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Objective: The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. Design: Cross-sectional prospective study. Setting: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. Participants: Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. Interventions: Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. Main Outcome Measures: In the majority of the subjects, an increase of internal nasal dimensions was observed. Results: Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). Conclusions: RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population. [ABSTRACT FROM AUTHOR]

Purpose: to check the effects of rapid maxillary expansion (RME) with Haas, made by orthodontistic, in speech of the patient with cleft lip and palate. Methods: 12 subjects, 6 boys and 6 girls, with age between 7 and 14-year old, divided in two groups. Group 1 (G1), was submitted to conventional activation RME protocol and Group 2 (G2), was submitted to activation ERM protocol in accordance with Liou and Tsai (2005) as for alternate expansions and constrictions. The subjects were submitted to speech evaluation, perceptual analysis by speech therapists and laymen judgment and spectrographic evaluation of speech with Praat program. Results: the measure of vocal' emission times was statistically relevant after RME to vocal [i] in G1 and to vocal [a] in G2. In perceptual analysis, no statistical relevance was found among the groups as for Nasality and Articulation evaluation, but as judges deemed that Nasality became better, they deemed that Articulations was better too, as well as the variables "Better", "Equal" and "Worse". Conclusion: the decrease of vocal emission times after RME, show us that the increase in nasal air escape cause a smaller emission time. The perceptual analysis seems to be an efficient kind of evaluation, demonstrating agreement amongst the judges, both layman as well as speech pathologists. The perceptual analysis also showed that as Nasality decreases, the Articulation improves. [ABSTRACT FROM AUTHOR]

Introduction: The correction of maxillary transverse discrepancy is achieved by means of rapid maxillary expansion, which may be performed by conventional or surgically-assisted rapid maxillary expansion, and more recently, by miniscrew-assisted rapid palatal expansion (MARPE). This study assessed the bone thickness of the palate on cone-beam computed tomography (CBCT) images for placement of mini-implants and anchorage of MARPE., Methods: The sample consisted of 223 CBCT scans from patients of both genders (137 females and 86 males) aged ≥18 years. By using the Image Studio software (Anne Solutions, São Paulo, Brazil), measurements of the bone thickness of the palate were performed bilaterally, as follows: in the axial plane, the bone thicknesses were determined in the anterior region (distal face of the first premolars) and the posterior region (distal face of the first molars), at 3 mm and 6 mm laterally to the midpalatal suture. So in the sagittal plane, the bone thicknesses of the palate were measured in these placements from the palatal cortical to the nasal floor cortical in the anterior region at 30°, 45°, and 90°. In the posterior region, the bone thickness was determined only at 90°. The statistical tests used were the Kruskal-Wallis H test (analysis of variance on ranks) with Dunn's post-hoc test and Mann-Whitney U test (P <0.05)., Results: The bone thickness of the palate in the anterior region varied from 8.57 mm in women to 11.28 mm in men at 3 mm from the midpalatal suture and from 7.99 mm in women to 10.47 mm in men at 6 mm for 30°; from 6.35 mm in women to 9.28 mm in men at 3 mm from the midpalatal suture and from 6.20 mm in women to 8.88 mm in men at 6 mm for 45°; from 4.51 mm in women to 6.85 mm in men at 3 mm from the midpalatal suture and from 4.29 mm in women to 6.64 mm in men at 6 mm for 90°. In the posterior region, the bone thickness varied from 2.93 mm (3 mm from the suture) to 1.78 mm (6 mm from the suture) for women and from 3.24 mm (3 mm from the suture) to 1.99 mm (6 mm from the suture) for men. In general, the bone thickness of the palate is greater in the anterior region at 3 mm from the midpalatal suture at 30°., Conclusions: There was high variability in the bone thickness of the palate among patients and in different areas. Therefore, it is necessary to make an individualized diagnosis of the patient and manufacture the MARPE appliance carefully by performing a prior evaluation of the palatal bone thickness by means of CBCT to determine the ideal sites and inclinations for placement of mini-implants., (Copyright © 2022. Published by Elsevier Inc.)

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 (T 1 ), at the end of RPE (T 2 ), and 1 month after the appliance removal (T 3 ). 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 T 1 and T 2 , this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T 1 95% confidence interval [CI], 1.08-1.26; T 2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T 3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T 3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T 3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T 1 and T 2 ., 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 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: This randomized clinical trial aimed to compare the skeletal and dental effects of miniscrew-anchored maxillary protraction (MAMP) using hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients with Class III malocclusion., Methods: This was a randomized, parallel, controlled trial. Forty growing patients with Class III malocclusion and maxillary deficiency (Wits appraisal of less than -1 mm) were randomized into 2 groups. Patients were recruited at the Orthodontic Clinic of Bauru Dental School, University of São Paulo, Brazil. The HH group was composed of patients with Class III malocclusions in the late mixed or early permanent dentition treated with a HH expander with 2 miniscrews in the maxilla and 2 miniscrews in the anterior region of the mandible. Class III elastics were used from the maxillary first molars to the mandibular miniscrews placed between permanent canines and first premolars. The CH group was composed of patients treated with a similar protocol except for the use of a CH expander in the maxilla. The primary outcomes included the frequency of overjet correction and sagittal skeletal effects produced with treatment. Allocation was performed with a simple randomization process. Blinding was performed only during assessments. Data were analyzed blindly on an intention-to-treat basis. Intergroup comparison was performed using analysis of covariance. Mean differences (MD) and 95% confidence interval (CI) were obtained for all variables., Results: The final sample for the HH group was 20 subjects (8 female, 12 male; initial age of 10.7 years), whereas the final sample for the CH group was 15 subjects (6 female, 9 male; initial age of 11.5 years). The frequency of overjet correction observed in the HH and CH groups was 94.4% and 71.4% (risk ratio, 1.32; 95% CI, 0.93-1.88), respectively. Both groups presented similar skeletal sagittal and vertical outcomes after maxillary protraction. The maxillary length (CoA) showed a similar increase in both groups (MD, 1.12 mm; 95% CI, -0.03 to 2.27). The CH group demonstrated a greater mesial displacement of maxillary first molars after treatment than the HH group (MD, 1.22 mm; 95% CI, 0.33-2.11). HH and CH groups produced 2.88 and 1.97 overjet corrections (MD, 0.53 mm; 95% CI, -0.52 to 1.59), respectively., Conclusions: MAMP using HH and CH expanders produced a frequency of overjet correction of 94.4% and 71.4%, respectively. Similar skeletal effects were observed between MAMP using HH and CH expanders. Greater control of the mesial displacement of maxillary first molar during maxillary protraction using hybrid expanders was observed., Registration: The trial was registered at http://ClinicalTrials.gov, under the identifier NCT03712007., Protocol: This trial protocol was not published., Funding: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) - Finance Code 001, and by the São Paulo Research Foundation (FAPESP) - Grants nos. 2017/04141-9, 2017/24115-2, and 2019/03175-2., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To develop and validate a prediction model to forecast long-term stability of early treatment with rapid maxillary expansion (RME) and facemask (FM) in a large sample of Class III growing patients., Methods: The Brazilian Group (BG) consisted of 73 consecutively treated Caucasian Class III patients (41 females and 32 males). Mean age at T0 (before treatment) was 7.1 ± 1.6 years, while mean age at T1 (long-term follow-up) was 21.8 ± 3.2 years. The Italian Group (IG, validation cohort) comprised 28 consecutively treated Caucasian Class III patients (14 females and 14 males, mean age at T0 9.0 ± 1.3 years and mean age at T1 18.2 ± 1.4 years). Cephalometric analysis was performed on lateral cephalograms at T0. Gender and cephalometric variables, chronologic age, and dentition phase at T0 were used as predictors for long-term unsuccessful treatment at T1. All predictors for unsuccessful treatment in the BG were subjected to bivariate logistic regression. Only those statistically significant predictors in the bivariate logistic regression entered mixed stepwise logistic regression with P = 0.05 to enter and to leave. The validity of the prediction model derived from the BG was then tested on the IG., Results: The prediction model consisted of only one cephalometric variable: the angle between the Condylar Axis and the Mandibular Plane (CondAx-MP) (odds ratio: 1.52, 95% confidence interval: 1.25-1.85, P < 0.0001). Unsuccessful treatment at T1 was predicted for values of CondAx-MP at T0 greater than the cut-off value of 147.8 degrees. BG patients predicted incorrectly were 3 out of 22 for the unsuccessful cases and 1 out of 51 for the successful cases. Therefore, accuracy was 0.95, sensitivity 0.86, specificity 0.98, and positive and negative predictive values were 0.95 and 0.94. When the predictive model was applied on IG, all five unsuccessful cases were predicted correctly, while only 1 out of 23 successful patients was predicted incorrectly., Conclusion: CondAx-ML was identified as a reliable predictor for long-term stability of early Class III treatment with RME and FM., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To evaluate the influence of the maturational stages of zygomaticomaxillary sutures (ZMS) on the response to maxillary protraction., Subjects and Methods: A total of 40 Class III patients were treated retrospectively with either a combination of rapid maxillary expansion and facial mask (RME/FM) or bone-anchored maxillary protraction (BAMP). The RME/FM group consisted of 18 patients (mean age 8.3 years), while the BAMP group was comprised of 22 patients (mean age 11.8 years). The initial CBCT images (T1) of the ZMSs were classified blindly. 3D models from CBCT images at the start and at the end of orthopaedic treatment were registered on the anterior cranial base, and corresponding structures were measured on colour-coded maps and semitransparent overlays. The amounts of protraction of the maxilla, zygoma, orbitale and maxillary first molars for both groups were analysed with two-way ANOVA with Holm-Sidak post hoc test for multiple comparisons., Results: A significant association was found between the early maturation stages of the ZMSs and the amount of maxillary protraction, regardless of the protraction method used. Class III patients with ZMS stages A and B showed greater maxillary protraction than patients at stage C., Conclusion: The maturational stages of ZMS are associated with the response maxillary protraction., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)