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Objective: To evaluate the effect of rapid palatal expansion (RPE) using Haas-type expanders on children’s oral health-related quality of life (OHRQOL) and compare said effect with that previously reported for the use of Hyrax-type expanders. Materials and methods: Forty participants aged 8–10 years with transverse maxillary deficiency were treated using Haas appliances. OHRQOL was measured using the CPQ8 − 10 before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after appliance removal (T3). Generalized mixed models were fitted to assess the effect of the Haas-type expander compared to previously collected data (a nontreated and a Hyrax-type expander-treated group). Results: RPE with Haas-type appliances had a negative impact on overall OHRQOL at T1 and T2 (P = 0.001), and a positive impact at T3 (P = 0.001). The Haas-type expander had a significantly greater negative impact on OHRQOL than the Hyrax-type appliance during RPE. At T1, overall scores using the Haas-type expander were 1.08 times the scores using the Hyrax-type expander (i.e., 8% increase; 95% CI, 1.01–1.17; P = 0.033). Patients using the Haas appliance had 1.24 times the scores of those using Hyrax-type devices for the oral symptoms domain at T1 (i.e., 24% increase; 95% CI, 1.06–1.46; P = 0.009). Conclusions: Correction of the transverse maxillary deficiency by RPE using the Haas appliance in children 8–10 years improves OHRQOL. The Haas- and Hyrax-type devices temporarily worsen OHRQOL during treatment, however, the negative impact is less with the Hyrax-type expander than with the Haas-type expander, because it causes fewer negative oral symptoms. Clinical relevance: From a patient-centered perspective, the use of the Hyrax over the Haas appliance may be suggested as it causes less negative oral symptoms during use. [ABSTRACT FROM AUTHOR]

This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the expansive effects of pterygomaxillary disjunction (PMD) in surgically assisted rapid maxillary expansion (SARME) surgery using a meta‐analysis approach. Materials and Methods: The study conducted a comprehensive literature search across five databases: PubMed, Scopus, Medline, Embase, and Cochrane, adhering to the PRISMA 2020 guidelines. Dental alterations were assessed using either cone‐beam computed tomography (CBCT) or dental casts, while skeletal changes were exclusively measured from CBCT scans. We analysed the dentoskeletal changes between PMD +/− groups and conducted a within‐group comparison. The primary focus of the results was on the mean differences observed in pre‐ and post‐operative measurements. Results: Dental expansion was larger in the PMD+ group but not statistically significant. Skeletal expansion showed a significantly larger expansion in the posterior region in the PMD+ group (P =.033). Without PMD, anterior palatal expansion was significantly larger (P =.03), and the buccal tipping of posterior teeth was also significantly larger (P =.011) to achieve acceptable dental expansion outcomes. Conclusions: Both PMD +/− groups of SARME surgery can achieve satisfactory dental expansion outcomes. However, bone expansion and tooth inclination are also important factors that influence orthodontic treatment and post‐expansion stability. By reducing the bony resistance with PMD, larger posterior palatal expansion and more parallel bony expansion are observed. In contrast, without PMD, there is smaller palatal expansion and greater tooth inclination in the posterior region. This could potentially lead to compromised periodontal conditions following expansion. [ABSTRACT FROM AUTHOR]

Objective: The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. Methods: A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1‐34 patients were treated with RME, followed by FM therapy; G2‐34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT‐RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 – Control Group – 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow‐up. McNemar test, Fisher's exact test and intra‐ and inter‐observer concordance (K) were performed (p ≤.05). Results: There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p <.001) in relation to the disc shape in T1, since G1 (8 TMJs −11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 – p >.999; G2 – p =.063; G3 – p =.500) and shape (G1 – p > 0.999; G2 – p =.250; G3 – not calculable), between T1 × T2, in any of the groups studied. Conclusion: The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short‐term evaluation. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• This review article focuses on the biomechanics of conventional rapid palatal expansion (RPE) and miniscrew-assisted rapid palatal expansion appliances (MARPE). • Three main things play an important role in the type of movements that follow rapid maxillary expansion: 1) Center of resistance and anatomy of maxilla, 2) Appliance system, and 3) Forces, Stress, and Strain. • The nature of forces after expansion is cyclical with force activation and decay occurring after each turn/activation of the expansion appliance. • The stress levels expressed by RPE and MARPE are different which is responsible for the difference in the effects because of RPE and MARPE • Even within MARPE, bone-anchored MARPE design and hybrid MARPE design result in different force systems or stress on the oral structures. Posterior Crossbite is a common condition resulting because of transverse maxillary deficiency. The growth of the craniofacial complex finishes first in the transverse dimension, followed by sagittal and vertical dimensions. Conventional rapid palatal expansion (RPE) appliances are commonly used to correct transverse maxillary deficiency. Although RPE is efficient in correcting posterior crossbite, it results in dental side effects such as buccal tipping of maxillary molars, root resorption, bone dehiscence, and relapse. Mini-implant-assisted RPE has been introduced to increase the skeletal effects of expansion especially in patients with increased maturation and greater interdigitation of midpalatal suture. This article will review the biomechanics of RPE and mini-implant-assisted RPE. Additionally, the different designs of MARPE and the long-term clinical effects of expansion appliances will also be discussed in detail. [ABSTRACT FROM AUTHOR]

Background Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs. Objectives The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition. Material and methods Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient's medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis. Results The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was €32.05 in favour of QH (P  = 0.583; NS). From a societal perspective, the mean cost difference was €32.61 in favour of QH (P  = 0.742; NS). The total appliance cost alone was higher in the RME group €202.67 resp. €155.58 in the QH group (P  = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children's educational loss, the QH becomes €58 more costly than the RME. There was a statistically significant difference in chair time and visits between centres (P  < 0.001). Conclusion The difference in costs between RME and QH is not statistically significant, however, there is a slightly higher probability that RME is more expensive than QH with a mean cost of an additional €32 per patient from a healthcare perspective. Different work procedures at different centres indicate that logistics around the patient's treatment is a more important aspect than appliance used to decrease the number of visits and save chair time and thereby also costs. [ABSTRACT FROM AUTHOR]

Objective(s): This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta‐titanium expansion arch (AEA) and miniscrew‐assisted rapid palatal expansion (MARPE). Materials and Methods: The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta‐titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew‐assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone‐bean computed tomographies at pre‐ and post‐treatment stages. The variables were compared using the independent t‐test. Results: The buccal bone thickness was similar for both groups at the post‐treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. Conclusion: Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function‐generating bite type M (FGB‐M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. Methods: One hundred eighty‐one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB‐M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre‐treatment (T0) and post‐treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1–T0 interval was of 17.3 months (RPE), 24.6 months (FGB‐M) and 18.2 months (controls). Results: The statistical analysis showed that there were no statistically significant differences between the RPE and FGB‐M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. Conclusion: The comparison between patients treated with RPE and FGB‐M showed that there were no statistically significant differences between the RPE and FGB‐M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effect of combining a bone-borne palatal expander (distractor) with a maxillary osteotomy in the treatment of narrowed maxillae in treated cleft palate patients. Few articles in the literature isolated the effects of transpalatal distraction in cleft patients and most either excluded cleft patients or grouped them with non-cleft patients. The hypothesis is that the use of a bone-borne palatal expander in conjunction with a maxillary osteotomy would improve the amount of maxillary expansion at the anterior segment with less tipping of the segments and provide a harmonious arch form. Methods: We studied four patients above 14 years of age with repaired cleft palate and progressive anterior constriction of the arch. All patients received a bone-borne distractor (UNI-Smile Distractor, Titamed, Belgium) combined with a LeFort I level osteotomy without pterygomaxillary disjunction. Dental models and CBCT measurements were used to analyze the skeletal and dental effects of the intervention. Result: All the patients who completed the trial had satisfactory expansion and normalization of the maxillary arch form. The average increase in the intercanine distance was 12.9 mm while the average increase in the intermolar distance was 7.2 mm. No significant change in molar inclination or buccal bone thickness was observed. Conclusion: The use of bone-borne palatal expanders aided by a maxillary osteotomy (transpalatal distraction) in treated cleft palate patients can provide a harmonious arch form in adolescent and adult patients. This trial was registered in the clinical trials registry with the ID NCT03837652 on February 12, 2019. [ABSTRACT FROM AUTHOR]

Abstract Objective To analyze and compare the effects of a traditional laboratory-fabricated Hyrax expander (T-Hyrax) and two different 3D-printed Hyrax expander models relative to tension points, force distribution, and areas of concentration in the craniofacial complex during maxillary expansion using finite element analysis. Materials and methods Three maxillary expanders with similar designs, but various alloys were modeled: a T-Hyrax, a fully printed Hyrax (F-Hyrax), and a hybrid printed Hyrax (H-Hyrax). The stress distributions and magnitude of displacements were assessed with a 5 mm expansion in a symmetrical finite element model. The areas of interest included the teeth, alveolar processes, midpalatal suture, nasal complex, circummaxillary sutures (CS), and the expanders themselves. Results The highest stress value (29.2 MPa) was found at the midpalatal suture of the F-Hyrax, while the lowest stress (0.90 MPa) was found at the temporozygomatic suture in the T-Hyrax. On average, the F-Hyrax increased stress at the CS by 24.76% compared with the T-Hyrax and H-Hyrax. The largest displacements were found at the upper incisor (U1) and anterior nasal spine (ANS). The findings indicated an average increase of 12.80% displacement at the CS using the F-Hyrax compared to the T-Hyrax. Conclusion The F-Hyrax exerts more stress and displacement on the maxilla than both the T-Hyrax and H-Hyrax, where the weak link appears to be the solder joint.

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Dental Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The present study was designed to compare, on cone‐beam computed tomography imaging, the skeletal and dental effects of the SARPE (Surgically assisted rapid palatal expansion) and MISMARPE (Minimally Invasive Surgical and Miniscrew‐Assisted Rapid Palatal Expansion) techniques. Materials and methods: The sample of adult patients with transverse maxillary deficiency (TMD) was divided into two groups, and scans were obtained preoperatively (T0) and immediately after completion of expansion (T1). The posterior and anterior linear transverse distances of the maxilla and the angulation of the maxillary first molars were evaluated. The data were entered into a generalized estimating equations model to verify the postoperative effects of the different techniques. Results: None of the techniques caused any appreciable change in the angulation of the molars. The skeletal changes were similar, with significantly greater gains in the nasal fossa and intermaxillary distance when using the MISMARPE. Conclusion: The technique can be an effective and lower morbidity alternative to SARPE. [ABSTRACT FROM AUTHOR]

Objective: To analyze and compare the effects of a traditional laboratory-fabricated Hyrax expander (T-Hyrax) and two different 3D-printed Hyrax expander models relative to tension points, force distribution, and areas of concentration in the craniofacial complex during maxillary expansion using finite element analysis. Materials and methods: Three maxillary expanders with similar designs, but various alloys were modeled: a T-Hyrax, a fully printed Hyrax (F-Hyrax), and a hybrid printed Hyrax (H-Hyrax). The stress distributions and magnitude of displacements were assessed with a 5 mm expansion in a symmetrical finite element model. The areas of interest included the teeth, alveolar processes, midpalatal suture, nasal complex, circummaxillary sutures (CS), and the expanders themselves. Results: The highest stress value (29.2 MPa) was found at the midpalatal suture of the F-Hyrax, while the lowest stress (0.90 MPa) was found at the temporozygomatic suture in the T-Hyrax. On average, the F-Hyrax increased stress at the CS by 24.76% compared with the T-Hyrax and H-Hyrax. The largest displacements were found at the upper incisor (U1) and anterior nasal spine (ANS). The findings indicated an average increase of 12.80% displacement at the CS using the F-Hyrax compared to the T-Hyrax. Conclusion: The F-Hyrax exerts more stress and displacement on the maxilla than both the T-Hyrax and H-Hyrax, where the weak link appears to be the solder joint. [ABSTRACT FROM AUTHOR]

(1) Background: Skeletally anchored appliances for maxillary expansion are a less invasive alternative to surgery and are increasingly often selected as a method of treatment. The purpose of this study was to retrospectively evaluate the efficacy of maxillary expansion using distractors supported by temporary orthodontic implants (TOIs) in patients of differing sex and age. (2) Methods: The study group consisted of patients treated with distractors anchored to TOIs between July 2019 and June 2022. The group was divided into adolescent and the adult patients. Effectiveness was evaluated one and two weeks after installation of the distractors and the results were analyzed statistically. (3) Results: In total, 39 patients were treated, of which 21 were women and 18 men, ranging in age from 11 to 42. A group of 8 girls and 9 boys younger than 18 years were included. The presence of diastema at the first follow-up visit was observed in all girls and in 8 of the boys, as well as in 7 women and in none of the men. At the second visit, no diastema was found in one woman, but was noted in 3 men (p = 0.007). At the completion of distraction, diastema was observed in all the girls and in 12 women, as well as in 8 out of 9 boys and in 3 men (p = 0.015). (4) Conclusions: The effectiveness of the distraction procedure in adolescents is positive, regardless of sex. However, in adults, the procedure has limited effectiveness in males. [ABSTRACT FROM AUTHOR]

Background: Scarce evidence is available regarding the occurrence and prevalence of hard/soft tissue deficiencies among patients undergoing surgically assisted rapid maxillary expansion (SARME) as compared to non-surgical rapid maxillary expansion (NSRME) approaches. The purpose of this study is to evaluate the effect of NSRME and SARME upon the periodontal structures. Methods: A literature search was performed to identify studies that fulfilled pre-established eligibility criteria, evaluating changes in the periodontium (e.g., probing depths) and hard/soft tissue deficiencies (e.g., bone levels, gingival recession) within patients undergoing NSRME and SARME procedures. Results: A total of 21 articles were included in the present review. Four of them evaluated the outcomes of both NSRME and SARME procedures, while six and eleven studies analyzed NSRME alone and SARME alone, respectively. The incidence of hard (e.g., changes in buccal bone width/height) and soft tissue deficiencies (e.g., gingival recession, keratinized tissue, and clinical attachment level) is slightly increased among patients undergoing maxillary expansion with worsened outcomes during NSRME procedures. Conclusions: The impact of NSRME and SARME upon the periodontium remains inconclusive. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: This study evaluated the stress distribution in the dentoalveolar and palatal bone structures during maxillary expansion in a 17-year-old male patient with bilateral cleft lip and palate (BCLP) using expanders with dental (HYRAX) and skeletal anchorage (MARPE). For the generation of the specific finite element models, cone-beam computed tomography was used, and the DICOM files were exported to Mimics 3-Matic (Materialise) and Patran (MSC Software) software. Three specific three-dimensional models were generated: A) HYRAX: conventional four-banded hyrax screw (9 mm); B) MARPE-DS: 3 miniscrews (1.8 mm diameter – 5.4 mm length) and four-banded dental anchorage; and C) MARPE-NoDS: 3 miniscrews without dental anchorage. Maxillary expansion was simulated by activating the expanders transversely 1 mm on the "X" axis. HYRAX resulted in higher levels of deformation predominantly in the dentoalveolar region. MARPE-DS showed stress in the dentoalveolar region and mainly in the center of the palatal region, at approximately 4,000 με. MARPE-NoDS exhibited evident stress only in the palatal region. High stress levels in the root anchoring teeth were observed for HYRAX and MARPE-DS. In contrast, MARPE-NoDS cause stress on the tooth structure. The stress distribution from the expanders used in the BLCP showed asymmetric expansive behavior. During the initial activation phase of expansion, the HYRAX and MARPE-DS models produced similarly high strain at the dentoalveolar structures and upper posterior teeth displacement. The MARPE-NoDS model showed restricted strain on the palate.

IntroductionAdenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.Materials and methodsIn this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5-15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4-6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.ResultsCompared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81 ± 3.31 to 3.75 ± 2.38 in expansion group (p

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.

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. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate surgically assisted rapid maxillary expansion (SARME), with osteotomies separating the maxilla into two segments (SARME-2S) and three segments (SARME-3S), on obstruction symptoms and nasal cavity dimensions in patients with maxillary transverse skeletal deficiency (MTSD). Materials and methods: Sixteen patients with MTSD of 7 mm or above were evaluated in each group, for a total of 32 patients. All patients were evaluated pre- and postoperatively up to 10 months after the expander activations. The minimum cross-sectional area (MCA) and the volume of the nasal cavities were identified by acoustic rhinometry. The Nasal Obstruction Symptom Evaluation (NOSE) scale questionnaire was applied. The palate surface area (PSA) was measured, via digitized maxillary models, as a criterion for comparison with the other variables studied. Results: There was no difference between the groups (p = 0.370) and was verified a significant increase in PSA postoperatively. MCA showed a small increase without statistical significance, and together with the volume of the nasal cavities remained constant during the study. NOSE scale scores decreased significantly in the postoperative periods, implying a decrease in nasal obstruction symptoms in both groups. Conclusions: SARME with two and three segments show similar results, and both may improve nasal obstruction symptoms when present in patients with MTSD. Clinical relevance: SARME, regardless of the chosen surgical technique, should follow the recommendation to correct just the MTSD. While an improvement in nasal breathing is expected, this must be understood as likely, but not certain. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). Methods: This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). Results: The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. Conclusions: Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. Clinical relevance: EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to evaluate the density of the midpalatal suture (MPS) of individuals with maxillary expansion (rapid maxillary expansion, RME), surgically assisted rapid maxillary expansion (SARPE), and miniscrew-assisted rapid palatal expansion (MARPE) through computed tomography. An electronic search was performed in four databases, MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) in February 2023 and updated in April 2023, using previously established search strategies. Studies were retrieved without restrictions in terms of data, language, or publication status. The risk of bias assessment was based on a quality assessment tool for before-and-after studies. Ten studies were included in our systematic review, and nine studies were included for our quantitative analysis. The analyses were performed by subgroup according to the evaluation of the region, anterior, middle, and posterior, including the three types of treatment: RME, SARPE, and MARPE. Heterogeneity was high for the three regions (anterior 95%, medium 97%, and posterior 84%) and a statistical difference was found in two of the three regions (anterior p = 0.06, medium p = 0.031, and posterior p < 0.001). There is not enough evidence to state that the MPS density is different after 6 months of RME in the anterior and middle regions; the bone density values for SARPE and MARPE suggest that 6 or 7 months after expansion, there is still no bone density similar to the initial one in the three regions. [ABSTRACT FROM AUTHOR]

Objective: We report the orthodontic treatment of a class II malocclusion with anterior open bite and posterior crossbite in a patient with Down syndrome (DS) treated with mini‐implants. Methods: Treatment began with rapid maxillary expansion with a Haas appliance, followed by dental alignment and leveling with a fixed appliance and the correction of class II dental relationships with the use of orthodontic mini‐implants associated with a sliding jig. Results: The results obtained at the end of the treatment were satisfactory, with improvements in occlusion, including bite closure; maxillary expansion; and the correction of dental relationships. Conclusion: When well‐planned, orthodontic treatment in a patient with DS achieves satisfactory results from a skeletal, occlusal, and facial perspective. [ABSTRACT FROM AUTHOR]

(1) Background: Skeletally anchored appliances for maxillary expansion are a less invasive alternative to surgery and are increasingly often selected as a method of treatment. The purpose of this study was to retrospectively evaluate the efficacy of maxillary expansion using distractors supported by temporary orthodontic implants (TOIs) in patients of differing sex and age. (2) Methods: The study group consisted of patients treated with distractors anchored to TOIs between July 2019 and June 2022. The group was divided into adolescent and the adult patients. Effectiveness was evaluated one and two weeks after installation of the distractors and the results were analyzed statistically. (3) Results: In total, 39 patients were treated, of which 21 were women and 18 men, ranging in age from 11 to 42. A group of 8 girls and 9 boys younger than 18 years were included. The presence of diastema at the first follow-up visit was observed in all girls and in 8 of the boys, as well as in 7 women and in none of the men. At the second visit, no diastema was found in one woman, but was noted in 3 men (p = 0.007). At the completion of distraction, diastema was observed in all the girls and in 12 women, as well as in 8 out of 9 boys and in 3 men (p = 0.015). (4) Conclusions: The effectiveness of the distraction procedure in adolescents is positive, regardless of sex. However, in adults, the procedure has limited effectiveness in males.

Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. There was a median reduction of 21% in nasal airway resistance post SARME (P = 0.002). The NOSE scale score decreased (P < 0.001) and nasal breathing quality VAS scores increased in both nostrils (P < 0.001). Transverse measurements between the upper canines (C–C), premolars (PM–PM), and molars (M–M), and maxillary perimeter showed significant increases (P < 0.001), while the anteroposterior maxillary arch length showed a significant decrease (P = 0.016). An inverse proportional correlation was found between PM–PM and nasal airway resistance (r = −0.395; P = 0.034) and between M–M and nasal airway resistance (r = −0.383; P = 0.040). These results demonstrate that surgically expanding the posterior region of the maxilla results in decreased nasal airway resistance, decreased obstructive symptoms, and improved patient respiratory quality. [ABSTRACT FROM AUTHOR]

• Miniscrew-assisted rapid palatal expansion (MARPE) therapy improves the airway spaces in all their segments, including the minimal transverse constriction. • The effects of MARPE therapy on the airway spaces are similar for the last two levels of intermaxillary suture maturation. • Adult patients treated with the MARPE treatment had an increase of 13.85% in their total upper pharyngeal airway. 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 (T 0) 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 (T 1), 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. [ABSTRACT FROM AUTHOR]

Midline diastema has been a popular aesthetic problem for children. Several treatment options are available, however, the use of elastic bands without other appliances for closing the diastema still remains a pressing issue in Vietnam, which could be done by the patient’s parents either themselves or under the dental practitioners’ suggestion. Objective: To report a specific case about the extensive extrusion regarding upper central incisors in a pediatric patient due to misusing the elastic band, in which management was complex due to an unfavorable situation for splinting. Case Report: Single rubber band usage for orthodontic movement in closing diastema has been an unresolved disaster in Vietnam, leading to the need for early diagnosis and immediate intervention when facing the complications. Conclusion: Significant information dissemination is paramount for long-term improvement in the oral health of pediatric patients in Vietnam and around the world. [ABSTRACT FROM AUTHOR]

Objective: Compare changes in arch form after RME achieved by Expander with Differential Opening (EDO), Hyrax‐type and Haas‐type expanders. Materials and Methods: Dental models were obtained from 61 patients aged 7‐11 years before expansion (T1) and 6 months after the active phase when the appliances were removed (T2). The groups were formed according to the expander used: EDO (n = 18, mean age: 9.46 ± 0.82 years), Hyrax‐type (n = 22, mean age: 9.62 ± 1.57 years) and Haas‐type (n = 21, mean age: 9.29 ± 1.05 years). The expander's activation protocol consisted of 7 mm, except for EDO's anterior screw, which was 9 mm. The measurements of upper and lower intercanine distance, inter‐first permanent molar, arch perimeter and length, maxillary canine and first‐permanent molar inclination, and palatal depth were performed using the OrthoAnalyzer 3D software. Intergroup comparisons of T1 and between changes (T2‐T1) were performed using ANOVA followed by Tukey. Results: In the upper intercanine distance EDO provided a greater increase than Haas‐type. In the distance between upper fist permanent molars EDO showed higher values than Haas‐type and Hyrax‐type. In the lower intercanine distance and maxillary arch length, Haas‐type promoted higher increase than EDO. Conclusions: The EDO promoted greater transverse changes in anterior region than Haas‐type and greater transverse changes in posterior region of the maxilla than both conventional expanders. The appliance used for RME influences dental arch changes after treatment; therefore, it is recommended to individualize the choice of expander depending on the clinical necessity of each case. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the temperature of the palate during rapid maxillary expansion through thermal imaging. Material and methods: Modified Hyrax palatal expander was installed in 11 patients. Thermal images of the palate were obtained using the FLIR A325 infrared camera. The evaluation was carried out 6 times: T0 - without activation; T1 - 4; T2 - 8; T3 - 12; T4 - 16; T5 - 30 screw activations. The thermographic images were analyzed qualitatively by visualizing the colors and quantitatively, by measuring the temperature of the palate at points Sp1, Sp2, Sp3 and Line 1 (Li1), in the midpalatal suture and Sp4 and Line 2 (Li2) in the lateral region of the hard palate. ANOVA and Games-Howell statistical tests were used. Results: When evaluating each region over time, in Sp4 and Li2, it was observed a lower temperature in T5 than in T1 and in Li1 a lower temperature in T5 than in T4 (p<0.05). Conclusion: Similar temperatures were observed in the central and lateral regions of the palate. Higher temperatures were recorded at the time of the first activations and lower temperatures were recorded on the 14th day. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Illustrating F‐quad helix with extension arms that simultaneously expand maxillary arch and rotate its central incisor adjacent to the alveolar cleft while aligning palatally ectopic canines. Incisor rotation occurred before alveolar grafting, while canine traction was performed after alveolar grafting. The construction of this appliance is shown in detail. [ABSTRACT FROM AUTHOR]

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Anterior open bite is considered one of the most challenging malocclusions to correct, especially regarding stability. There are numerous publications on the subject but with controversial information. Disagreements occur in most aspects of this malocclusion, such as the definition of an open bite, its etiological factors, treatment timing, and ideal treatment alternatives. The lack of consensus on the etiology of anterior open bite has led to different treatment approaches, which may explain the high rate of post-treatment instability. Furthermore, the etiological factors of this malocclusion typically result in myofunctional imbalance, which alters the harmony of muscular forces responsible for maintaining an adequate occlusion. Nevertheless, the literature indicates a scarcity of scientific evidence that myofunctional therapy helps to correct open bites. In addition, there is evidence that eliminating deleterious habits allows spontaneous overbite correction and brings physiological and psychological benefits to the child. Considering the possibility of a spontaneous reduction of this malocclusion with age, it is understood that not every child needs early treatment. To avoid overtreatment, the choice for intervention should assess possible causes and severity, the patient's age, and parental concerns. Therefore, this paper discusses possible early treatment approaches for anterior open bite. [ABSTRACT FROM AUTHOR]

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 deficit>7 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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate self-perceived pain levels in the Hyrax compared to other types of maxillary expansion (ME) appliances in growing patients. Methods: An unrestricted search of indexed databases and manual searching were performed up to October 2022. Randomized controlled trials (RCTs) comparing the Hyrax appliance with other ME appliances were included. Data screening, extraction, and Risk of Bias (RoB) assessment with the Cochrane tool were performed by two authors. Results: Six RCTs were included. The number of participants in the included RCTs ranged between 34 to 114 and included both male and female growing patients. Various tools were used to measure self-perceived pain including the Graphic Rating Scale for Pain, the Wong–Baker Faces Pain Scale, the Numerical Rating Scale, the visual analogue scale, and a questionnaire. One RCT reported that pain intensity in patients treated with the Hyrax was higher than in the Haas appliance, with a statistically significant difference limited to the first day. Two RCTs reported that pain intensity in patients treated with the Leaf expander was lower than in the Hyrax during the first 7 days of treatment. Two RCTs reported no significant differences in pain intensity between the Hyrax and other ME appliances. One RCT reported that pain intensity in patients using the computer-guided skeletal ME appliance was higher than in the Hyrax appliance at the first day after expansion. Four RCTs had a high RoB, and two RCTs had a moderate RoB. Conclusions: Within the limitations of the present systematic review and based on the currently available evidence, it is challenging and inconclusive to identify the best maxillary expansion appliances, regarding pain levels for growing patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the research was to com-pare the dimensions of the upper jaw between different age groups for the installation of mini-implants for rapid maxillary expansion. Materials and Methods: The study was descriptive, retroprospective and observational. Cone beam computed tomography was used for the evaluation of 30 patients between 7 and 56 years of age, divided into three groups, ten up to 14 years, ten from 15 to 30 years, and ten from 31 years and older. The premolar and molar regions were selected for the measurement of the maxilla in the coronal plane, both bone and soft tissue. To compare the measurements, the Kruskal Wallis and Mann-Whitney U tests were used. Results: No statistically significant differences were found between the groups. The thicknesses of the bone tissue decreased from the first premolar to the second molar from 9.48 +/-3.71 mm to 5.40 +/-2.80 mm respectively, while the soft tissue thicknesses were more homogeneous with measurements of 0.56 +/-0.74 mm to 2.76 +/- 2.42 mm. Conclusions: The dimensions of the bone and soft tis-sue of the upper jaw, evaluated vertically for the installa-tion of mini-implants, were similar in all the age groups studied, with larger dimensions in men than in women at the premolar level. The dimensions of the maxilla for the palatal miniimplants were close to 9 mm in bone tissue and 3 mm of soft tissue at the level of premolars and 5 mm in hard tissue with 1 mm of soft tissue at the level of molars.

Introduction: In recent years, rapid maxillary expansion (RME) in prepubertal growth stages has been deeply investigated; however, its study has recently been increasing in adults without need for surgery. Material and Methods: At this stage, maxillary deficiencies can be treated with skeletally supported expanders with various device designs proposed by authors, with their own work protocols. Results: RME in adults can result in substantial expansion similar to that obtained in patients who have not yet completed the ossification of the mid-palatal suture, so it could be considered a favorable treatment alternative to correct crossbites and transverse deficiency of the maxilla. Conclusion: The objective of this review is to present the results reported in the scientific literature about RME in adults between 18 to 60 years of age.

Abstract Background Midpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients. Materials and methods The study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1–45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p

This study aimed to analyze the treatment effects of miniscrew-assisted rapid palatal expansion using dental cone-beam computed tomography (CT) in adolescents. The study group comprised 20 patients who underwent cone-beam CT before and after miniscrew-assisted rapid palatal expansion (MARPE). Paired t-test and analysis of variance were used to analyze significant differences before and after treatment. Skeletal and dentoalveolar measurements indicated highly significant differences, with these expansions increasing progressively in the downward direction. The extent of anterior midpalatal suture expansion was significantly greater than that of the posterior part. Significant expansion was observed at the nasal width and inter-zygomaticomaxillary suture distance. MARPE can expand the craniofacial skeletal structure to the uppermost nasal bone and lateral to the zygomaticomaxillary sutures. The expansion was greater in the lower maxillary part, demonstrating an overall triangular maxillary expansion. The midpalatal suture opening was greater in the anterior than in the posterior side, whereas the posterior suture opening proportion was higher than that of the conventional rapid palatal expansion previously reported. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effect of rapid maxillary expansion (RME) on the inflammatory and stress response of patients undergoing orthodontic treatment. Methods: Eighty salivary samples were collected from patients (n=16) during RME at five moments: before the expander placement (T1); 25 minutes after its first activation (T2); seven days after placement, shortly after the patient arrived at the dental clinic (T3); 25 minutes after the appliance activation on day seven (T4) and one month after the last activation of the appliance (T5). Cortisol and nitric oxide levels were evaluated using an immunoassay kit and the Griess method, respectively. Friedman and Wilcoxon tests were used for statistical analysis (P<0.05). Results: Participants' mean age was 11.5 years. There was a significant change in cortisol levels over the study period in the total sample (P<0.01), for the Haas appliance (P=0.01), female sex (P=0.01), younger children (P=0.01), presence of large overbite (P=0.02), presence of posterior crossbite (P=0.006), Class I type occlusion (P=0.02) and mesofacial facial type (P=0.02). Regarding nitric oxide, there was a significant change over the study period in those who wore the Haas appliance (P=0.04). For nitric oxide levels, T1 was significantly higher than T3, T4 and T5 (P<0.05) for those who wore a Haas appliance. Conclusion: The period anticipating the consultation at the waiting reception area was more stressful than the dental procedure in patients undergoing RME. This procedure did not cause alterations in salivary biomarkers related to inflammation. [ABSTRACT FROM AUTHOR]

To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders. Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%). Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P =.608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P <.001; T2: 23.15, P <.001; T3: 9.35, P =.008). MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders. [ABSTRACT FROM AUTHOR]

Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm2 at the palate level and 23.3 mm2 at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Key Clinical Message Illustrating F‐quad helix with extension arms that simultaneously expand maxillary arch and rotate its central incisor adjacent to the alveolar cleft while aligning palatally ectopic canines. Incisor rotation occurred before alveolar grafting, while canine traction was performed after alveolar grafting. The construction of this appliance is shown in detail.