: A review of recent reports. J World Fed Orthod 2020; 9:S54-S58. [PMID: 33023733 DOI: 10.1016/j.ejwf.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
The miniscrew-assisted rapid palatal expander (MARPE) has extended not only skeletal effects with fewer dental changes and but also the age limit of nonsurgical maxillary expansion treatment. Amid its gaining popularity in clinical orthodontics, our current understanding of treatment effectiveness, efficiency, and stability needs to be reassessed. In this review article, the authors have attempted to evaluate MARPE from various aspects with a focus on recent studies.
Collapse
Affiliation(s)
- Hyoung-Seon Baik
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon-Goo Kang
- Department of Orthodontics, Kyung Hee University, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| |
Collapse
|
30
|
Yoon A, Abdelwahab M, Liu S, Oh J, Suh H, Trieu M, Kang K, Silva D. Impact of rapid palatal expansion on the internal nasal valve and obstructive nasal symptoms in children. Sleep Breath 2020; 25:1019-1027. [PMID: 32648185 DOI: 10.1007/s11325-020-02140-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the impact of rapid palatal expansion (RPE) on the nasal airway subjectively by utilizing patient-reported outcome measures (PROM) and objectively by evaluating validated internal nasal valve (INV) measurements obtained from cone beam computed tomography (CBCT) in pediatrics. MATERIALS AND METHODS In this retrospective cohort study, subjects who underwent RPE from March to December 2018 with cone beam CT and Nasal Obstruction Symptom Evaluation (NOSE) scores were included. Exclusion criteria included craniofacial deformity, allergies, asthma, recent nasal trauma, or surgery. INV measurements (angle and cross-sectional area), diastema, midpalatal suture opening, and NOSE scores were evaluated. RESULTS Fifty-one subjects met the inclusion criteria with a mean age of 10.1 ± 2.6. Pre-expansion mean NOSE score was 32.55 (moderate) while post-expansion was 13.92 (mild). Mean NOSE score improved significantly by an average of 18.63 following post-expansion (P < 0.0001). The patients' right and left INV angles increased significantly by a mean of 2.42° and 2.65° respectively (P < 0.0001). Right and left INV cross-sectional areas increased significantly by an average of 14.35 mm2 (P < 0.0001) and 14.17 mm2 (P < 0.0001) respectively. An average expansion of the diastema and the suture was 1.60 mm and 3.05 mm respectively (P < 0.0001), with an average of 6.29 mm of expansion. We found the amount of diastema expansion to correlate with change in NOSE score (R = - 0.32, P = 0.022). Age and diastema showed a negative correlation (R = - 0.44, P = 0.0019), while INV angle and diastema showed a statistically significant positive correlation (R = 0.28, P = 0.048). CONCLUSIONS RPE showed improvement in both NOSE scores and objective measures of the INV. This may show the possibility of considering RPE in managing resistant pediatric nasal airways. Future studies should include collaboration with pediatric otolaryngologists, with the inclusion of pediatric patients with persistent nasal obstruction.
Collapse
Affiliation(s)
- Audrey Yoon
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.,Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, 94103, USA
| | - Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA.,Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - James Oh
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Heeyeon Suh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, 94103, USA
| | - Michael Trieu
- UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Kevin Kang
- UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Daniela Silva
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.
| |
Collapse
|
31
|
Li Q, Tang H, Liu X, Luo Q, Jiang Z, Martin D, Guo J. Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion. Angle Orthod 2020; 90:432-441. [PMID: 33378437 PMCID: PMC8032299 DOI: 10.2319/080919-522.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate changes in dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion (MARME) and observe correlations between changes of upper airway and vertical skeletal pattern in young adults. MATERIALS AND METHODS In this retrospective study, 22 patients (mean age, 22.6 ± 4.5 years; 4 male 18 female) with transverse discrepancy underwent MARME. Cone beam computed tomography was taken before and 3 months after expansion. Vertical and horizontal dimensions and volume of the nasal cavity, nasopharyngeal, retropalatal, retroglossal and hypopharyngeal airway were compared before and after MARME. Correlations between changed volume and dimensions were explored, as well as the vertical skeletal pattern. RESULTS Nasal osseous width, maxillary width, volume of the nasal cavity and nasopharynx increased significantly (P < .05). Enlarged nasopharyngeal volume correlated with increased nasal width at the PNS plane (P < .05). There were no correlations between expanded volume and maxillary width. No measurements except nasal cavity volume had a correlation with Sum angle. Increased maxillary width correlated negatively with hard palate thickness (P < .05). CONCLUSIONS (1) MARME caused an increase in volume of the nasal cavity and nasopharynx, with expansion of nasal osseous width and maxillary width. (2) Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed no direct relation with increased volume. (3) In this study, it was unclear about the association between changes of the upper airway and vertical skeletal pattern because of complex structures. (4) Palate thickness affected skeletal expansion of the maxilla in MARME.
Collapse
|
32
|
Chang HP, Chen YF, Du JK. Obstructive sleep apnea treatment in adults. Kaohsiung J Med Sci 2019; 36:7-12. [PMID: 31512369 DOI: 10.1002/kjm2.12130] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/21/2019] [Indexed: 11/07/2022] Open
Abstract
Sleep-related breathing disorders are complex problems that decrease quality of life and increase morbidity and mortality in patients. Comprehensive evaluation is essential for selecting and planning obstructive sleep apnea (OSA) treatments. However, the many proposed OSA treatments are rarely compared in the literature. The literature on OSA consists largely of case series studies, and the paucity of controlled studies makes comparisons of OSA treatments difficult. This article provides a brief overview of the most common OSA interventions. Because of the controversies and unanswered questions about OSA treatments, further studies are needed to define what treatments are best for specific OSA patients.
Collapse
Affiliation(s)
- Hong-Po Chang
- School of Dentistry and Graduate Program of Dental Science, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dentistry (Orthodontics), Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Chen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Institute of Oral Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Je-Kang Du
- School of Dentistry and Graduate Program of Dental Science, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Prosthodontics, Faculty of Dentistry, Kaohsiung Medical University, Hospital, Kaohsiung, Taiwan
| |
Collapse
|
33
|
Abdalla Y, Brown L, Sonnesen L. Effects of rapid maxillary expansion on upper airway volume: A three-dimensional cone-beam computed tomography study. Angle Orthod 2019; 89:917-923. [PMID: 30942607 DOI: 10.2319/101218-738.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare changes in pharyngeal airway volume and minimal cross-sectional area (MCA) between patients undergoing rapid maxillary expansion (RME) and a matched control group and to identify markers for predicting airway changes using cone-beam computed tomography (CBCT). MATERIALS AND METHODS Pre- and posttreatment CBCT scans were selected of children who had RME (14 girls and 12 boys; mean age, 12.4 years) along with scans of a control group (matched for chronological age, skeletal age, gender, mandibular inclination) who underwent orthodontic treatment for minor malocclusions without RME. Changes in airway volume and MCA were evaluated using a standardized, previously validated method and analyzed by a mixed-effects linear regression model. RESULTS Upper airway volume and MCA increased significantly over time for both the RME and matched control groups (P < .01 and P = .05, respectively). Although the RME group showed a greater increase when compared with the matched controls, this difference was not statistically significant. A reduced skeletal age before treatment was a significant marker for a positive effect on the upper airway volume and MCA changes (P < .01). CONCLUSIONS Tooth-borne RME is not associated with a significant change in upper airway volume or MCA in children when compared with controls. The younger the skeletal age before treatment, the more positive the effect on the upper airway changes. The results may prove valuable, especially in RME of young children.
Collapse
|
34
|
Storto CJ, Garcez AS, Suzuki H, Cusmanich KG, Elkenawy I, Moon W, Suzuki SS. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion. Angle Orthod 2019; 89:713-720. [PMID: 30896250 DOI: 10.2319/070518-504.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). MATERIALS AND METHODS Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. RESULTS There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. CONCLUSIONS Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.
Collapse
|
35
|
Kavand G, Lagravère M, Kula K, Stewart K, Ghoneima A. Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion. Angle Orthod 2019; 89:566-574. [PMID: 30768911 DOI: 10.2319/070818-507.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare changes in upper airway volume after maxillary expansion with bone- and tooth-borne appliances in adolescents and to evaluate the dentoskeletal effects of each expansion modality. MATERIALS AND METHODS This retrospective study included 36 adolescents who had bilateral maxillary crossbite and received bone-borne maxillary expansion (average age: 14.7 years) or tooth-borne maxillary expansion (average age: 14.4 years). Subjects had two cone beam computed tomography images acquired, one before expansion (T1) and a second after a 3-month retention period (T2). Images were oriented, and three-dimensional airway volume and dentoskeletal expansion were measured. Analysis of variance was used to test for differences between the two expansion methods for pretreatment, posttreatment, and prepost changes. Paired t-tests were used to test for significance of prepost changes within each method. RESULTS Both groups showed significant increase only in nasal cavity and nasopharynx volume (P < .05), but not oropharynx and maxillary sinus volumes. Intermolar and maxillary width increased significantly in both groups (P < .05); however, the buccal inclination of maxillary molars increased significantly only in the tooth-borne group (P < .05). There was no significant difference between tooth- and bone-borne expansion groups, except for the significantly larger increase in buccal inclination of the maxillary right first molar after tooth-borne expansion. CONCLUSIONS In adolescents, both tooth- and bone-borne RME resulted in an increase in nasal cavity and nasopharynx volume, as well as expansion in maxillary intermolar and skeletal widths. However, only tooth-borne expanders caused significant buccal tipping of maxillary molars.
Collapse
|