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Background: Palatal expansion is a common way of treating maxillary transverse deficiency. Under mechanical force, the midpalatal suture is expanded, causing local immune responses. This study aimed to determine whether macrophages participate in bone remodeling of the midpalatal suture during palatal expansion and the effects on bone remodeling. Methods: Palatal expansion model and macrophage depletion model were established. Micro-CT, histological staining, and immunohistochemical staining were used to investigate the changes in the number and phenotype of macrophages during palatal expansion as well as the effects on bone remodeling of the midpalatal suture. Additionally, the effect of mechanically induced M2 macrophages on palatal osteoblasts was also elucidated in vitro. Results: The number of macrophages increased significantly and polarized toward M2 phenotype with the increase of the expansion time, which was consistent with the trend of bone remodeling. After macrophage depletion, the function of osteoblasts and bone formation at the midpalatal suture were impaired during palatal expansion. In vitro, conditioned medium derived from M2 macrophages facilitated osteogenic differentiation of osteoblasts and decreased the RANKL/OPG ratio. Conclusions: Macrophages through polarizing toward M2 phenotype participated in midpalatal suture bone remodeling during palatal expansion, which may provide a new idea for promoting bone remodeling from the perspective of regulating macrophage polarization. [ABSTRACT FROM AUTHOR]

Abstract Background Palatal expansion is a common way of treating maxillary transverse deficiency. Under mechanical force, the midpalatal suture is expanded, causing local immune responses. This study aimed to determine whether macrophages participate in bone remodeling of the midpalatal suture during palatal expansion and the effects on bone remodeling. Methods Palatal expansion model and macrophage depletion model were established. Micro-CT, histological staining, and immunohistochemical staining were used to investigate the changes in the number and phenotype of macrophages during palatal expansion as well as the effects on bone remodeling of the midpalatal suture. Additionally, the effect of mechanically induced M2 macrophages on palatal osteoblasts was also elucidated in vitro. Results The number of macrophages increased significantly and polarized toward M2 phenotype with the increase of the expansion time, which was consistent with the trend of bone remodeling. After macrophage depletion, the function of osteoblasts and bone formation at the midpalatal suture were impaired during palatal expansion. In vitro, conditioned medium derived from M2 macrophages facilitated osteogenic differentiation of osteoblasts and decreased the RANKL/OPG ratio. Conclusions Macrophages through polarizing toward M2 phenotype participated in midpalatal suture bone remodeling during palatal expansion, which may provide a new idea for promoting bone remodeling from the perspective of regulating macrophage polarization.

Abstract Background The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper’s release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. Results Part of an orthodontist’s role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. Conclusions Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.

Background: The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. Results: Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. Conclusions: Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the clinical outcomes of using two different devices to treat upper palatal discrepancies evaluated with a digital intraoral scanner. Methods: A total of 64 patients were enrolled and treated with either an elastodontic expansion device (32 patient test group, 16 females and 16 males, mean age 7.08 ± 0.44) or Haas expander (32 patient control group, 16 females and 16 males, mean age 7.32 ± 0.50). The two groups exhibited similar orthodontic features. The orthodontic criteria were: skeletal class I relationship; molar class I relationship; complete eruption of upper sixths; presence of unilateral or bilateral cross bite. All dental casts were examined and subsequently scanned with an intraoral scanner (I-Tero) pre-treatment (T0) and 12 months after the onset of therapy (T1) to assess the distance between the decidous upper canines (ICW, intercanine width) and the distance between the mesiopalatal cusps of the upper first molars (IMW, intermolar width). For statistical analysis, the t-test for continous variables and the chi-square test for categorical variables were used, respectively. Results: There were no statistically significant differences between the mean and SD of the expansions that resulted from the Haas expander and the elastodontic devices (Haas expander vs. Eptamed: ICW_T1 (Haas) = 42.34 (3.09), ICW_T1 (Eptamed) = 42.69 (2.77); p = 0.743; IMW_T1 (Haas) = 34.22 (2.29), IMW_T1 (Eptamed) = 34.00 (2.56); p = 0.800). The two devices were similarly effective. Conclusions: Elastodontic devices and the Haas expander can successfully help the orthodontist to conduct upper arch expansion treatment. However, elastodontic devices are more comfortable during the resolution of palatal discrepancies compared to palatal expander devices. [ABSTRACT FROM AUTHOR]

Piezocision™ assisted orthodontics as a technique was first published 14 years ago. This technique has evolved into a treatment concept that allows the orthodontist to treat successfully challenging cases by creating differential anchorage in three planes while maintaining or enhancing the patients' periodontal phenotype. Technical advances in digital dentistry over the past 10 years have brought some important innovations to Piezocision™ assisted orthodontic surgery. Dynamic Navigated Piezocision™ allows the surgeon to see the corticotomies in REAL TIME on the monitor screen, thus avoiding roots, anatomical structures and getting to proper depth. Piezocision™ allows for Precision orthodontics. In the past 10 years it has helped in distalization mechanics, bite opening, severe torque issues, treatment of posterior crossbites in adults, posterior open bites, anterior open bites, alveolar insufficiencies and impacted teeth eruption. [ABSTRACT FROM AUTHOR]

Abstract Background Assessment of midpalatal suture maturation on cone-beam computed tomography (CBCT) scans is performed by visual inspection and is therefore subjective. The extent to which the assessment of midpalatal suture maturation is affected by rater experience has not been adequately explored in the existing literature, thus limiting the availability of evidence-based findings. This study compared the outcomes of classification by dental students, orthodontic residents, and orthodontists. Methods Three different groups of students, orthodontic residents, and orthodontists evaluated 10 randomly chosen CBCT scans regarding midpalatal suture maturation from a pool of 179 patients (98 female and 81 male patients) aged 8 – 40 years which were previously classified by evaluating CBCT scans. The pool was set as benchmark utilizing midpalatal suture maturation classification by one examiner (OsiriX Lite version 11.0; Pixmeo SARL, Bernex, Switzerland). For assessment of intra-rater reliability of the examiners of each group the randomly chosen subjects were reclassified for midpalatal suture maturation after a wash-out period of two weeks by using the same software. Statistical analysis was performed to evaluate intra- and interrater reliability of the three groups with differing experience level. Results Groupwise intra-rater reliability assessment between the classification and reclassification was weak for examiners with a low level of experience (k = 0.59). Orthodontists had highest degree of agreement with regard to benchmark classification with an inter-rater reliability to be considered as moderate (k = 0.68). Conclusions Assessment of midpalatal suture maturation on CBCT scans appears to be a subjective process and is considerably related to the experience level of the examiner. A high level of clinical experience seems to be favorable but does not necessarily ensure accurate results.

Background: Many types of maxillary expansion devices with different expansion rates are used in the treatment of maxillary arch constriction. This study aimed to assess the effectivenessof a new removable plate appliance to improve maxillary arch constriction in comparison to similar common devices.Methods and Materials: The present quasiexperimental study was conducted on 15 patients who had referred to the dental clinic of Birjand University of Medical Sciences between July 2020 and December 2021. In the case group, the maxilla was widened with a transparent removable plate made of thermoplastic plates without wire components. The information of patients in the control group (treated with the removable acrylic plate with a midline screw and wire components) was extracted from a similar study. Data were subjected to statistical analysis using SPPS version 25. T-test, Mann-Whitney and one-sample T-test were used to compare groups. P-value less than 0.05 was considered statistically significant.Results: The average amount of monthly intermolar expansion was 0.871±0.552 and 1.156±1.09 mm in the case and control groups, respectively. The mean amount of monthly inter-canine expansion was 0.994±0.498 mm and 0.931±0.869 mm in the case and control group, respectively. The results indicated no significant difference between the two study groups in terms of intermolar expansion (P=0.07) and intercanine expansion (P=0.68). The degree of satisfaction with the treatment was significantly higher in the case group, compared to the control group (P=0.01).Conclusion: It seems that the transparent thermoplastic removable plate without wire components is not more effective in the treatment of patients with maxillary arch stenosis compared to the common model with wire components. However, the use of this new device can be effective in increasing patients’ satisfaction by maintaining the efficiency of treatment.

Background: Assessment of midpalatal suture maturation on cone-beam computed tomography (CBCT) scans is performed by visual inspection and is therefore subjective. The extent to which the assessment of midpalatal suture maturation is affected by rater experience has not been adequately explored in the existing literature, thus limiting the availability of evidence-based findings. This study compared the outcomes of classification by dental students, orthodontic residents, and orthodontists. Methods: Three different groups of students, orthodontic residents, and orthodontists evaluated 10 randomly chosen CBCT scans regarding midpalatal suture maturation from a pool of 179 patients (98 female and 81 male patients) aged 8 – 40 years which were previously classified by evaluating CBCT scans. The pool was set as benchmark utilizing midpalatal suture maturation classification by one examiner (OsiriX Lite version 11.0; Pixmeo SARL, Bernex, Switzerland). For assessment of intra-rater reliability of the examiners of each group the randomly chosen subjects were reclassified for midpalatal suture maturation after a wash-out period of two weeks by using the same software. Statistical analysis was performed to evaluate intra- and interrater reliability of the three groups with differing experience level. Results: Groupwise intra-rater reliability assessment between the classification and reclassification was weak for examiners with a low level of experience (k = 0.59). Orthodontists had highest degree of agreement with regard to benchmark classification with an inter-rater reliability to be considered as moderate (k = 0.68). Conclusions: Assessment of midpalatal suture maturation on CBCT scans appears to be a subjective process and is considerably related to the experience level of the examiner. A high level of clinical experience seems to be favorable but does not necessarily ensure accurate results. [ABSTRACT FROM AUTHOR]

Copyright of Kieferorthopädie: die Zeitschrift für die Praxis is the property of Quintessenz Verlags GmbH 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 Background The purpose of this study is to investigate the long-term efficacy and stability of Miniscrew-assisted Rapid Palatal Expansion (MARPE), including its primary outcomes, namely the nasomaxillary complex transverse skeletal and dental expansion, and related secondary outcomes. Methods Electronic databases and manual literature searches, up to October 31, 2022, were performed. The eligibility criteria were the following: studies on patients with transverse maxillary deficiency treated with MARPE in adults and adolescents over 13.5 years of age. Results Ultimately, twelve articles were included in the analysis, one prospective and eleven retrospective observational studies. Five studies showed a moderate risk of bias, while the remaining seven studies were at a serious risk of bias. The GRADE quality of evidence was very low. MARPE is an effective treatment modality for transverse maxillary deficiency (mean success rate: 93.87%). Patients showed increased mean in the skeletal and dental transverse expansion. The basal bone composition, mean alveolar bone and mean dental expansion accounted for 48.85, 7.52, and 43.63% of the total expansion, respectively. There was a certain degree of skeletal and dental relapse over time. MARPE could also cause dental, alveolar, and periodontal side effects, and have an impact on other craniofacial bones, upper airway, and facial soft tissue. Conclusions MARPE is an effective treatment for transverse maxillary deficiency, with a high success rate and a certain degree of skeletal and dental relapse over time.

Copyright of Dental Press Journal of 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.)

Background: The purpose of this study is to investigate the long-term efficacy and stability of Miniscrew-assisted Rapid Palatal Expansion (MARPE), including its primary outcomes, namely the nasomaxillary complex transverse skeletal and dental expansion, and related secondary outcomes. Methods: Electronic databases and manual literature searches, up to October 31, 2022, were performed. The eligibility criteria were the following: studies on patients with transverse maxillary deficiency treated with MARPE in adults and adolescents over 13.5 years of age. Results: Ultimately, twelve articles were included in the analysis, one prospective and eleven retrospective observational studies. Five studies showed a moderate risk of bias, while the remaining seven studies were at a serious risk of bias. The GRADE quality of evidence was very low. MARPE is an effective treatment modality for transverse maxillary deficiency (mean success rate: 93.87%). Patients showed increased mean in the skeletal and dental transverse expansion. The basal bone composition, mean alveolar bone and mean dental expansion accounted for 48.85, 7.52, and 43.63% of the total expansion, respectively. There was a certain degree of skeletal and dental relapse over time. MARPE could also cause dental, alveolar, and periodontal side effects, and have an impact on other craniofacial bones, upper airway, and facial soft tissue. Conclusions: MARPE is an effective treatment for transverse maxillary deficiency, with a high success rate and a certain degree of skeletal and dental relapse over time. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

Background: Maxillary crowding is a common orthodontic issue that can impact a patient's oral health and overall well-being. The timing of orthodontic treatment plays a crucial role in achieving optimal results. Materials and Methods: Thirty patients who received early intervention with palatal expansion (Group A) and 30 patients who underwent late orthodontic treatment (Group B) were included in this study. The age range for Group A was 8–10 years, while Group B had an age range of 16–18 years. Pretreatment and posttreatment records, including dental models and cephalometric radiographs, were analyzed to assess the effectiveness of the respective treatments. Results: In Group A, the mean duration of treatment was 12 months, and the maxillary crowding was corrected by an average of 4.5 mm. In Group B, the mean treatment duration was 24 months, and maxillary crowding was corrected by an average of 3.2 mm. The early intervention group (Group A) exhibited a statistically significant reduction in treatment duration and greater correction of maxillary crowding compared to the late orthodontic treatment group (Group B) (P < 0.05). Conclusion: Early intervention with palatal expansion is an effective approach for correcting maxillary crowding, leading to shorter treatment duration and greater improvement compared to late orthodontic treatment.

Background: Maxillary crowding is a common orthodontic issue that can impact a patient's oral health and overall well-being. The timing of orthodontic treatment plays a crucial role in achieving optimal results. Materials and Methods: Thirty patients who received early intervention with palatal expansion (Group A) and 30 patients who underwent late orthodontic treatment (Group B) were included in this study. The age range for Group A was 8–10 years, while Group B had an age range of 16–18 years. Pretreatment and posttreatment records, including dental models and cephalometric radiographs, were analyzed to assess the effectiveness of the respective treatments. Results: In Group A, the mean duration of treatment was 12 months, and the maxillary crowding was corrected by an average of 4.5 mm. In Group B, the mean treatment duration was 24 months, and maxillary crowding was corrected by an average of 3.2 mm. The early intervention group (Group A) exhibited a statistically significant reduction in treatment duration and greater correction of maxillary crowding compared to the late orthodontic treatment group (Group B) (P < 0.05). Conclusion: Early intervention with palatal expansion is an effective approach for correcting maxillary crowding, leading to shorter treatment duration and greater improvement compared to late orthodontic treatment. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the clinical outcomes of using two different devices to treat upper palatal discrepancies evaluated with a digital intraoral scanner. Methods: A total of 64 patients were enrolled and treated with either an elastodontic expansion device (32 patient test group, 16 females and 16 males, mean age 7.08 ± 0.44) or Haas expander (32 patient control group, 16 females and 16 males, mean age 7.32 ± 0.50). The two groups exhibited similar orthodontic features. The orthodontic criteria were: skeletal class I relationship; molar class I relationship; complete eruption of upper sixths; presence of unilateral or bilateral cross bite. All dental casts were examined and subsequently scanned with an intraoral scanner (I-Tero) pre-treatment (T0) and 12 months after the onset of therapy (T1) to assess the distance between the decidous upper canines (ICW, intercanine width) and the distance between the mesiopalatal cusps of the upper first molars (IMW, intermolar width). For statistical analysis, the t-test for continous variables and the chi-square test for categorical variables were used, respectively. Results: There were no statistically significant differences between the mean and SD of the expansions that resulted from the Haas expander and the elastodontic devices (Haas expander vs. Eptamed: ICW_T1 (Haas) = 42.34 (3.09), ICW_T1 (Eptamed) = 42.69 (2.77); p = 0.743; IMW_T1 (Haas) = 34.22 (2.29), IMW_T1 (Eptamed) = 34.00 (2.56); p = 0.800). The two devices were similarly effective. Conclusions: Elastodontic devices and the Haas expander can successfully help the orthodontist to conduct upper arch expansion treatment. However, elastodontic devices are more comfortable during the resolution of palatal discrepancies compared to palatal expander devices.

Objectives: To correlate skeletal and airway measures on imaging with polysomnographic and self-reported measures after distraction osteogenesis maxillary expansion (DOME), in the effort to identify clinically relevant sites of expansion to guide treatment for adult patients with obstructive sleep apnea (OSA). Materials and methods: This is a retrospective study reviewing subjects who underwent DOME and had the complete set of the following data: peri-treatment cone-beam computed tomography (CBCT) scans, polysomnography (PSG), Epworth Sleepiness Scale (ESS), and nasal obstruction symptom (NOSE) scores. Results: Of 132 subjects who underwent DOME, 35 met inclusion criteria (71% men, mean age 27.7 ± 6.5 years, mean BMI 26.0 ± 6.4 kg/m2) and were enrolled in the study. There was a significant reduction in the NOSE score from 11.4 ± 5.5 to 3.6 ± 3.1, in the ESS score from 12.0 ± 4.6 to 7.1 ± 4.7, and in the apnea–hypopnea index (AHI) from 17.1 ± 15.8 to 7.01 ± 6.2 (p < 0.0001), after DOME. Nasal floor width at the nasopalatine canal level showed a statistically significant correlation with AHI reduction (p <.0001). Conclusions: DOME is significantly associated with reduction of nasal obstruction, sleepiness, and severity of OSA. The findings suggest that expansion at the anterior third of the bony nasal passage, specifically where the nasopalatine canal is located predicts its clinical efficacy. This site may be a useful target anatomically via imaging. [ABSTRACT FROM AUTHOR]

In dental practice, pediatric patients with a wide range of manifestations of malocclusion viz. crossbite, dental crowding, and skeletal Class III due to transverse discrepancy of the abnormally constricted maxilla or palate are found. However, the dental management of such kind of malocclusion with narrow palate needs a meticulous dental evaluation. Appliances used for treating such malocclusion conditions may include Slow‑Maxillary Expansion (SME) or Rapid Maxillary Expansion (RME) orthodontic or orthopedic appliances. Considerable success has been described in the literature using the maxillary/palatal expansion modality. Unusual systemic and nondental effects of expansion appliances therapy have been described in some scientific studies. However, no comprehensive review article has been published describing the nondental and systemic effects of RME/SME therapy in Pediatric Dentistry. Considering the above scenarios, the updated and comprehensive review of the relevant literature is necessary for health professionals. Dental professionals including pediatric dentists and orthodontists need to consider such untoward or unexpected effects of RME/ SME treatment modality. Hence, the current comprehensive review article has been written with the aim to meticulously describe the relevant scientific literature about nondental/extraoral and systemic effects of RME/SME appliances. [ABSTRACT FROM AUTHOR]

Abstract The objective of the present study was to evaluate and compare the effect of the computer-aided static navigation technique on the accuracy of the maxillary skeletal expansion (MSE) appliances. Material and Methods: Forty orthodontic self-drilling mini-implants were placed in ten anatomically based standardized polyurethane models of a completely edentulous upper maxilla, manufactured using a 3D impression procedure. The four orthodontic self-drilling mini-implants for anchoring the MSE appliance were digitally planned on 3D planning software, based on preoperative cone-beam computed tomography (CBCT) scan and a 3D extraoral surface scan. Afterwards, the surgical templates were virtually planned and manufactured using stereolithography. Subsequently, the orthodontic self-drilling mini-implants were placed an postoperative CBCT scans were performed. Finally, coronal entry-point, apical end-point and angular deviations were calculated using a t-test for independent samples or a non-parametric Signed Rank test. Results: Statistically significant differences were not shown at coronal entry-point (p = 0.13), apical end-point (p = 0.41) and angular deviations (p = 0.27) between the planned and performed orthodontic self-drilling mini-implants. Conclusions: Computer-aided static navigation technique enables accurate orthodontic mini-implant placement for the MSE appliances.

Background: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. Material and methods: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. Results: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. Conclusion: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate and compare the effect of the computer-aided static navigation technique on the accuracy of the maxillary skeletal expansion (MSE) appliances. Material and Methods: Forty orthodontic self-drilling mini-implants were placed in ten anatomically based standardized polyurethane models of a completely edentulous upper maxilla, manufactured using a 3D impression procedure. The four orthodontic self-drilling mini-implants for anchoring the MSE appliance were digitally planned on 3D planning software, based on preoperative cone-beam computed tomography (CBCT) scan and a 3D extraoral surface scan. Afterwards, the surgical templates were virtually planned and manufactured using stereolithography. Subsequently, the orthodontic self-drilling mini-implants were placed an postoperative CBCT scans were performed. Finally, coronal entry-point, apical end-point and angular deviations were calculated using a t-test for independent samples or a non-parametric Signed Rank test. Results: Statistically significant differences were not shown at coronal entry-point (p = 0.13), apical end-point (p = 0.41) and angular deviations (p = 0.27) between the planned and performed orthodontic self-drilling mini-implants. Conclusions: Computer-aided static navigation technique enables accurate orthodontic mini-implant placement for the MSE appliances. [ABSTRACT FROM AUTHOR]

Abstract Background The use of palatal miniscrew offers the possibility to improve the effectiveness of orthodontic expansion devices. Palatal expanders supported by miniscrew can be applied with different clinical protocols. Some authors proposed the use of four palatal miniscrews during miniscrew-supported palatal expansion to maximize skeletal effects in young adults’ treatment. However, bone availability decreases in the posterior paramedian palatal regions, making the positioning of the two-posterior paramedian palatal miniscrews challenging, when it is performed avoiding nasal cavities invasion. Some authors proposed miniscrews insertion in a specific region located laterally to the palatal process of the maxillary bone, and apically relatively to the dento-alveolar process. The aim of this study was to evaluate the bone thickness, cortical bone thickness, and mucosae depth of this anatomical site that, in this study, was defined as palatal posterior supra-alveolar insertion site. Results The evaluation of bone availability of palatal posterior supra-alveolar insertion site at different antero-posterior levels showed that the maximum amount of total bone thickness was found between the second premolar and the first molar. At this level total bone, thickness is significantly (p

Hearing loss is a highly prevalent condition in the pediatric population. Pediatric maxillary expansion is a widespread treatment to address transverse maxillary deficiency. First reports describing an association between improvements for patients with HL and PME initiated in the 1960s. In this systematic review and meta-analysis we aim to review the role of maxillary expansion in reducing conductive hearing loss in pediatric population. Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked. Main outcome was expressed as the difference between air-bone gap, compliance, ear volume and conductive hearing thresholds before and after treatment and the 95% confidence interval. A total of 10 studies (218 patients) met inclusion criteria. The pooled data in the meta-analysis under a random effects model shows a statistically significant difference of 10.57 dB mean reduction after palatal expansion. The air-bone gap was significantly reduced by 5.39 dB (CI 95% 3.68, 7.10). Compliance and volume were assessed in three studies, with a non-significant positive difference in the compliance (0.14) and a statistically significant difference for volume (0.80) after palatal expansion. This systematic review and meta-analysis found a positive effect of pediatric maxillary expansion in conductive hearing loss in well-select children. However, results cannot be extrapolated for children with conductive hearing loss without an accompanying orthodontic indication (maxillary constriction). It showed that the existing prospective studies exhibited qualitative pitfalls, limiting the ability to obtain conclusive evidence about the role of pediatric maxillary expansion on conductive hearing loss in children. [ABSTRACT FROM AUTHOR]

Aim: The study was to examine rapid maxillary expansion (RME), semi-rapid maxillary expansion (SRME), and slow maxillary expansion (SME) compare the root resorptions occurring in the supporting upper first premolar teeth during treatment by using micro-computed tomography (micro-CT). Methodology: Thirty individuals that required maxillary expansion and upper first premolar tooth extraction were divided into three groups consisting of 10 individuals for RME, SRME, and SME. RME group, first premolar and first molar teeth with hyrax screw were activated 1/4 tour twice daily with the banded hyrax appliances. SRME group, acrylic bonded hyrax appliances were activated 1/4 tour per every morning and night until the opening of the suture. Upon the opening of the suture, it was activated 1/4 tour per every two days until sufficient maxillary expansion was gained. SEM group, quad helix appliances were activated per every 20 days. After 12 weeks of the retention period, the upper first premolar teeth were extracted. The teeth were scanned with Micro-CT (SkyScan 1172, Kontich, Belgium), and images were analyzed Dell Precision T5500 to determine the resorption crater volumes. Results: In all samples, the resorption craters were concentrated on the buccal surfaces of the tooth roots. The highest resorption craters volume, the total resorption volume, was observed in the RME group, followed by the SRME group, and the least resorption crater volume was detected in the SME group. Conclusion: Since the supporting teeth were exposed to more force on the root surfaces, the most resorption was seen in the RME group. [ABSTRACT FROM AUTHOR]

Background and purpose: Transverse problems in the maxilla (high arched- narrow hard plates) can cause respiratory disorders. Palatal expansion can be helpful in this way. The present study aimed at evaluating the effect of bone borne expansion and tooth borne palatal expansion on airway volume. Materials and methods: A review study was performed by search in Google Scholar, Scopus, PubMed, Embase, and Cochrane using the following keywords: maxillary expansion, palatal expansion, miniscrew-assisted palatal expansion, tooth borne, bone borne, rapid palatal expansion, airway dimension, and Cone beam computed tomography. The search was limited to articles published in January 2011-April 2021. Results: In the initial search, 343 articles were found. After reviewing the titles and abstracts only 20 papers were found that studied the effect of bone and tooth borne palatal expansion on airway dimensions and met the inclusion criteria. The studies indicated that both bone expansion and tooth borne palatal expansion could considerably increase airway volumes. However, only bone borne palatal expansion enabled more predictable and greater skeletal expansion and less teeth response. Conclusion: Both bone and tooth borne palatal expansion are efficient in increasing the airway volume. Further randomized clinical trials with large sample size and matched control groups, longer follow-up periods and measuring respiration index such as apnea-hypopnea index are suggested.

Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.

BackgroundMini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture.MethodsFifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used.ResultsRegarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P

Treatment of third-class malocclusions often presents a challenge for orthodontists. Skeletal disharmony is often associated with dental malposition. There are several therapeutic choices, including the use in combination of transverse expansion of the maxilla with rapid palatal expander (RPE) and posterior-anterior traction with a Delaire face mask (FM). The purpose of the study is to verify whether there are significant differences in the treatment outcome in the case of use of a face mask followed by a palatal expander or with the sequence of these auxiliaries reversed. Subject and Methods: The two groups were both made up of 13 patients, subdivided into group A, i.e., those whose sequence involved the use of extraoral traction first and then the disjunctor, and those with an inverted sequence in group B. Some cephalometric parameters and dento-skeletal characteristics were evaluated pre-treatment (t0) and at the end of therapy (t1). Results: Considering the T1–T0 of group A (Delaire + rapid palatal expander), the evaluation of the results obtained in this work allows us to observe how within group A there is a significant improvement in the Witts and Nanda indices and facial convexity. Group B (treated with the palate disjunctor sequence followed by traction with Delaire's mask) showed a significant improvement in ANB, in AoBo, and AppBpp values and in convexity. The two groups were comparable, and no statistically significant difference was highlighted. Discussion: The early therapy of the third skeletal classes by means of a rapid palate expander and face mask is effective. There is no statistically significant difference in the two groups who performed the therapy in reverse mode. This suggests that the clinician should choose the treatment sequence based on the skeletal and occlusal conditions of their patients at the start of treatment. Conclusion: Early therapy of third skeletal classes with sagittal expansion using a rapid palate expander can be performed earlier or later than posterior-anterior traction with a Delaire mask. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping. [ABSTRACT FROM AUTHOR]

The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal Expansion) by measuring electromyographic and electrokinesographic activity. 24 adult patients with unilateral posterior crossbite on the right side were selected from the Orthodontic Department of the University of Milan. Three electromyographic and electrokinesographic surface readings were taken respectively before surgery (T0) and 8 months after surgery (T1). The electromyographic data of both right and left masseter and anterior temporalis muscles were recorded during multiple tests: standardized maximum voluntary contraction (MVC)s, after transcutaneous electrical nerve stimulation (TENS) and at rest. T0 and T1 values were compared with paired Student's t-test (p < 0.05). Results: Significant differences were found in the activity of right masseter (p = 0.03) and right temporalis (p = 0.02) during clench, in the evaluation of right masseter at rest (p = 0.03), also the muscular activity of masseters at rest after TENS from T0 to T1 (pr = 0.04, pl = 0.04). No significant differences were found in the activity of left masseter (p = 0.41) and left temporalis (p = 0.39) during clench and MVC, in the evaluation of left masseter at rest (p = 0.57) and in the activity during MVC of right masseter (p = 0.41), left masseter (p = 0.34), right temporalis (p = 0.51) and left temporalis (p = 0.77). Results showed that the activity of the masseter and temporalis muscles increased significantly after SARPE during rest and clenching on the side where the cross-bite was treated. [ABSTRACT FROM AUTHOR]

A "spontaneous" correction of the Class II malocclusion has been described after maxillary expansion (ME) treatment. The aim of the present review was to systematically summarize changes in the sagittal dentoskeletal parameters of growing Class II patients after ME. The study protocol was developed according to the PRISMA statement and registered in PROSPERO before literature search, data extraction and analysis. The PICO model was followed in the definition of the research question, search strategies and study selection criteria. Randomized and non-randomized studies on the sagittal effects of ME published in English language without date restrictions were electronically searched across the Cochrane Library, Scopus and MEDLINE/PubMed databases. Changes in sagittal dentoskeletal cephalometric parameters were analysed. The risk of bias in randomized and nonrandomized studies was assessed using the Rob2 and ROBINS-I tools, respectively. A narrative synthesis was performed, focusing on the investigated population, intervention, comparison, and main outcomes. Pairwise meta-analyses were used to compare the outcomes assessed in subjects who underwent ME versus untreated subjects. Ten studies met the inclusion criteria, four were included in the pairwise meta-analyses due to the presence of a control group. Slight but significant improvements in OVJ (MD: -0.36; 95%; CI [-0.69 to -0.01]; p = .04) and 6/6 molar relation (MD: 1.5; 95%; CI [0.69 to 1.61]; p < .0001) were found in patients who underwent ME compared with untreated subjects, whereas no improvement in skeletal parameters was observed. However, the limitations of a small body of moderate-quality evidence and possible confounding factors should be considered. Evidence on the sagittal skeletal and dental effects of ME in Class II patients is still ambiguous, suggesting the need for more clinical trials, including appropriate control subjects, randomization and blinding during outcome assessment., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this study was to evaluate changes in shape of the palatal vault after maxillary expansion with hyrax expander (HE) and leaf expander (LE), using 3D Geometric Morphometric Analysis., Setting and Sample Population: Overall, 250 patients (110 M, 140 F) with maxillary transverse deficiency were selected for this study. In this study, 127 subjects were treated with HE, 123 with LE., Materials and Methods: Digital dental models were obtained pre-treatment (T0) and after 12 months from the cementation of the device (T1) and processed by means of a digital scanner. Linear and morphometric analyses were conducted to determine the effects of each appliance on dental measurements and palatal shape, and a multiple linear regression was performed to analyse the influence of anchorage and appliance type on final shape., Results: Morphometric analysis showed that there was a lowering of the palatal vault in the HE group, while in the LE group it remained unchanged: the difference in palatal shape at time T0 and T1 was statistically significant in both treatments (HE vs. LE). In the HE group, the change in shape also included the upper part of the palatal vault in the vertical dimension, while in the LE group the change in shape interested mainly palatal shelves and the lower portion of the palate., Conclusions: Both LE and HE produce clinically significant changes in the morphology of the palatal vault., (© 2024 The Author(s). Orthodontics & Craniofacial Research published by John Wiley & Sons Ltd.)

Daniele Cantarella,1 Lorena Karanxha,1 Paolo Zanata,2 Christoph Moschik,3 Ana Torres,3 Gianpaolo Savio,4 Massimo Del Fabbro,1,5 Won Moon6,7 1Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; 2Private Dental Laboratory Practice, Castelfranco Veneto, Italy; 3Private Orthodontic Practice, Munich, Germany; 4Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova, Padova, Italy; 5IRCCS Orthopedic Institute Galeazzi, Milan, Italy; 6Orthodontics, The Forsyth Institute, Cambridge, MA, USA; 7Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, KoreaCorrespondence: Daniele CantarellaDepartment of Biomedical, Surgical and Dental Sciences, University of Milan, via Commenda 10, Milan, ItalyEmail danielecant@hotmail.comAbstract: The miniscrew-assisted rapid palatal expansion approach has given new opportunities for the treatment of maxilla transverse deficiency by providing an alternative to the surgical approach for adult patients. However, the presence of a thin palatal bone can compromise the success of such approach. Recently, the digital planning of the miniscrew-assisted appliances has offered unique advantages in terms of safety and accuracy of the overall process. The aim of this study is to describe the digital planning and MSE fabrication with cad-cam technology using 6 mini-screws in cases with a palatal bone thickness of less than 2.5 mm.Keywords: digital orthodontics, MSE, maxillary transverse deficiency, palatal expansion, MARPE

Aim: In the literature, many studies and articles are investigating new devices and approaches to achieve rapid palate expansion through the opening of the palatal suture, and evaluating the skeletal, dental, and soft tissue effects. The purpose of this review was to assess how palatal expansion is performed in adolescent patients with permanent dentition. Furthermore, it was reported as an example of successful orthodontic treatment of an 11-year-old female patient affected by maxillary skeletal transverse deficiency, in permanent dentition. Methods: A search of the literature was conducted on PubMed, Cochrane, Scopus, Embase, and Web of Science databases. Inclusion criteria were the year of publication between 2017 and 2022, patients aged 10 to 16 years in permanent dentition, with transversal discrepancy, treated with tooth-borne, bone-borne, hybrid palatal expanders. Results: A total of 619 articles were identified by the electronic search, and finally, a total of 16 papers were included in the qualitative analysis. Conclusions: From this study, it was assessed that MARPE is more predictable, and it determines a more significant expansion of the suture than the Hyrax expander, with fewer side effects. [ABSTRACT FROM AUTHOR]

Background: The use of palatal miniscrew offers the possibility to improve the effectiveness of orthodontic expansion devices. Palatal expanders supported by miniscrew can be applied with different clinical protocols. Some authors proposed the use of four palatal miniscrews during miniscrew-supported palatal expansion to maximize skeletal effects in young adults' treatment. However, bone availability decreases in the posterior paramedian palatal regions, making the positioning of the two-posterior paramedian palatal miniscrews challenging, when it is performed avoiding nasal cavities invasion. Some authors proposed miniscrews insertion in a specific region located laterally to the palatal process of the maxillary bone, and apically relatively to the dento-alveolar process. The aim of this study was to evaluate the bone thickness, cortical bone thickness, and mucosae depth of this anatomical site that, in this study, was defined as palatal posterior supra-alveolar insertion site. Results: The evaluation of bone availability of palatal posterior supra-alveolar insertion site at different antero-posterior levels showed that the maximum amount of total bone thickness was found between the second premolar and the first molar. At this level total bone, thickness is significantly (p <.05) greater compared to the other sagittal sites and it offers on average around 2 mm of extra bone depth for miniscrew placement. Cortical bone thickness is adequate for primary miniscrew stability. Overall, cortical bone thickness considered at different insertion sites showed significant statistically (p <.05) differences. The findings of this study showed that palatal mucosa is particularly thick with average values ranging from 4 to 7 mm, and its extension ultimately affects miniscrew length selection. Palatal mucosa thickness showed no clinically significant differences comparing different sagittal and vertical insertion sites. Data also showed that palatal mucosal thickness slightly significantly increases (p <.05) with the inclination of the insertion axis relative to the occlusal plane. Finally, study findings showed that vertical growth pattern can significantly affect considered outcomes (p <.05). Conclusions: Palatal posterior supra-alveolar insertion site is an appropriate site for posterior insertion of palatal miniscrews. Considering high anatomical variation preliminary CBCT evaluation is important to achieve optimal miniscrew placement. [ABSTRACT FROM AUTHOR]

Background and purpose: Transverse problems in the maxilla (high arched- narrow hard plates) can cause respiratory disorders. Palatal expansion can be helpful in this way. The present study aimed at evaluating the effect of bone borne expansion and tooth borne palatal expansion on airway volume. Materials and methods: A review study was performed by search in Google Scholar, Scopus, PubMed, Embase, and Cochrane using the following keywords: maxillary expansion, palatal expansion, miniscrew-assisted palatal expansion, tooth borne, bone borne, rapid palatal expansion, airway dimension, and Cone beam computed tomography. The search was limited to articles published in January 2011-April 2021. Results: In the initial search, 343 articles were found. After reviewing the titles and abstracts only 20 papers were found that studied the effect of bone and tooth borne palatal expansion on airway dimensions and met the inclusion criteria. The studies indicated that both bone expansion and tooth borne palatal expansion could considerably increase airway volumes. However, only bone borne palatal expansion enabled more predictable and greater skeletal expansion and less teeth response. Conclusion: Both bone and tooth borne palatal expansion are efficient in increasing the airway volume. Further randomized clinical trials with large sample size and matched control groups, longer follow-up periods and measuring respiration index such as apnea-hypopnea index are suggested. [ABSTRACT FROM AUTHOR]

Objectives: 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. Material and methods: 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. Results: 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). Conclusion: SARPE promoted substantial buccal tipping of posterior teeth and some bone displacement; it also moved the maxilla and teeth forward and increased nasal width. Clinical relevance: 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. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Surgically Assisted Rapid Palatal Expansion (SARPE) promote maxillary expansion in skeletally mature patients. This technique is effective; however, some side effects are still unknown. Objectives: evaluate the presence of alveolar defects (dehiscences and fenestrations) in patients submitted to the SARPE. The null hypothesis tested was: SARPE does not influence the number of dehiscences and fenestrationss. Methods: A retrospective quasi-experiment study of a convenience sample of 279 maxillary teeth, in 29 patients evaluated with Cone Beam Computed Tomography (CBCT) at T1 (before SARPE), T2 (after expansion) and T3 (after retention), was performed. The examined teeth were: canines, first and second premolars, first and second molars. in axial, coronal, and cross-sectional views. The evaluations involved viewing slices from mesial to distal of the buccal roots. Results: All statistical analyses were performed using SAS 9.3 and SUDAAN softwares. Alpha used in the study was 0.05. Alveolar defects increased statistically from T1 (69.0%) to T2 (96.5%) and T3 (100%). Dehiscences increased 195% (Relative Risk 2.95) at the end of expansion (T2). After retention (T3), individuals were on average 4.34 times more likely to develop dehiscences (334% increase). Fenestrations did not increase from T1 to T2 (p = 0.0162, 7.9%) and decreased from T2 to T3 (p = 0.0259, 4.3%). Presence of fenestrations at T1 was a significant predictor for the development of dehiscences in T2 and T3. Dehiscences increased significantly in all teeth, except second molars. Conclusion: The null hypothesis was rejected. After SARPE the number of dehiscences increased and fenestrations decreased. Previous alveolar defects were predictor for dehiscences after SARPE.

Objective: For the treatment of obstructive sleep apnea in adults, mandibular advancement devices (MADs) are often used. Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile, midfacial development using biomimetic oral appliance therapy might provide a suitable alternative. However, the effect of this procedure on the maxillary air sinuses is unknown; therefore, changes in sinus pneumatization were investigated in this study. Methods: After obtaining informed consent, 16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam (CB) CT scans taken, and biomimetic upper appliances (DNA appliance®, Vivos Therapeutics, Inc., USA) were constructed.All subjects were instructed to wear the device 12–16 h/day. Each month, examination for the progress of midfacial development was recorded. Post-treatment, a follow-up 3D CBCT scan was undertaken with no device in the patient's mouth. Pre- and post-treatment linear and volumetric measurements were obtained using appropriate software, and compared statistically using t-tests. Results: The mean age of the sample was 25.0 yrs ± 8.7. The mean treatment time was 15.5 mths ± 5.2. Post-treatment, the transpalatal bone width increased from 35.3 mm ± 3.0 to 38.5 mm ± 2.0 (P < 0.001); the maxillary air sinus volume on the left side increased from 18.8 cm3 ± 6.5 to 20.0 cm3 ± 6.0 (P < 0.05), and from 18.5 cm3 ± 5.7 to 19.7 cm3 ± 5.8 (P < 0.05) on the right side. Conclusions: Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults. In view of these preliminary findings, further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.

Introduction: Surgically Assisted Rapid Palatal Expansion (SARPE) promote maxillary expansion in skeletally mature patients. This technique is effective; however, some side effects are still unknown. Objectives: evaluate the presence of alveolar defects (dehiscences and fenestrations) in patients submitted to the SARPE. The null hypothesis tested was: SARPE does not influence the number of dehiscences and fenestrationss. Methods: A retrospective quasi-experiment study of a convenience sample of 279 maxillary teeth, in 29 patients evaluated with Cone Beam Computed Tomography (CBCT) at T1 (before SARPE), T2 (after expansion) and T3 (after retention), was performed. The examined teeth were: canines, first and second premolars, first and second molars. in axial, coronal, and cross-sectional views. The evaluations involved viewing slices from mesial to distal of the buccal roots. Results: All statistical analyses were performed using SAS 9.3 and SUDAAN softwares. Alpha used in the study was 0.05. Alveolar defects increased statistically from T1 (69.0%) to T2 (96.5%) and T3 (100%). Dehiscences increased 195% (Relative Risk 2.95) at the end of expansion (T2). After retention (T3), individuals were on average 4.34 times more likely to develop dehiscences (334% increase). Fenestrations did not increase from T1 to T2 (p = 0.0162, 7.9%) and decreased from T2 to T3 (p = 0.0259, 4.3%). Presence of fenestrations at T1 was a significant predictor for the development of dehiscences in T2 and T3. Dehiscences increased significantly in all teeth, except second molars. Conclusion: The null hypothesis was rejected. After SARPE the number of dehiscences increased and fenestrations decreased. Previous alveolar defects were predictor for dehiscences after SARPE. [ABSTRACT FROM AUTHOR]

Objective: In this pilot study, craniofacial changes associated with biomimetic oral appliance therapy (BOAT) were investigated to test the hypothesis of non-surgical remodeling of the maxillary air sinuses in rhinosinusitis.Methods: Three consecutive Korean patients (mean age 9.3 yrs) presented to a dental office with a history of chronic rhinosinusitis. After obtaining informed consent, 3D cone-beam CT scans were taken that showed circumferential mucosal thickening and inflammatory maxillary sinus disease, obstructed ostiomeatuses, and enlarged inferior turbinates. All cases were treated using BOAT (DNA appliance®).Results: Approximately 10 months after BOAT, the paranasal sinuses were aerated without mucosal thickening; the sinus walls were intact, and the ostiomeatal units were patent. All mean craniofacial parameters measured increased, except the transpalatal bone width, which remained unchanged.Discussion: Although enhancement of the maxillary air sinuses through non-surgical remodeling is suspected in these three cases of pediatric rhinosinusitis, additional studies are warranted. [ABSTRACT FROM AUTHOR]

Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of vomer position and prevalence of periodontal dehiscence in patients who underwent surgically assisted rapid palatal expansion (SARPE). The null hypotheses were the following: (1) vomer position in the coronal plane does not influence the degree of skeletal and dental expansion; and (2) there is no association between expansion, periodontal dehiscence and vomer position. Methods: Twenty-one patients were evaluated before treatment (T0) and immediately after SARPE expansion (T1). After SARPE, the vomer was in the right side in 11 patients and in the left in 10 patients. Skeletal and dental effects were evaluated using CBCT, landmarks and measurements. Results: The maxilla and the nasal cavity expanded asymmetrically. The side containing the vomer had less skeletal expansion but more dental tipping. Dehiscence increased significantly from T0 to T1 and was associated with the amount of skeletal displacement, especially when greater than 3.20 mm. In the first premolars region, there was more than 2 mm of asymmetric expansion observed in 38.5% of the patients. Conclusion: The null hypotheses were rejected. The side containing the vomer had less skeletal expansion of the maxilla and nasal cavity but more dental tipping. Dehiscence increased after expansion, but there were no differences between sides. [ABSTRACT FROM AUTHOR]

Objective: Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function. Review Methods: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3). Results: A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm3/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89). Conclusion: The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to assess the diagnostic ability of the crown‐to‐root length ratio of the primary second molar and the position of the corresponding underlying premolar in estimating future anchoring teeth exfoliation during maxillary expansion. Setting and Sample Population: Fifty‐four subjects (30 females, 24 males; 108 teeth) aged 8.2 ± 1.0 years that underwent palatal expansion. Methods: The upper second premolar position of the corresponding expander anchoring primary molar was determined in relation to the ipsilateral first permanent molar half‐pulp chamber (HPC) line on panoramic radiographs. Subjective and objective (based on measurements) assessments of the crown‐to‐root length ratio of anchoring primary molars were performed. Exfoliation after the expansion was recorded over a retention period of 12 months. All the assessments were performed individually by three examiners at two 3‐week‐apart sessions, trained and calibrated before enrolment. The intra‐/inter‐examiner agreements were evaluated, and the diagnostic accuracy of the methods was calculated. Results: All methods exhibited almost perfect intra‐ and at least substantial inter‐examiner agreement (Kappa >0.8 and ≥0.63, respectively). Good diagnostic accuracy was seen for the premolar position to the HPC line (0.7‐0.8), while the crown‐to‐root length ratio methods exhibited hardly sufficient accuracy. The diagnostic agreement of the methods was fair. Conclusions: When primary molars are considered as anchoring teeth for maxillary expansion, the premolar position in relation to the HPC line appears to be the most valid and reliable method for predicting their stability. Despite high repeatability values, the crown‐to‐root length ratio needs a cut‐off point re‐definition to increase its predicting ability. [ABSTRACT FROM AUTHOR]

Transverse Maxillary Deficiency is a common dental malocclusion that usually presents as constricted maxilla with both functional as well as esthetic effects on the individual suffering from it. Functional appliance can be used in children whose mid palatal suture has not ossified but adults required surgical approach such as surgically assisted rapid palatal expansion. We conducted a literature review of techniques of surgical rapid maxillary expansion, appliances commonly used for expansion and finally the complications associated with it postoperatively. Review of available literature was conducted using literature present in PubMed, Google scholar, ESCO and semantic scholar using the following keywords in combination such as "Surgically assisted rapid palatal expansion", "Hyrax appliance", "Haas Appliance" and "Transverse Maxillary Deficiency". Out of the 210 articles screened, 40 were included in this literature review. Presently, surgically assisted rapid maxillary expansion is a treatment option for patients in their adulthood in which the mid-palatal suture has been closed. Expansion appliances such as Haas and Hyrax are used adjunctively with surgical modalities. [ABSTRACT FROM AUTHOR]

Treatment of third-class malocclusions often presents a challenge for orthodontists. Skeletal disharmony is often associated with dental malposition. There are several therapeutic choices, including the use in combination of transverse expansion of the maxilla with rapid palatal expander (RPE) and posterior-anterior traction with a Delaire face mask (FM). The purpose of the study is to verify whether there are significant differences in the treatment outcome in the case of use of a face mask followed by a palatal expander or with the sequence of these auxiliaries reversed. Subject and Methods: The two groups were both made up of 13 patients, subdivided into group A, i.e., those whose sequence involved the use of extraoral traction first and then the disjunctor, and those with an inverted sequence in group B. Some cephalometric parameters and dento-skeletal characteristics were evaluated pre-treatment (t0) and at the end of therapy (t1). Results: Considering the T1–T0 of group A (Delaire + rapid palatal expander), the evaluation of the results obtained in this work allows us to observe how within group A there is a significant improvement in the Witts and Nanda indices and facial convexity. Group B (treated with the palate disjunctor sequence followed by traction with Delaire’s mask) showed a significant improvement in ANB, in AoBo, and AppBpp values and in convexity. The two groups were comparable, and no statistically significant difference was highlighted. Discussion: The early therapy of the third skeletal classes by means of a rapid palate expander and face mask is effective. There is no statistically significant difference in the two groups who performed the therapy in reverse mode. This suggests that the clinician should choose the treatment sequence based on the skeletal and occlusal conditions of their patients at the start of treatment. Conclusion: Early therapy of third skeletal classes with sagittal expansion using a rapid palate expander can be performed earlier or later than posterior-anterior traction with a Delaire mask.