ABSTRACT
Objective@#This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT). @*Methods@#Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups: 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed. @*Results@#Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows: 1) Skeletal expansion: zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion: intercanine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%. @*Conclusions@#In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.
ABSTRACT
The aim of this systematic review was to evaluate the effectiveness and complications of corticotomy and piezocision in canine retraction. Five electronic databases (PubMed, SCOPUS, Web of Science, Embase, and CENTRAL) were searched for articles published up to July 2017. The databases were searched for randomized control trials (RCTs), with a split-mouth design, using either corticotomy or piezocision. The primary outcome reported for canine retraction was either the amount of tooth movement, rate of tooth movement, or treatment time. The secondary outcome was complications. The selection process was based on the PRISMA guidelines. A risk of bias assessment was also performed. Our search retrieved 530 abstracts. However, only five RCTs were finally included. Corticotomy showed a more significant (i.e., 2 to 4 times faster) increase in the rate of tooth movement than did the conventional method. For piezocision, both accumulative tooth movement and rate of tooth movement were twice faster than those of the conventional method. Corticotomy (with a flap design avoiding marginal bone incision) or flapless piezocision procedures were not detrimental to periodontal health. Nevertheless, piezocision resulted in higher levels of patient satisfaction. The main limitation of this study was the limited number of primary research publications on both techniques. For canine retraction into the immediate premolar extraction site, the rate of canine movement after piezocision was almost comparable to that of corticotomy with only buccal flap elevation.
Subject(s)
Bias , Bicuspid , Methods , Orthodontics , Patient Satisfaction , Tooth Movement TechniquesABSTRACT
Background : Infants born with a cleft lip-palate is facial deformity requires restoration of the integrity of the soft facial tissue. Interdisciplinary management provides the necessary integration of procedures, which will yield the most satisfactory results.Objective : To present a unique procedure combining pre-surgical orthopedic treatment and primary lip-nose repair for infants with unilateral complete cleft lip and palate.Design : A retrospective, descriptive study.Setting : Orthodontic Department, Faculty of Dentistry and Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen UniversityIntervention : First the patient received pre-operative orthopedic treatment. A passive obturator was used as an adjunct to aid feeding and guide growth of the lateral palatal segments. Combined primary lip and nasal reconstruction, were done during a single surgery.Result : The patient came to hospital with complete unilateral complete cleft lip and palate. A passive obturator with lip strapping was prescribed to resolve feeding problems and guide the growth of palatal segments. A one-stage surgery combining lip and nasal reconstruction was performed. The surgical lip and nose revision yielded good early aesthetics of the soft lip and nose tissue.Conclusion : Pre-surgical orthopedic treatment combined with primary lip-nose repair is an effective treatment of unilateral cleft lip and palate.Key words : Obturator, unilateral complete cleft lip and cleft palate, primary lip-nose reconstruction.
ABSTRACT
Background : Infant born with cleft lip and cleft palate problem requires treatment to restore the integrity of facial soft tissueObjective : The objective of this article is to present a treatment procedure for the bilateral compleate cleft lip and cleft palate infant.Setting : Orthodontic Department, Faculty of Dentistry, Khon-Kaen University and Srinagarind Hospital, Faculty of Medicine, Khon-Kaen UniversityIntervention : The initial treatment used a presurgical orthopedic appliance. The surgical treatment comprised gingivoperiosteoplasty, primary lip and nasal reconstruction, all done in one-stage.Result : A better early facial soft tissue esthetics was achieved.Conclusion : A Thai male infant, aged 15 days, born in Khon-Kaen Province, came to Sringarind Hospital with the problem of complete bilateral cleft lip and cleft palate. An obturator with lip strapping was delivered in order to help with the feeding problem. At the same time, time, this appliance was used to mold the primary palate and lateral palatal segments into a better relationship, and to lessen the gap width of the cleft. The reduced distance between the prolabium and lateral lip segments helped decrease soft tissue tension during and after lip repair. Besides, a special appliance, the Naso-Alveolar Molding appliance (NAM) was used for this baby in order to help molding the alar cartilages and extending the columella length before the surgery. A one-stage surgery combining the gingivoperiosteoplasty, lip and nasal reconstruction was performed. The result of this coordinated treatment brought about better early esthetics of the soft tissue lip and nose.Key words : Nasoalveolar Molding Appliances. Bilateral Cleft Lip and Cleft Palate. Presurgical Orthopedics. Primary lip and nose reconstruction. Gingivoperios teoplasty