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Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.

For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. After a sufficient amount of flap is made available, it is gently introduced through the osteotomy gap until it reaches the palatal mucosa defect and is then sutured. In the patient case presented, the palatal mucosa healed fully within 18 days, and the patient reported no nasal regurgitation of food, defective speech, fetid odour, bad taste, or upper respiratory tract or ear infection during the postoperative period. This technique using a BFP flap should therefore be considered in the context of unexpected tearing of the palatal mucosa in patients undergoing a segmented Le Fort I osteotomy.

Maxillary canines are the second most commonly impacted teeth. Two thirds of these impacted canines are palatal, and one third are labially impacted. Maxillary labial impactions comprise approximately 0.33% to 0.75% of the general population. Like palatal impactions, preventive and interceptive methods can be employed to help the impacted tooth erupt and avoid surgical uncovering. Early extraction of appropriate primary teeth and palatal expansion has helped some of these impactions erupt spontaneously. Most labially impacted canines are positioned "in the slot," in a midalveolar location between the lateral incisor and first premolar. If they do not erupt after preventive or interceptive means, they can be managed with simple closed-eruption uncovering techniques. The most difficult labial impactions are ectopically positioned. These are usually horizontally positioned, mesial to the lateral incisor. They can be very apically positioned, near the base of the nose and near the midline. The rarest labial impaction occurs between the central and lateral incisors or between the premolars. These are extremely rare and require special orthodontic and uncovering techniques. All of these ectopic impactions require a technique that leaves the impacted tooth uncovered so the orthodontist can employ the proper mechanics to move these teeth without damage to adjacent structures. This article elucidates the surgical uncovering techniques and the orthodontic mechanics to successfully move these teeth and minimize root resorption, bone loss, and recession.

© 2022 Elsevier Inc.Objective: This study aims to compare the changes in the nasal airway volume and nasal airflow using acoustic rhinometry (AR), rhinomanometry (RMN), and dental volumetric tomography (DVT) after surgically assisted rapid maxillary expansion (SARME). Study Design: Our study consists of 13 adults, 3 male and 10 female patients, aged between 15 and 26, with completed skeletal development. In our study, DVT imaging was obtained twice, preoperation and 3 months after expansion. AR and RMN measurements were recorded, and Visual Analog Score (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) Scale surveys were scored at preoperation and 3 months after expansion. Nasopharyngeal-oropharyngeal airway volume and areas were calculated using the Romexis 3.8.3.R (Planmeca, Helsinki, Finland) and Nemotec V2019 (Madrid, Spain) software programs. IBM SPSS Statistics 22 (SPSS IBM, Armonk, New York) was used for statistical analysis. Results: Comparing the preoperation and postexpansion measurements by both software programs revealed a statistically significant increase in the nasopharyngeal airway volume. No statistically significant change was observed in the oropharyngeal airway volume. Furthermore, we found a statistically significant increase in VAS but a significant decrease in NOSE. Conclusion: According to our findings, nasal airway volume increased after SARME, and although there was no significant change in nasal resistance, patients’ quality of life increased significantly.

Evaluate the treatment effects of maxillary protraction using palatal plates and compare them to those with conventional tooth-borne anchorage in growing patients with Class III malocclusion.Forty patients were divided into 2 groups according to the type of anchorage used: group 1 (n = 20; mean age, 10.5 ± 1.6 years; palatal plates) and group 2 (n = 20; mean age, 10.0 ± 1.2 years; tooth-borne appliances). Lateral cephalograms were taken before and after maxillary protraction. Skeletal, dental, and soft-tissue variables were measured. For statistical analysis, paired and independent t tests were performed.Group 1 showed maxilla advancement by 2.3 ± 1.0 mm compared with group 2 by 0.9 ± 0.6 mm, and group 2 indicated clockwise rotation of the mandible, but there was no such clockwise rotation in group 1 (P 0.001). Group 1 had a less lingual inclination of the mandibular incisors than group 2 (IMPA, -1.0 ± 3.8° vs -3.8 ± 2.8°; P 0.05). There was no difference in soft-tissue changes between the 2 groups.A facemask with palatal plate induced maxillary advancement with less mandibular clockwise rotation and dental movement than conventional tooth-borne anchorage. This modality can be used efficiently for maxillary protraction in growing patients with Class III malocclusion.

This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR).An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools.The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy.The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.

© 2022 Elsevier Inc.Objective: The objective of this study was to evaluate the effects of nonsurgical rapid maxillary expansion (RME) and surgically assisted RME (SARME) on palatal morphology and upper arch dimensions using three-dimensional (3D) models in skeletally mature patients. Study Design: Thirty-eight skeletally mature patients with a maxillary transverse deficiency were divided into RME and SARME groups. Nineteen patients in the RME group (mean age, 19.16 ± 2.25 years) were treated using a full-coverage bonded acrylic splint expander; 19 patients in the SARME group (mean age, 20.38 ± 3.36) were treated using the banded palatal expansion appliance with hyrax screws. The 3D models were obtained before and after expansion. The maxillary dental arch widths, maxillary first molar angulation, palatal area, and palatal volume were calculated on the 3D models. Results: All variables showed statistically significant changes after the retention period (P < .001). The maxillary arch width between first premolars (P < .05), the palatal area (P < .01), and the palatal volume (P < .05) significantly increased in the SARME group compared to the RME group. The maxillary first molar tipping in the RME group was significantly higher than that in the SARME group (P < .01). Conclusions: Although SARME has more positive effects in skeletally mature patients, nonsurgical RME can be considered as an alternative by evaluating surgical risks, periodontal status, and the need for skeletal expansion.

Children with Down syndrome (DS) have distinct orofacial structures that predispose them to sleep-disordered breathing. The management options for obstructive sleep apnea 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 with a fixed orthodontic appliance is a viable alternative for DS patients because it separates the midpalatal suture and dilates the airway, regardless of the patient’s compliance. We present a case of a 15-year-old boy with DS and severe obstructive sleep apnea, which dramatically improved with rapid maxillary expansion 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 rapid maxillary expansion for treating obstructive sleep apnea in children with DS. CITATION: Kim A, Cho HJ, Choi EK, Choi YJ. Improvement in obstructive sleep apnea in a child with Down syndrome with rapid palatal expansion. J Clin Sleep Med. 2022;18(7):1885–1888.

Maxillary expansion is one of the treatment options for the correction of the skeletal constriction of the upper jaw. However, evidence regarding the best treatment effects with the use of rapid vs. slow maxillary expansion in the early adolescence period (i.e., between the age of 12 and 16 years) is still lacking in the available literature.The aim of the present study was to investigate the effectiveness of rapid and slow maxillary expansion in treating posterior skeletal constriction, and to compare the 2 techniques in terms of skeletal and dentoalveolar changes by using cone-beam computed tomography (CBCT).The sample consisted of 34 patients (15 males and 19 females) suffering from posterior skeletal constriction. They were randomly allocated either to the rapid maxillary expansion (RME) group (17 patients aged 13.76 ±0.32 years) or to the slow maxillary expansion (SME) group (17 patients aged 14.02 ±0.28 years). The skeletal and dental landmarks, and changes in the posterior dimensions were examined using CBCT radiographs at the beginning of treatment (T1) and at the end of the observation period (T2).There were no significant differences between the 2 groups in terms of skeletal and dental changes except the amount of change in the inter-premolar width at the root apex, which was greater in the SME group (p = 0.007), as well as the amount of change in the skeletal palatal width in the molar region, which was also greater in the SME group (p = 0.008).Both maxillary expansion protocols were effective in treating posterior skeletal constriction. The average changes in the skeletal and dental widths were generally similar in both groups. Therefore, SME can be considered as an alternative to RME in patients with skeletal maxillary constriction in the early adolescence period.

The present study aimed to evaluate the consequences of rapid maxillary expansion in the buccal bone thickness and dehiscence of subjects with unilateral cleft lip and palate.This prospective cohort study consisted of 30 participants, 20 males and 10 females, between 8 and 15 years old. Participants were allocated into 3 groups, according to the type of maxillary constriction, and were treated with different types of expanders: G1, hyrax; G2, fan-type; G3, inverted mini-hyrax. Cone-beam computed tomography scans were performed immediately before treatment and after 90 days of retention. Linear measurements were obtained by the same calibrated and blinded examiner.An average of 0.8 mm decrease in buccal bone thickness (P 0.001) and a 0.5 mm increase in dehiscence (P 0.001) were observed. There was no significant difference between the cleft and noncleft side for all variables (P 0.05), as there was no significant difference between groups (P 0.05).The findings in this study allow the conclusion that the orthopedic forces of rapid maxillary expansion lead to a decrease in the posterior buccal bone volume in unilateral cleft lip and palate patients.

Purpose. The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods. Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon ( n = 23 ), PAOO ( n = 28 ), and MARPE ( n = 28 ) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results. All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area Conclusions. All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.

This parallel cohort study aimed to assess the dentoalveolar, skeletal, periodontal, and airway effects of tooth-borne (hyrax) and computer-guided miniscrew-supported rapid palatal expansion appliances.Thirty-six subjects were randomly allocated into 2 groups. Eighteen subjects (mean age, 12.2 years; male-to-female ratio, 10:8) were assigned to receive treatment with the hyrax appliance (group A), and 18 subjects were treated with the computer-guided miniscrew-supported appliance (group B). The same type of expansion screw and expansion protocol was used in both groups. Linear and angular measurements of skeletal, dentoalveolar, periodontal, and nasal floor changes were performed on the pretreatment and posttreatment cone-beam computed tomography images (6-month follow-up). Descriptive statistics and the independent Student t test were used for the statistical analysis. Intraoperator reliability was evaluated using a 2 sample t test. The level of significance was P ≤0.05.Ten subjects were censured because posttreatment cone-beam computed tomography imaging was not performed because of the coronavirus disease 2019 pandemic. In the remaining 26 subjects, increases in linear measurements were observed in both groups. The transversal skeletal increase was greater and statistically significant in the group treated with the bone-borne expander (P ≤0.05). The dentoalveolar transverse diameters were greater in the tooth-supported expander group, with no statistically significant difference between the groups. The buccal inclination of the maxillary first molar was observed in the group with the tooth-borne expander, with a statistically significant difference between the 2 groups. A slight reduction of buccal and palatal thicknesses at the level of the maxillary first molars was observed in both groups, smaller in the skeletal expander group, with a statistically significant difference between the 2 groups only on the right buccal cortical plate. The width of the nasal floor increased more in the group with skeletal expander with a statistically significant difference of 2 mm.Computer-guided miniscrew-supported maxillary expanders allowed a greater transversal increase of the nasal-maxillary skeletal structures by reducing the dentoalveolar side effects of the tooth-supported devices.

The aim of this study was to assess the effects of reverse headgear (RHG) treatment combined with rapid maxillary expansion (RME) on the trabecular structure of the mandibula using fractal dimension (FD) analysis.Forty-four individuals with skeletal Class III malocclusion were selected from the archives and divided into two groups as patients who underwent treatment with RME + RHG (RHG-G, 22 patients) and untreated control group (C-G, 22 patients). The before (T0) and after (T1) treatment lateral cephalometric and panoramic radiographs were collected in the RHG-G and in the control group, radiographs obtained with similar time intervals were grouped as T0 and T1. Cephalometric and FD analysis was conducted on T0 and T1 lateral cephalometric and panoramic radiographs. The intragroup comparison of cephalometric and FD data was performed using paired t test and Wilcoxon Signed Ranks test, while independent t test and Mann-Whitney U test were used for intergroup comparison.C-G had higher FD values in the right mandibular corpus and left mandibular ramus values at T0 (P .05). The only significant difference in the intragroup comparisons was detected in the FD values of the right mandibular corpus in the C-G (P .05). No significant differences were found in the FD between the groups in any of the areas measured (P .05).RME + RHG therapy did not cause any significant trabecular changes in the mandibula when compared to the control group.

The purpose of this study was to use cone-beam computed tomography to compare immediate and long-term effects of conventional and miniscrew-assisted rapid palatal expansion (MARPE) appliances on root resorption in 2 treatment groups and a control group.One hundred eighty cone-beam computed tomography images of 60 patients at 3 time points were assessed: initial, postexpansion, and debond. The patients were divided into 3 groups: control (n = 19), rapid palatal expansion (RPE) appliance (n = 21), and MARPE (n = 20). The period of initial to debond varied for the 3 groups: 2 years, 7 months for controls; 2 years, 9 months for RPE; and 2 years, 8 months for MARPE. The length of mesiobuccal, distobuccal, and palatal root of the maxillary first molar (1M); the buccal root of maxillary first premolar; and second premolar were measured. The inclination of the 1M, intercuspal width (ICW), interroot width (IRW), ICW/IRW ratio, maxillary skeletal width were measured in all 3 groups at different time points.Immediately after expansion, RPE and MARPE groups showed a significant increase in the molar inclination, ICW, ICW/IRW ratio, and maxillary skeletal width compared with controls at postexpansion. However, the long-term comparison did not show any significant difference for root resorption and expansion parameters between the 3 groups, except the ICW/IRW ratio, which was higher in MARPE than controls at debond. A significant negative association was observed between the length of the mesiobuccal root of 1M and molar inclination (β = -0.025; 95% confidence interval, -0.050 to 0.0008; P 0.05). The expansion of ICW and IRW did not show a significant association with root resorption.The long-term outcomes showed no difference in the amount of root resorption between the RPE, MARPE, and control groups. Molar inclination showed a significant negative association with the length of the mesiobuccal root of the 1M.

The purpose of this study was to evaluate maxillary expansion, operative time and pain associated with a new minimally invasive surgical technique to treat maxillary hypoplasia in adult patients. Consecutive patients were included and prospectively analyzed. The technique consists in miniscrew-assisted rapid palatal expansion (MARPE), minimally invasive approach to maxillary osteotomies, latency period and activation period until the desired expansion. The parameters evaluated included operative time, treatment-related pain by the visual analog scale (VAS), and transverse maxillary expansion. The Shapiro-Wilk test was used to assess the normality of data distribution. A paired t-test was used to compare the data between T0 (preoperative) and T1 (postoperative - end of activation). The significance level was set at 5%. Eleven patients were included. Mean operative time was 24.11 min (14.4-32 min) and overall postoperative VAS score was 2.81 (0-9). A comparative analysis showed significant increases in maxillary width at the skeletal, alveolar, and dental levels (p 0.0001 for all), with a mean range of 1.8 (SD 0.3) mm to 4.7 (SD 0.5) mm. The present minimally invasive surgical MARPE (MISMARPE) technique appears to yield good skeletal outcomes with minimal trauma. It might have potential for clinical use, but larger comparative studies are needed to confirm the clinical relevance of the approach.

Objective To compare the 2 surgically assisted rapid maxillary expansion (SARME) techniques, the conventional 2-segment osteotomy between maxillary central incisors and the 3-segment osteotomy between maxillary lateral incisors and canines bilaterally. Authors hypothesized that the 3-piece would provide better bone expansion. Study Design A pilot study was conducted; 19 patients were divided into 2 groups: conventional 2-segment osteotomy (10 patients) and 3-segment osteotomy (9 patients). Dental and skeletal measurements of the preoperative and postoperative cone beam computed tomography images were analyzed. Pre- and postoperative periodontal probing was performed, patients’ cosmetic perception was evaluated in a colored visual analog scale (VAS), and surgical time was measured with a regular chronometer. Results Three-segment SARME resulted in greater bone expansion (5.12 vs 6.20 mm; P = .016), less molar inclination (7.16 vs 3.57 degrees; P = .028), better patient cosmetic perception (3.13 vs 7.68 in a VAS; P = .000), and longer surgical time (43 vs 52 minutes; P = .026). Furthermore, the 2-segment group presented necrosis of 1 central incisor. Conclusions Results suggest that 3-piece SARME is more effective for bone expansion of the maxilla.

Introduction This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health–related quality of life (OHRQOL) in children. Methods Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after the appliance removal (T3). Generalized mixed models were used for data analysis (α = 0.05). Results Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. Conclusions Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. Registration This trial was not registered. Protocol The protocol was not published before trial commencement. Funding This study was financed by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior – Brazil, Financing Code 001.

The aims of this study were to evaluate the effects of systemic administration of Salvia officinalis Linnaeus (L.) leaf extract on new bone formation in the expanded premaxillary suture in rats in vivo and to examine the antioxidant effects and phenolic profile of Salvia officinalis (SO) leaf and root extracts in vitro.Fourteen male Sprague Dawley rats were allocated to two groups: SO group (n = 7) and control group (n = 7). An open-loop spring was attached to the upper incisors of each rat to expand the premaxillae. A 5-day expansion period followed by a 12-day retention period was observed. The rats in the SO group received systemic administration of 20 mg SO/kg/day via the orogastric route for 17 days. Histomorphometric examinations were carried out to examine the amount of new bone formation, number of capillaries, and intensity of inflammatory cell response. Immunohistochemical analysis was conducted to examine the number of osteoblasts and osteoclasts. Leaf and root extracts of SO were also analyzed for antioxidant activity and phenolic compounds in vitro.Statistical analysis showed that the following were higher in the SO group than in the control group: new bone formation, number of osteoblasts and osteoclasts, intensity of inflammatory cell response (neutrophils, lymphocytes, and macrophages), and number of capillaries. The major compound identified in SO leaf extract was rosmarinic acid, while luteolin derivatives, salvianolic acid F, and medioresinol were also present.Salvia officinalis L. from leaf extract provided antioxidant effects and stimulated enhanced new bone formation in the expanded midpalatal suture after maxillary expansion in rats.ZIELSETZUNG: Ziele dieser Studie waren die Bewertung der Auswirkungen einer systemischen Verabreichung von Salvia officinalis Linnaeus (L.) auf die Knochenneubildung in der erweiterten prämaxillären Naht bei Ratten unter In-vivo-Bedingungen sowie die Untersuchung der antioxidativen Wirkungen und des phenolischen Profils von Salvia officinalis(SO)-Extrakten unter In-vitro-Bedingungen.Vierzehn männliche Sprague-Dawley-Ratten wurden 2 Gruppen zugeordnet: SO- (n = 7) und Kontrollgruppe (n = 7). An den oberen Schneidezähnen jeder Ratte wurde eine offene Feder zur prämaxillären Erweiterung angebracht. Untersucht wurden eine 5‑tägige Expansionsperiode, gefolgt von einer 12-tägigen Retentionsdauer. Den Ratten in der SO-Gruppe wurde 17 Tage lang 20 mg SO/kg/Tag über eine orogastrale Sonde verabreicht. Histomorphometrische Untersuchungen wurden durchgeführt, um die Menge der Knochenneubildung, die Anzahl der Kapillaren und die Intensität der Entzündungszellen zu ermitteln, ferner eine immunhistochemische Analyse, um die Anzahl der Osteoblasten und Osteoklasten zu bestimmen. Blatt- und Wurzelextrakte von SO wurden zudem in vitro auf antioxidative Aktivität und phenolische Verbindungen analysiert.Die statistische Analyse hat gezeigt, dass die Knochenneubildung, die Anzahl der Osteoblasten und Osteoklasten, die Intensität der Entzündungszellen sowie die Anzahl der Kapillaren in der SO-Gruppe höher waren als in der Kontrollgruppe. Die wichtigste im SO-Blattextrakt identifizierte Verbindung war Rosmarinsäure, zusätzlich waren Luteolinderivate, Salvianolsäure F und Medioresinol nachweisbar.Der Salvia-officinalis-L.-Blattextrakt hatte antioxidative Wirkungen und stimulierte die erhöhte Knochenneubildung in der erweiterten mittleren Gaumennaht nach Expansion des Oberkiefers bei Ratten.

To evaluate dental and skeletal changes caused by surgically assisted rapid palatal expansion (SARPE) using the superimposition of three-dimensional cone-beam computed tomography (CBCT) images on the cranial base.This is a retrospective quasi-experiment before-and-after study using a convenience sample. Twenty-four adult patients (13 male and 11 female) were evaluated before SARPE (T0), immediately after expansion (T1), and after 6 months of retention (T2). CBCT scans were superimposed on the anterior cranial base using voxel-based registration. Measurements from different reference points were used for comparisons between times.At T1, all teeth had significant buccal tipping. At T2, most teeth remained in the same position as at T1, except the first premolar and the first molar, whose buccal roots moved slightly. The amount of bony expansion was 65 to 70% of the amount of tooth movement. The A point and maxillary incisors moved anteriorly from T0 to T1 and T2 (p 0.0001). Inter-nasal distance had increased significantly at T1 (p 0.0001) and remained stable at T2 (p = 0.478). No expansion was achieved at the zygomatic arch (p = 0.114).SARPE promoted substantial buccal tipping of posterior teeth and some bone displacement; it also moved the maxilla and teeth forward and increased nasal width.No other clinical studies have evaluated dental and skeletal changes caused by SARPE using superimposition of 3D CBCT images on the cranial base. This study findings may help clinical dentists plan treatments using safe and reliable information.

To compare, using cone-beam computed tomography, the dentoskeletal changes in rapid maxillary expansion with tooth-bone-borne (Hybrid Hyrax) and tooth-borne (Hyrax) appliances.Forty-two patients who met the eligibility criteria (aged 11-14 years; transverse maxillary deficiency, posterior crossbite, and presence of upper first premolars and molars) were screened and allocated into two groups: HHG (treatment with Hybrid Hyrax) and HG (treatment with Hyrax).The primary outcomes included nasomaxillary dimensional changes. CBCT was performed before and 3 months after the activation phase. Measurements were performed using DolphinThe premolar region in HHG showed increased skeletal changes than in HG, with the difference being 1.5 mm (0.5; 2.6) in the nasal cavity (P = .004), 1.4 mm (0.3; 2.5) in the nasal floor (P = .019), and 1.1 mm (0.2; 2.1) in the maxilla (P = .022). The molar region in HHG showed increased skeletal changes with the difference being 0.9 mm (0.2; 1.5) in the nasal cavity (P = .005), and 0.9 mm (0; 1.8) in the maxilla (P = .042) than in HG. Premolar inclination was higher in HG.Hybrid Hyrax showed more skeletal changes and fewer dental side effects, especially in the first premolar region. The amount of activation influenced the higher nasal skeletal changes in the Hybrid hyrax group.

International audience; AimPrimary sleep bruxism (SB) affects between 6 and 30% of children and adolescents. Its frequency increases with age, reaching a peak at 10–14 years of age, after which it drops until adulthood. The treatment of SB has not been extensively documented, resulting in a lack of reference points and legitimate concerns for dentists in their everyday practice. The aim of this literature review was to summarize the available evidence on the management of SB in children and adolescents and the efficacy of the different approaches.MethodA systematic literature search was conducted according to PRISMA guidelines from January 2006 to December 2020 using the PubMed, The Cochrane Library, Science Direct, and Google Scholar databases. All types of SB treatment were accepted. Eight studies were selected for their protocol quality, according to the PICOS tool.ResultsSeveral treatment methods were assessed from the eight clinical studies selected, such as occlusal splint, palatal expansion, and pharmacological treatment. Assessment of the treatment methods was difficult because only eight studies were selected, and both the treatment methods and the study protocols used were different. The therapeutic strategies found in the literature were based on the general condition of the case. Treatment approaches were distinguished into treatments for isolated SB and those for SB associated with ventilatory disorders.ConclusionThe current study shows the need to define diagnostic criteria adapted to SB in children in order to improve epidemiological surveys and subsequently clinical practice. To overcome the difficulties related to SB diagnostic criteria, a multidisciplinary approach, involving pediatricians, otorhinolaryngologists, and dental practitioners, is essential for a better management and follow-up of young patients. A case-by-case approach, taking into account the specificities of each young patient, seems the most appropriate management today.

Objectives To evaluate the long-term effects of mini-screw–assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT). Materials and Methods A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion–ANS height, ANS–PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated. Results The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls. Conclusions MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.

Maxillary skeletal expansion (MSE) provides a new nonsurgical method for the treatment of patients with insufficient maxillary arch expansion width. In this study the aerodynamic changes of the upper airway after MSE in adult patients were explored based on three-dimensional reconstruction technology of cone-beam computed tomographic data and the numerical simulation technology of computational fluid dynamics. An upper airway experimental model was then created based on three-dimensional printing technology and tested in vitro to verify the reliability of the numerical simulation method. The comparison between numerical simulation and experimental results shows that the 2 results are in good agreement. The results of numerical simulation showed that the cross-sectional area of the upper airway was increased after MSE, the pressure and velocity of the upper airway were reduced, and airway resistance was also reduced during exhalation and inhalation. This study shows that MSE can effectively improve the airway dynamics of patients.

PURPOSE Otitis media with effusion (OME), recurrent acute otitis media and conductive hearing loss (CHL) are significantly prevalent in children with cleft palate (CP) and cleft lip and palate (CLP). Rapid Maxillary Expansion (RME) appears to have a positive effect also on middle ear disorders in these patients. The study aims to offer a prospective evaluation of RME effects in a group of patients with CP/CLP in terms of OME, CHL. METHODS A prospective observational study was conducted. Thirty-four CP, CLP and submucosa cleft patients who received orthodontic indication to RME treatment for OME or conductive hearing loss in a tertiary institutional Care Unit of San Paolo Hospital, Milan (IT), were included. Twenty-two patients matched for age and with analogous inclusion criteria except for indication to RME treatment were enrolled in the control group. Clinical otolaryngological evaluation, pure tone audiometry and tympanogram were performed at the beginning of treatment (T0), at the end of the expansion (T1) and at 6-month follow-up (T2). MAIN OUTCOME MEASURES Air-bone gaps and tympanogram results at each time interval. RESULTS In the main group, RME allowed a statistically significant improvement of air-bone gaps (according to frequency, p

Background The objective of this study was to evaluate the short-term and long-term effects of tooth-anchored and bone-anchored maxillary expansion appliances on the condyle–fossa relationship, compared to those in a matched control group. Another objective of the study was to evaluate whether the amount of dental and skeletal expansion is correlated with the condyle–fossa relationship. Methods A total of 180 cone-beam computed tomography scans (CBCTs) for 60 subjects were analyzed for 3 groups: 1) bone-anchored maxillary expansion (BA; n = 20); 2) tooth-anchored maxillary expansion (TA; n = 21); and 3) controls (n = 19) at pretreatment, post-expansion (T2), and post-treatment (T3). The posterior joint space (PJS), superior joint space (SJS), anterior joint space, angle of mandibular condyle, distance of the condyle to the mid-sagittal plane, the inter-molar cuspal width, and the skeletal maxillary width (SMW) were measured for all 3 groups. Results Both BA and TA led to a significant increase in inter-molar cuspal width, SMW, and TA led to a significant increase in PJS as compared to controls at T2. However, there was no significant difference in the joint spaces between the BA, TA, and control groups in the long term. Both the BA and TA groups showed a significant increase in SMW at T3 compared to the control group. Molar extrusion showed a weak correlation with PJS at T2 (r = 0.46) and T3 (r = 0.51), and a moderate correlation with SJS at T2 (r = 0.61) and T3 (r = 0.69). Conclusions TA led to a significant increase in PJS, compared to a control group, at T2, but there was no long-term difference in the condyle–fossa relationship among the BA, TA, and control groups. Molar extrusion showed moderate correlation with SJS and PJS.

Objectives This study aimed to assess the success rate and the amount of suture separation after the miniscrew-assisted rapid palatal expansion (MARPE) procedure in relation to the chronological age and sex of the patients. Materials and methods The periapical radiographs of 215 subjects (95 male; 120 female; range, 6–60 years) who had undergone MARPE treatment were retrospectively analyzed. The success of suture separation was determined and, in suture-separated subjects, the amount of suture separation was evaluated by suture separation ratio calculated from the periapical radiograph obtained after active expansion. Association tests were performed using linear-by-linear association, the Jonckheere-Terpstra test, Fisher’s exact test, and the Mann–Whitney U test, and linear regression models were also developed. Results The success rate of suture separation was 61.05% in male, 94.17% in female, and 79.53% in both sexes. There was a statistically significant association between older age and suture nonseparation in male (p p = 0.221). In suture-separated subjects, there was a statistically significant trend toward a low amount of suture separation with older age subgroups in both sexes (p Conclusions Older patients treated with MARPE, particularly in male, may have a reduced likelihood of both success in suture separation and sufficient basal bone expansion. Clinical relevance This study demonstrates that clinicians should consider that the success rate of MARPE and the amount of suture separation may depend on chronological age and sex.

The objectives of this study were to assess the changes in right vs left nasal cavity volumes and minimum cross-sectional width, nasopharyngeal, and oropharyngeal volumes of the upper airway in response to rapid maxillary expansion (RME).Pretreatment and posttreatment cone-beam computed tomography scans of 28 patients with a mean age of 9.86 ± 2.43 years and 20 age- and sex-matched controls were digitized and linear, angular, and volumetric measurements were obtained.Nasopharyngeal volume, right, and left nasal cavity volumes, and minimum cross-sectional widths increased significantly 2 years post RME (P 0.05). These measurements did not show any significant increase in the control group (P 0.05), whereas the oropharyngeal volume increase for both groups was comparable (P = 0.92). In the experimental group, the right and left nasal cavity volumes were not significantly different at baseline or posttreatment. However, the change that occurred was significantly larger for the left nasal cavity. This change for the control group was more significant for the right nasal cavity. Maxillary right and left molar inclinations were positively correlated to the nasal cavity volume, showing that the more buccally inclined the maxillary molars were, the smaller the nasal cavity volume.Nasopharyngeal and right and left nasal cavity volumes and minimum cross-sectional widths increase significantly after RME in young children. Expansion decreases the degree of difference in volume between the right and left nasal cavities. The buccal inclination of maxillary molars is correlated with nasal cavity volume.

To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected.The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4).The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons.Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

Background Patients with unilateral cleft lip and palate were associated with different nasomaxillary complex from the normal population. Although the biomechanical effects of conventional rapid palatal expansion (Hyrax expansion) and bone-borne rapid palatal expansion (micro-implant-assisted expansion) in non-cleft patients have been identified by multiple studies, little is known in patients with unilateral cleft lip and palate. The purpose of this study was to investigate and compare the biomechanical effects of the conventional and bone-borne palatal expanders in a late adolescence with unilateral cleft lip and palate. Methods A cone beam CT scan of a late adolescence with unilateral cleft lip and palate was selected to construct the three-dimensional finite element models of teeth and craniofacial structures. The models of conventional and born-borne palatal expanders were established to simulate the clinical maxillary expansion. The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacements in craniofacial structures and teeth. Results Bone-borne palatal expander achieved more transverse movement than conventional palatal expander in the whole mount of craniofacial regions, and the maximum amount of expansion was occurred anteriorly along the alveolar ridge on cleft-side. The expanding force from born-borne palatal expander resulted in more advancement in nasomaxillary complex than it in conventional palatal expander, especially in the anterior area of the minor segment of maxilla. Stresses from the both expanders distributed in similar patterns, but larger magnitudes and ranges were generated using the bone-borne expander around the maxillary buttresses and pterygoid plates of sphenoid bone. The maximum expanding stresses from born-borne palatal expander were concentrated on palatal slope supporting minscrews, whereas those from conventional palatal expander were concentrated on the anchoring molars. In addition, the buccal tipping effect of teeth generated using the bone-borne expander was less than it using the conventional palatal expander. Conclusion Bone-borne expander generated enhanced skeletal expansion at the levels of alveolar and palate in transversal direction, where the miniscrews contributed increased expanding forces to maxillary buttresses and decreased forces to buccal alveolar. Bone-borne expanders presented a superiority in correcting the asymmetric maxilla without surgical assistant in late adolescence with unilateral cleft lip and palate.

Background No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients. Objective The objective of this systematic review was to compare PROMs in RME versus SME in growing patients. Materials and Methods Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied. Results Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P I2 = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction. Conclusions Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.

In this case study, we report the successful treatment of a 35-year-old woman with a hyperdivergent skeletal pattern, open bite and severe transverse deficiency, exhibiting a skeletal Class III malocclusion. The treatment plan included 3D correction of these issues with surgically assisted rapid maxillary expansion (SARME) to solve the transverse deficiency, presurgical orthodontic treatment including aligning and levelling of the teeth in both arches, LeFort I osteotomy and bilateral sagittal split ramus osteotomy, and postsurgical correction of malocclusion. Orthodontic treatment was performed with labial brackets, and the patient achieved satisfactory occlusion and a significantly improved facial profile. Retention at the 1-year follow-up showed stable occlusion and arch forms with a harmonious facial profile.

INTRODUCTION The management of multiple dimensions in orthognathic surgery often requires careful planning. Too large discrepancies could require a sequential procedure to make alignment of the archs possible. REPORT OF CASE The authors report a case of a 30-year-old partially edentulous man with severe maxillary hypoplasia caused by an untreated ankyloglossia. The transverse deficiency was estimated at more than 15 mm and the sagittal discrepancy shows a negative overjet of 11.5 mm. These wide deficits needed a 2-step surgery and the use of computed-aided design/computed-aided manufacturing. The first step was a palatal expansion by a fan-shaped Le Fort I osteotomy. The second step treated sagittal discrepancy and re-expanded the maxilla.At the end, the sagittal dimension got normal and the maxilla have been widened to almost 7 mm. CONCLUSION Custom-made surgery is very useful for uncommon cases, in particular for toothless patients. It facilitates complex operations and allows precise results.

The aim of this review article is to identify and present an overview on the effects of different palatal expansion device on periodontium. Orthodontic treatment is a popular option for adolescents and adult patients for achieving better alignment of teeth and better esthetics. Palatal expansion technique is useful in treatment of patients’ malocclusion. With newer palatal expansion devices, patient’s malocclusion can be treated in better way. It is important to understand that oral hygiene plays an important role in the maintenance of periodontal health during orthodontic treatment. In adult patients, regular monitoring regarding the periodontal health should be performed prior to and during orthodontic treatment.

Background The purpose of the study was to evaluate dental and skeletal changes induced by tooth-bone–borne, tooth-tissue–borne, and tooth-borne rapid maxillary expansion (RME) appliances using postero-anterior (PA) cephalometric radiographs. Methods A total of 54 patients’ (25 boys, 29 girls) PA cephalometric radiographs who had bilateral posterior crossbite and RME treatment were included and divided into three groups according to the type of appliance used during treatment: tooth-bone–borne RME appliance (hybrid Hyrax) (7 boys, 11 girls, mean age 13.28 ± 1.20 years), tooth-tissue–borne RME appliance (TTB) (8 boys, 10 girls, mean age 13.08 ± 1.06 years) and tooth-borne RME appliance (Hyrax) (10 boys, 8 girls, mean age 12.05 ± 1.35 years). Pretreatment (T0) and posttreatment (T1) PA cephalometric radiographs were analyzed with Dolphin software v. 11.7 (Chatsworth, CA). The comparisons of the groups were performed with Two-way analysis of variance. P Results Significant and equal increase of right molar relationship and upper intermolar molar widths occurred in all groups. Dental midline discrepancy showed significant increase in only hybrid Hyrax group between T0 and T1. Significant increases were reported for lateronasal width in hybrid Hyrax and tooth-tissue–borne groups (P Conclusions Both skeletal and dental changes were observed after RME in all groups. However, the greatest skeletal changes were seen in hybrid Hyrax and tooth-tissue-borne groups.

Introduction The aim of this prospective study was to assess the 3-dimensional skeletal and dental effects induced by a new maxillary protraction approach using customized miniplates for anchorage compared with a control group of traditional tooth-borne maxillary protraction. Methods Forty-one growing patients at prepubescent stage with skeletal Class III malocclusion participated in this study. These patients were randomly split into 2 groups. In group 1 (n = 20), patients underwent maxillary protraction anchored with customized miniplates. The miniplates were individually designed and inserted using the surgical templates. In group 2 (n = 21), patients underwent tooth-borne maxillary protraction. Pretreatment and posttreatment cone-beam computed tomography scans were obtained, and 30 measurements of cone-beam computed tomography images were acquired and calculated. The changes after treatment and the comparison of the 2 groups were assessed. Results After maxillary protraction, group 1 showed a greater forward movement of the maxilla than group 2. The maxilla length increased more in group 1 than in group 2. The rotations of the palatal and mandibular planes in group 1 were less than those in group 2. In group 1, the maxillary incisors proclined less, the mandibular incisors retroclined less, and the maxillary first molars extruded less. Conclusions Compared with tooth-borne maxillary protraction, customized miniplates anchored maxillary protraction produced more maxillary growth, fewer dental changes, and less maxillary and mandibular plane rotation.

Summary Objective To assess the stability of the effects of the modified Alt-RAMEC and facial mask (FM) protocol at a post-pubertal observation. Methods Twenty-one Class III patients (11 males and 10 females, 6.5 ± 0.7 years) treated consecutively with the Alt-RAMEC/FM approach and presenting with lateral cephalograms taken before treatment (T1), after treatment (T2), and at post-pubertal observations (T3) were compared with 22 Class III patients (9 males and 13 females, 6.9 ± 1.2 years) treated with the rapid maxillary expansion (RME) and FM protocol and with 15 Class III untreated subjects (7 males and 8 females, 6.2 ± 2.2 years). At T3, all patients showed a post-pubertal skeletal maturation stage (CS4–CS6). Descriptive statistics and statistical comparisons between the three groups at T1 and for the T3–T1, T2–T1, and T3–T2 changes were assessed by means of the ANOVA or Kruskal–Wallis test. Results During the overall observation period, Alt-RAMEC/FM and RME/FM protocols produced statistically significant favourable effects when compared with the Control group (ANB + 2.8° and +2.2°, respectively; Wits appraisal +4.4 mm and +2.7 mm, respectively). No statistically significant differences were found between the outcomes of the Alt-RAMEC/FM and RME/FM protocols neither at the post-pubertal or short-term observations. Limitations Retrospective study and the comparison with an historical control sample of subjects with untreated Class III malocclusion. Conclusions The Alt-RAMEC/FM protocol cannot be recommended as the approach of choice for the therapy of Class III dentoskeletal disharmony in very young subjects compared to the conventional RME/FM protocol.

Objective The aim of this study was to compare and assess the pain perception, anxiety, and discomfort between two different rapid maxillary expansion (RME) protocols in patients with unilateral cleft lip and palate (UCLP). Design This is a prospective study. Setting The study was done in a comprehensive cleft care center. Patien and Participants The sample included 26 patients between ages 6 and 9 years with a history of repaired UCLP. Interventions The patients were randomly allotted into 2 groups—Group A and Group B. Group A received 1 RME activation per day and Group B received 2 activations per day. The participants after RME activation completed a self-report questionnaire and ranked the pain and anxiety levels using Faces pain scale and Hamilton anxiety scale, respectively. The evaluation was done every day for 1 week. Main Outcome Measure The Faces Pain Scale, Hamilton Anxiety Scale, and self-report questionnaires assessed the pain, anxiety, and discomfort experienced by the patients after 2 different types of RME activation protocols. Results Group B experienced significantly higher pain in the molars than Group A ( P Conclusion Patients who received 2 activations per day experienced significantly higher levels of pain in the molars compared to the patients who received a single activation per day. There were no significant differences between the 2 activation protocols in terms of pain in the palate, tongue, anxiety, and jaw discomfort.

Objective To investigate the effects of different lactoferrin concentrations on mid-palatal suture bone remodeling during palatal expansion and relapse in rats. Materials and methods Thirty-two 5-week-old male Wistar rats were randomly divided into four groups: EO (expansion only), E+LF1 (expansion plus 10 mg/kg/day daily LF), E+LF2 (expansion plus 100 mg/kg/day daily LF), and E+LF3 (expansion plus 1 g/kg/day daily LF). Thereafter, micro-computed tomography and micro-morphology of the mid-palatal suture were analyzed on day 7 and day 14, respectively. Results The arch widths were increased in all the four groups after expansion, and there was no significant difference among them on day 7. After relapse, however, the arch width in the E+LF3 group was significantly larger compared with EO group. In E+LF3 group and E+LF2 group, new bone formation and osteoblast number were enhanced with up-regulated expression of osteocalcin and collagen type I, while the expression of cathepsin K-positive cells was downregulated in E+LF3 group. Conclusion Lactoferrin gavage administration might increase the stability of palatal expansion and reduce relapse in a concentration-dependent manner by enhancing bone formation and inhibiting resorption. LF administration may be promising for optimizing the maxillary expansion outcome.

Objectives To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur. Materials and Methods This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity. Results The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X–2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%–32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = −0.56 to −0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%–66% of the variation in skeletal expansion. Conclusions This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.

Introduction The objective of this study was to evaluate short and long-term results of the application of the alternate rapid maxillary expansion/constriction (Alt-RAMEC) technique in patients with skeletal Class III malocclusion. Methods Forty-two white patients were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 12.7 ± 1.6 years (range, 9.4-15.9 years) before protraction. The average age at long-term follow-up was 19.4 ± 2.8 years (range, 17.2-26.9 years). A sample of nontreated patients with Class III malocclusion from the archives of orthognatic surgery in our hospital was used as a control group. The initial records were matched for sex, the severity of Class III malocclusion, and age (mean, 12.1 ± 1.4 years; range, 9.7-14.1 years) with the old records available in the archive. The control sample had records presurgery (mean, 19.8 ± 2.2 years; range, 16.6-21.6 years). Results The sagittal advancement of A-point, after the application of the technique, was 5.43 ± 2.71 mm. Some mandibular dentoalveolar adaptation was noted. The position of the maxilla was stable in the long term. In contrast, the control group showed limited growth at the maxillary level during the long-term follow-up period. Conclusions Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by Class III spring or elastic traction, 24 h/d, allows for satisfactory maxillary protraction, with stable long-term results. The comparison with a sample of matched nontreated patients with Class III malocclusion allowed to suggest the positive effect of the treatment on the maxillary position vs the natural evolution of the Class III skeletal discrepancy.

International audience; The highlighting of the role of craniofacial abnormalities in the development of obstructive sleep apnea syndrome has led to the development of different surgical procedures. Static craniofacial measures and dynamic airway collapse patterns are helpful to target surgical treatment. Maxillomandibular advancement (MMA) is the most effective surgical treatment in adults with selected criteria.

The aim of the study was to evaluate the effect of 4 μg/kg teriparatide administered at intermittent and continuous frequencies on bone formation in the expanded midpalatal suture region using histomorphometric and micro-computed tomography (micro-Ct) analysis. Settings and sample population: In this study, 24 Sprague Dawley male rats were used.The experimental animals were divided into 3 groups as follows: Group 1: only maxillary expansion, Group 2: maxillary expansion with continuous teriparatide administration (2 μg in the morning and 2 μg in the evening) and Group 3: maxillary expansion with intermittent teriparatide administration (daily 4 μg/kg). The expansion appliance was fixed to maxillary incisors of all animals within the 5-day expansion period, followed by a 12-day retention phase. Animals were sacrificed at the end of the retention period, and specimens were evaluated by micro-Ct and histomorphometric analysis respectively.The results of the histomorphometric analysis showed that Group 3 had the highest number of osteoblasts (1042 ± 90.76) (P .01). In addition, the results of micro-Ct analysis revealed that Group 3 had the highest bone volume/total volume (16% ± 0), bone mineral density (173.82 ± 2.6 mgHA/cmIntermittently administered TP (4 μg/kg once a day) was seen to enhance bone formation and mineralization. In the future, it can be used in drug studies that will increase or stimulate bone formation as well as in the midpalatal suture area.

PURPOSE: Contemporary literature suggests a similar transverse stability of a surgical-assisted rapid palatal expansion and a segmented Le Fort I osteotomy. The aim of this study was to compare postoperative complications of 1-stage (segmental maxillary osteotomy) and 2-stage (surgical-assisted rapid palatal expansion followed by Le Fort I osteotomy) treated patients to determine the preferred treatment strategy. MATERIALS AND METHODS: This retrospective study included 74 consecutive patients (age range: 14 - 57 years; 36 males, 38 females) with a moderate transverse maxillary hypoplasia: 32 patients were treated in a 1-stage protocol and 42 in a 2-stage protocol with a postoperative follow-up of at least 1 year. Dental complications such as loss of teeth, gingival dehiscence, periodontal bone loss, apical root resorption, and surgical complications such as pain, hemorrhage, altered neurosensitivity, wound infection, aseptic necrosis were analyzed. Univariate analysis consisted of a generalized linear model with logit link or Fisher exact test. RESULTS: No significant difference was found for group characteristics except for longer orthodontic treatment time in the 2-stage group. Incidence and severity of complications were comparable for the 1-stage and 2-stage patients. Only overall pain was significantly greater in the 2-stage patient group (P = .038). CONCLUSIONS: Considering a similar complication rate and transversal stability, the choice between 1-stage and 2-stage approach for patients with a moderate transverse maxillary hypoplasia should be patient specific. ispartof: JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:79 issue:7 pages:1531-1539 ispartof: location:United States status: published

Background Regardless of the treatment protocol, stability in Class III patients always represents a major concern. The aim of this study was to assess the short and long-term skeletal and dentoalveolar modifications in a group of class III patients treated with hybrid rapid maxillary expander (RME) and facemask (FM). Indeed, no long-term studies have been conducted yet with the objective of evaluating the effects of this kind of approach when applied to patients who have already gone thought their peak of growth. Material and methods 27 patients with skeletal Class III malocclusion were treated using hybrid RME according to alternating rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by 4 months of facemask therapy. After the orthopaedic phase, each patient underwent orthodontic treatment with fixed multibracket appliances. A mean follow-up of 7 years, 10 months was performed. Pre-treatment (TO), post-treatment (T1) and follow up (T2) cephalometric tracing were analysed, comparing dental and skeletal measurements. Results Point A advanced by a mean of 3.5 mm with respect to VerT, then relapsed by 0.7 in the post-facemask period, thereby yielding of a mean advancement of 2.7 at T2. The sagittal relationship significantly changed after RME + facemask protraction (3.8° of ANB and 5.189 mm of Wits). Although both Wits and ANB values worsened over time, the improvement from T0 is still appreciable at T2. Conclusion Despite the physiological relapse due to mandibular growth, the long-term cephalometric follow-up confirms the maintenance of all positive outcomes of the previous orthopaedic treatment with hybrid RME and facemask.

Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical orthodontic treatment for transverse maxillary deficiency. This study aimed to investigate the Oral Health-related Quality of Life (OHRQoL) and pain perception of patients undergoing MARPE treatment. Methods 42 consecutive patients (9 men, 33 women) from the age of 16 onwards (mean: 27.4 ± 9.3 years; range 17.1–55.7 years) who received a MARPE treatment were included. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. Patients filled out the questionnaire at baseline (T0) and weekly during the expansion phase (P1) and in the post-expansion phase (P2). Pain intensity was assessed with a Visual Analogue Scale (VAS) questionnaire and filled out daily during expansion, along with a question on the intake of analgesics. The mean weekly and total OHIP-score and OHIP-score per domain were calculated at T0, P1 and P2, as well as mean weekly and total VAS-scores for average pain, maximum pain and analgesics intake during P1. Kruskal–Wallis tests were used to test for differences in OHIP between T0, P1 and P2. The level of significance was set at 0.05. Results The mean OHIP-score was 10.86 ± 9.71 at T0 and increased to 17.18 ± 10.43 during P1 (p Conclusions MARPE is a generally well-tolerated expansion treatment. A temporary decline in OHRQoL and moderate pain are present at the start of expansion, followed by a recovery of OHRQoL and very mild pain during the rest of treatment. Clinicians should be aware of the effects of MARPE on patients’ quality of life and manage the expected discomfort and impediments with adequate communication and patient education.

Maxillary expansion is the mainstay therapy for maxillary transverse deficiency. There has been a constant search for the most effective yet biologically friendly method of maxillary expansion, alternatives being, slow, rapid and semi rapid.The purpose of this study was to explore the outcome of palatal expansion achieved using a removable plate and low continuous forces brought about by a semi rapid screw activation protocol.Retrospective study.Plaster models of 56 consecutive patients treated for maxillary expansion were obtained pre-treatment (TInterclass Correlation Coefficient [ICC] and Dahlberg's formula were used for reliability test. The differences in the mean values between the three duration groups [TSignificant increase in inter-molar, alveolar and palatal linear widths were observed from TThe appliance and protocol were effective in producing transverse expansion with minimal molar and alveolar tipping.

The effects of rapid maxillary expansion (RME) on the transverse palatine and midfacial sutures have been extensively scrutinized. Unlike the dentition stage, age-dependency was not yet regarded when investigating morphological changes of the tooth-bearing palate. Therefore, the first aim of the present study was to analyse age-dependent sutural and morphological changes of the palate in selected patients by cone-beam computed tomography (CBCT) and dental cast analysis. Secondly, age-dependent effects of RME on width, height, and depth of the palate in the region of the maxillary palatine processes were investigated by a comprehensive dental cast study, so that the combination of results could be used to provide a biomechanical explanation of the occurring changes.CBCT datasets of 9 patients (between 7.3 and 13.8 years) were measured around the median palatal suture and compared with the results of an individualised dental cast analysis. In addition, possible effects on other maxillary sutures were investigated. In the dental cast study, changes after RME in the tooth-bearing palate were analysed three-dimensionally in 60 children and adolescents. It was possible to divide those into three equally sized, age-dependant groups (PG1: 10 years, n = 20; PG2: ≥ 10 12 years, n = 20; PG3: ≥ 12 years, n = 20).The CBCT analysis reveals age-related differences in sutural responses. The opening width of the median palatine suture decreases cranially (frontal) and dorsally (horizontal). The opening mode thus changes from parallel to triangular in both planes. The transverse palatine suture completely opens in younger patients only (PG1 and PG2). The width increases are always significant in all patients. While in PG1 the width increase is greater posteriorly than anteriorly, this is always reversed in PG2 and PG3. The palatal height always increases significantly anteriorly, but posteriorly only in the youngest patients (PG 1) median and paramedian. In PG 2 and PG 3, the posterior height change is very small. That is the reason why the anteroposterior comparison reveals a much more pronounced height increase anteriorly than posteriorly.The comparison of selected CBCT data with a dental cast analysis allows the conclusion that the maxillary expansion after RME in children up to 10 years is rather parallel, whereas it occurs V‑shaped (anterior posterior transversal, inferior superior vertical) with increasing age, especially in adolescents from the age of 12. In addition to an age-progressive rigidity of the pterygopalatomaxillary junction, morphological changes of the transverse palatine suture during growth seem to be causal. Thus, age-dependent effects of palatal expansion occur due to a positional change of maxillary centres of rotation and resistance. From dental cast measurements, especially at the skeletal-basal level, conclusions can be drawn about the median palatal suture opening mode.ZIEL: Die Effekte der „rapid maxillary expansion“ (RME) auf die Sutura palatina mediana und Suturen des Mittelgesichts wurden umfangreich wissenschaftlich evaluiert. Morphologische Veränderungen des zahntragenden Gaumens dagegen sind bislang nur in Abhängigkeit vom Dentitionsstadium, nicht aber vom Alter der Patienten untersucht worden. Ziel der vorliegenden Studie war deshalb zunächst, an selektierten Patienten unterschiedlicher Altersstufen durch DVT(digitale Volumentomographie)- und Modellanalyse altersabhängige suturale und morphologische Veränderungen des Gaumens zu analysieren. Anschließend sollten altersabhängige Auswirkungen der RME auf Breite, Höhe und Tiefe des Gaumens im Bereich der Processus palatini der Maxilla durch eine umfangreiche Modellstudie bestimmt werden, sodass die Kombination der Ergebnisse abschließend zur biomechanischen Erklärung der auftretenden Veränderungen genutzt werden konnte.Bei 9 Patienten (zwischen 7,3 und 13,8 Jahren) wurden DVT-Datensätze im Bereich der medianen Gaumensutur vermessen und mit den Ergebnissen einer individualisierten Modellanalyse abgeglichen. Zusätzlich wurden mögliche Auswirkungen auf weitere maxilläre Suturen untersucht. In der Modellstudie wurden bei n = 60 Kindern und Jugendlichen Veränderungen des zahntragenden Gaumens nach RME dreidimensional analysiert. Es konnte dabei in 3 gleich große Patientengruppen in Abhängigkeit vom Alter unterteilt werden (PG1: 10 Jahre, n = 20; PG2: ≥ 10 12 Jahre, n = 20; PG3: ≥ 12 Jahre, n = 20).Die DVT-Analyse offenbart altersabhängige Unterschiede der suturalen Reaktionen. Die Öffnungsweite der Sutura palatina mediana reduziert sich in der Vertikalen besonders nach kranial, in der Transversalen nach dorsal. Infolgedessen ändert sich der Öffnungsmodus in beiden Ebenen von parallel zu triangulär. Die Sutura palatina transversa ist nur bei jüngeren Patienten (PG1 und PG2) durchgehend geöffnet. Die durch Modellanalyse ermittelten Breitenzunahmen sind bei allen Patienten immer signifikant. Während bei PG 1 die Breitenzunahme im posterioren Bereich größer ist als anterior, verhält sich dies bei PG 2 und PG 3 umgekehrt. Bei älteren Patienten ist die Breitenzunahme auf allen Ebenen anterior deutlich größer als posterior. Die Gaumenhöhe nimmt anterior bei allen Patienten signifikant zu, im posterioren Bereich dagegen median sowie rechts und links paramedian nur bei den jüngsten Patienten (PG 1). Bei PG 2 und PG 3 ist die Veränderung der Höhe posterior sehr gering. Deshalb ist hier im anterioposterioren Vergleich die Höhenzunahme anterior wesentlich deutlicher ausgeprägt als posterior.Der Vergleich selektierter DVT-Daten mit den Ergebnissen der Modellvermessung lässt die Interpretation zu, dass die maxilläre Erweiterung nach RME bei Kindern bis zum 10. Lebensjahr eher gleichförmig, mit zunehmendem Alter – besonders bei Jugendlichen ab dem 12. Lebensjahr – dagegen V‑förmig (anterior posterior transversal, inferior superior vertikal) erfolgt. Ursächlich dafür scheinen neben einer altersprogredienten Rigidität der pterygopalatomaxillären Verbindung insbesondere morphologische Veränderungen der Sutura palatina transversa im Wachstumsverlauf zu sein. Somit beruhen altersabhängige Effekte der Gaumennahterweiterung auf einer sich verändernden Lage maxillärer Rotations- und Widerstandszentren. Aus der Modellvermessung, besonders auf skelettal-basaler Ebene, lassen sich Rückschlüsse auf die Art der medianen Gaumensuturöffnung in der Transversalebene ziehen.