The effect of rapid maxillary expansion in children: a meta-analysis / Efeito da expansão rápida da maxila em crianças: uma metanálise

Abstract Introduction: Craniofacial growth is modified by chronic mouth breathing. Rapid maxillary expansion leads to separation of the mid-palatal suture, improving the occlusion and the upper airway size. Aim: Systematically evaluate scientific articles on the effects of rapid maxillary expansion on airway dimensions and classify the quality of the evidence of the information. Methods: Searches on PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE, as well as in the grey literature were performed. The articles found were selected and evaluated both for the risk of bias (ROBINS-I) and for the quality of evidence (GRADE). Results: Of the 309 works found, 26 papers were selected for full reading, of which 22 were excluded. Data compilation and analysis were performed in four papers, two being controlled non-randomized clinical trials and two non-randomized and uncontrolled clinical trials. No randomized clinical trial was found. Conclusions: The meta-analysis found an increase in the internasal and inter-zygomatic distances and oropharyngeal volume after rapid maxillary expansion, which, together with clinical findings, makes the recommendation favorable to the intervention. The quality of the evidence for each outcome was considered very low.

Resumo Introdução: O crescimento craniofacial é modificado pela respiração oral crônica. A expansão rápida da maxila promove a separação da sutura palatino mediana, melhora a oclusão e a dimensão da via aérea superior. Objetivo: Avaliar de forma sistematizada os artigos científicos dos efeitos da expansão rápida da maxila sob as dimensões das vias aéreas e classificar a qualidade da evidência das informações. Método: Foi feita a busca nas plataformas Pubmed, Lilacs, Embase, Scopus, Web of Science e Cochrane, bem como a literatura cinzenta. Os artigos foram selecionados e avaliados quanto aos riscos de viés (ROBINS-I), e feita a avaliação da qualidade da evidência (GRADE). Resultados: De 309 estudos encontrados, 26 artigos foram selecionados para leitura completa, dos quais 22 excluídos, restaram 4 artigos para a análise e compilamento de dados, dois ensaios clínicos não randomizados controlados e dois ensaios clínicos não randomizados e não controlados. Nenhum ensaio clínico randomizado foi encontrado. Conclusões: As metanálises mostraram aumento de distância internasal, interzigomática e volume orofaríngeo após a expansão rápida da maxila, o que, juntamente aos achados clínicos, torna a recomendação favorável à intervenção. A qualidade da evidência de cada desfecho foi considerada muito baixa.

Tratamiento multidisciplinario del exceso vertical total y deficiencia transversal del maxilar sin mordida cruzada posterior / Multidisciplinary treatment of total vertical excess and transverse maxillary deficiency without posterior crossbite

Introducción: La corrección del exceso vertical del maxilar traerá no solo cambios verticales en el perfil, sino también sagitales y transversales. La ausencia clínica de mordida cruzada posterior puede enmascarar deficiencias del ancho y provocar planes de tratamiento incorrectos. Objetivo: Describir los aspectos más importantes en la atención de un caso con exceso vertical y deficiencia transversal del maxilar sin mordida cruzada posterior. Presentación de caso: Paciente femenina de 26 años de edad acude a consulta por "dientes hacia adelante". El examen físico y el estudio de los medios diagnósticos permitieron concluir la existencia de exceso vertical y deficiencia transversal del maxilar. Clínicamente no se observó mordida cruzada posterior. El tratamiento por etapas incluyó ortodoncia, expansión e impactación quirúrgica del maxilar. Conclusiones: El ascenso quirúrgico del maxilar debe planificarse a partir de un análisis holístico. Incluye los cambios sagitales del perfil y de la relación transversal entre las arcadas, provocados por el efecto de rotación mandibular. La ausencia de mordida cruzada posterior no excluye la existencia de deficiencia transversal del maxilar. Asimismo, la dimensión definitiva de la expansión debe establecerse una vez que la arcada inferior alcance sus dimensiones definitivas(AU)

Introduction: The correction of the vertical excess of the maxilla will bring not only vertical changes in the profile, but also sagittal and transverse ones. The clinical absence of posterior crossbite can mask width deficiencies and lead to incorrect treatment plans. Objective: Describe the most important aspects in the care of a case with vertical excess and transverse deficiency of the maxilla without posterior cross bite. Case presentation: A 26-year-old female patient comes to the consultation for "teeth forward". The physical examination and the study of the diagnostic means allowed to conclude the existence of vertical excess and transverse deficiency of the maxilla. Clinically, no posterior crossbite was observed. Staged treatment included orthodontics, expansion and surgical impaction of the maxilla. Conclusions: The surgical ascent of the maxilla should be planned based on a holistic analysis. It includes the sagittal changes of the profile and the transverse relationship between the arcades, caused by the effect of mandibular rotation. The absence of posterior crossbite does not exclude the existence of transverse maxillary deficiency. Likewise, the definitive dimension of the expansion must be established once the lower arcade reaches its definitive dimensions(AU)

Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

AbstractSurgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).

Dentoskeletal features in individuals with ectopic eruption of the permanent maxillary first molar / 대한치과교정학회지

OBJECTIVE: The aim of the study was to analyze the prevalence and distribution of ectopic eruption of the permanent maxillary first molar (EEM) in individuals scheduled for orthodontic treatment and to investigate the association of EEM with dental characteristics, maxillary skeletal features, crowding, and other dental anomalies. METHODS: A total of 1,317 individuals were included and randomly divided into two groups. The first 265 subjects were included as controls, while the remaining 1,052 subjects included the sample from which the final experimental EEM group was derived. The mesiodistal (M-D) crown width of the deciduous maxillary second molar and permanent maxillary first molar, maxillary arch length (A-PML), maxillomandibular transverse skeletal relationships (anterior and posterior transverse interarch discrepancies, ATID and PTID), maxillary and mandibular tooth crowding, and the presence of dental anomalies were recorded for each subject, and the statistical significance of differences in these parameters between the EEM and control groups was determined using independent sample t-tests. Chi-square tests were used to compare the prevalence of other dental anomalies between the two groups. RESULTS: The prevalence of maxillary EEM was 2.5%. The M-D crown widths, ATID and PTID, and tooth crowding were significantly greater, while A-PML was significantly smaller, in the EEM group than in the control group. Only two subjects showed an association between EEM and maxillary lateral incisor anomalies, which included agenesis in one and microdontia in the other. CONCLUSIONS: EEM may be a risk factor for maxillary arch constriction and severe tooth crowding.

Surgically assisted rapid palatal expansion with tent screws and a custom-made palatal expander: a case report / 대한악안면성형재건외과학회지

Rapid palatal expansion(RPE) with the tooth-born appliance is not sufficient to apply to the patients with periodontal problem or insufficient tooth anchorage, and it leads to tipping of the anchorage teeth and increasing teeth mobility and root resorption. To avoid these disadvantages, we present the case using palatal screws and custommade palatal expander. A 23-year-old patient underwent surgically assisted rapid maxillary expansion with the Hyrax expansion using 4 tent screws. The study models were used to measure the pre-/-post surgical width of the anterior and posterior dental arches with a digital sliding caliper. In the result, the custom-made palatal expander with 4 tent screws is suitable for delivering a force to the mid-palatal suture expansion. And it is low cost, small sized and simply applied. The results indicated that maxillary expansion with the custom-made palatal anchorage device is predictable and stable technique without significant complications in patients.

Expansão rápida da maxila cirurgicamente assistida sob anestesia local: relato de caso / Surgically assisted rapid maxillary expansion under local anesthesia: case report

Introdução: A expansão rápida da maxila cirurgicamente assistida (ERMCA) é empregada para o tratamento das deficiências transversais verdadeiras em pacientes com maturidade esquelética, havendo uma associação entre o procedimento cirúrgico e o ortodôntico. Esse tratamento promove um aumento do perímetro do arco maxilar, o que melhora a acomodação da língua e corrige os corredores negros. O procedimento pode ser feito com anestesia local e é baixo o risco de complicações, tornando-se uma excelente alternativa de tratamento. Relato de caso e conclusão: Este artigo relata um caso de ERMCA, realizada sob anestesia local em ambiente ambulatorial. O paciente era portador de um quadro de deficiência transversal de maxila. A prática da ERMCA sob anestesia local em ambiente ambulatorial apresenta-se como um procedimento viável, de baixo custo, fácil execução e com riscos baixos, desde que seja executada conforme a técnica adequada.

Introduction: Surgically assisted rapid palatal expansion (SARPE) is indicated for the treatment of transverse maxillary deficiency in patients with skeletal maturity, through the association of orthodontic and surgical procedures. It leads to an increase in the maxillary arch, resulting in better accommodation of the tongue and correcting the black corridors. This procedure can be performed under local anesthesia with low risk of complications, thus being considered a practical alternative treatment. Case report and conclusion: This article reports a case of surgically assisted maxillary expansion performed under local anesthesia in an outpatient setting. The patient had a clinical picture of transverse maxillary deficiency. Performing SARPE under local anesthesia in an outpatient setting is a viable procedure, of low cost, easy implementation and low risk of complications once it is performed according to the appropriate technique.

Expansão maxilar em adultos e adolescentes com maturação esquelética avançada / Maxillary expansion in adults and adolescents with advanced skeletal maturation

A deficiência transversa da maxila é um fator agravante e complicador do tratamento ortodôntico em adultos. Sua correção ainda gera dúvidas e controvérsias entre clínicos e pesquisadores. O objetivo deste trabalho foi analisar e discutir fatores determinantes para o planejamento da expansão maxilar em adultos e adolescentes com maturação esquelética avançada. Ausências dentárias múltiplas, grandes inclinações dentoalveolares para vestibular, recessão gengival, perda óssea alveolar e mobilidade dos dentes posterossuperiores contraindicam a realização de expansão rápida da maxila em indivíduos adultos ou com maturação esquelética avançada. No entanto, esses fatores não devem ser considerados isoladamente para a escolha do método de expansão palatal nesses pacientes. Nessas situações, a Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC) pode ser uma opção, entretanto, a escolha por essa técnica deve basear-se principalmente na idade do paciente, no grau de maturação esquelética, na localização da deficiência transversa da maxila e nas estruturas anatômicas que oferecem maior resistência à expansão maxilar. O Hyrax é o aparelho mais indicado para indivíduos que vão se submeter à ERMAC.

The transverse maxillary deficiency is a complication factor in adults' orthodontic treatment. Its correction still generates doubts and controversies between clinicians and researchers. The aim of this paper is to discuss the determinative factors in planning maxillary expansion in adults and adolescents with advanced skeletal maturation. Multiple dental absences, several dentoalveolar buccal inclination, gingival recession, alveolar bone loss and mobility of posterosuperior teeth contraindicate the rapid maxillary expansion in adults or patients with advanced skeletal maturation. However, these factors should not be considered separately when choosing the method for palatal expansion in adults. In these situations Surgically Assisted Rapid Maxillary Expansion (SARME) can be an option. And the choice of the surgical technique (SARME) should focus mainly the patient's age, grade of skeletal maturation, anatomical structures that offer more resistance to the maxillary expansion and location of the palatal constriction. Hyrax is the expander appliance more indicated for patients that will be submitted to SARME.