Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Influência da idade e do tempo de uso da Placa Palatina de Memória por crianças com Trissomia do 21 nas mudanças miofuncionais orofaciais percebidas pelos pais, na adaptação e satisfação da família após quatro meses de tratamento / nfluence of age and time of use of the Stimulating Palatal Plate by children with Trisomy 21 on orofacial myofunctional changes perceived by parents, children's adaptation, and family's satisfaction after four months of treatment / Influencia de la edad y el tiempo de uso de la placa de memoria palatina por niños con trisomía 21 sobre los cambios miofuncionales orofaciales percibidos por los padres, adaptación y satisfacción familiar después de cuatro meses de tratamiento

Objetivo: verificar se a idade das crianças com Trissomia do 21 e o tempo de uso por dia da placa palatina de memória influenciam a adaptação da criança à placa, as mudanças miofuncionais orofaciais percebidas pelos pais e a satisfação da família, após quatro meses de tratamento. Métodos: participaram do estudo14 pais ou responsáveis legais de crianças com Trissomia do 21, com idades de 3 a 20 meses. O tratamento com a placa palatina de memória foi realizado durante quatro meses. A adaptação da criança à placa, as mudanças miofuncionais orofaciais percebidas pelos pais e a satisfação das famílias em relação ao tratamento foram investigadas por meio de questionário elaborado pelos autores da pesquisa e respondido pelas mães após quatro meses de tratamento. Resultados: a média de idade das crianças que participaram do estudo foi 10 meses e o desvio-padrão de 4,9 meses. O resultado do questionário indicou associação entre idade e postura de lábios relatada pelos pais com o uso da placa palatina de memória, sendo que todas as crianças menores de 10 meses mantiveram o selamento labial, de acordo com os pais, durante o uso da placa; bem como entre idade e satisfação com o tratamento, sendo que as mães das crianças menores mostraram-se mais satisfeitas. Conclusão: os resultados do estudo indicam que houve associação entre idade e postura de lábios relatada pelos pais com o uso da placa, bem como entre idade e satisfação com o tratamento e sugerem que o tratamento precoce com a placa palatina de memória beneficia as crianças com Trissomia do 21. (AU)

Purpose: to verify if the age of children with Trisomy 21 and the time of use per day of the stimulating palatal plate influence the child's adaptation to the plate, the orofacial myofunctional changes perceived by the parents, and the family's satisfaction, after four months of treatment. Methods: 14 parents or legal guardians of children with Trisomy 21, aged between 3 and 20 months, participated in the study. Treatment with the stimulating palatal plate was carried out for four months. The child's adaptation to the plate, the orofacial myofunctional changes perceived by the parents, and the families' satisfaction with the treatment were investigated through a questionnaire prepared by the research authors and answered by the mothers after four months of treatment. Results: The mean age of the children who participated in the study was 10 months and the standard deviation was 4.9 months. The results of the questionnaire indicated an association between age and lip posture, reported by parents, during the use of the stimulating palatal plate, and all children under 10 months maintained lip closure, according to the parents, during the use of the plate. Age was also associated with satisfaction with the service, as the mothers of younger children were more satisfied. Conclusion: The study results indicate an association between age and lip posture, reported by the parents, during the use of the plate, and between age and satisfaction with the service. Thus, it suggests that early treatment with the stimulating palatal plate benefits children with Trisomy 21. (AU)

Objetivo: verificar si la edad de los niños con Trisomía 21 y el tiempo de uso por día de la placa palatina de memoria influyen en la adaptación del niño a la placa, los cambios miofuncionales orofaciales percibidos por los padres y la satisfacción de la familia, después de cuatro meses de tratamiento. Métodos: Participaron en el estudio 14 padres o tutores legales de niños con trisomía 21, con edades comprendidas entre los 3 y los 20 meses. El tratamiento con la placa de memoria palatina se llevó a cabo durante cuatro meses. La adaptación del niño al plato, los cambios miofuncionales orofaciales percibidos por los padres y la satisfacción de las familias con el tratamiento fueron investigados a través de un cuestionario elaborado por los autores y respondido por las madres, después de cuatro meses de tratamiento. Resultados: La edad media de los niños que participaron en el estudio fue de 10 meses y la desviación estándar fue de 4,9. El resultado del cuestionario indicó una asociación entre la edad y la postura de los labios, reportada por los padres, con el uso de la placa de memoria palatina, y todos los niños menores de 10 meses mantuvieron el sello de los labios, según los padres, durante el uso de la placa de memoria palatina, así como entre la edad y la satisfacción con el servicio. Las madres de niños más pequeños estaban más satisfechas. Conclusión: Los resultados del estudio indican que hubo asociación entre la edad y la postura de los labios, reportada por los padres, con el uso de la placa, así como entre la edad y la satisfacción con el servicio, y sugieren que el tratamiento temprano con la placa de memoria palatina beneficia a los niños con trisomía 21. (AU)

Different rapid maxillary expansion methods in the treatment of adult patients with obstructive sleep apnea hypopnea syndrome / 中华口腔医学杂志

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by upper respiratory collapse during sleep, with a high prevalence and potentially fatal complications. Currently, maxillary transverse deficiency are considered to be an important pathogenic factor of OSAHS. For patients with poor compliance with positive airway pressure therapy, rapid maxillary expansion can increase the volume and ventilation of the upper respiratory tract, which is an alternative treatment. This paper reviewed the current research on surgically assisted rapid palatal expansion, miniscrew assisted rapid palatal expansion, and distraction osteogenesis maxillary expansion in the treatment of adult OSAHS. By comparing the indications, contraindications, complications, efficacy and long-term stability of the three treatment methods, it provided reference for treatment of patients with OSAHS.

Efecto de la expansión ósea maxilar en la vía aérea nasofaríngea: Una revisión bibliográfica / Effect of the maxillary bone expansion on the nasopharyngeal airway. A bibliographic review

Introducción: Uno de los tratamientos indicados para la deficiencia maxilar transversal es la expansión maxilar rápida (REM). El presente artículo trata sobre la terapia REM y muestra, a partir de una revisión bibliográfica, los diversos beneficios que esta puede brindar al paciente y los cambios que puede generar en su anatomía. Objetivos: Abordar el efecto de la terapia REM sobre la vía aérea nasofaríngea. También describir, en base a evidencia científica, los cambios que produce en la morfología y resistencia sobre la vía aérea faríngea. Esto mediante distintos métodos de estudios disponibles actualmente. Materiales y métodos: Se realizó una búsqueda bibliográfica en las bases de datos: PubMed, Clinicalkey y Epistemonikos. Se seleccionaron trabajos publicados en los últimos 8 años en adelante. De un universo total de 77 publicaciones, fueron seleccionados 12 estudios para esta revisión. Se excluyeron estudios en los cuales se realizaban acciones clínicas que escapan al tratamiento ortopédico. También se excluyeron tratamientos realizados para mejorar la vía aérea, basados en el tratamiento ortopédico del crecimiento mandibular. Resultados: En los estudios realizados mediante radiografías cefalométricas se obtuvo un aumento significativo (p <0.05) en el espacio de la vía aérea nasofaríngea, en particular en las medidas AD2 y AD-PtV, después del tratamiento ortodóncico. Por otro lado, AD1 también aumentó, pero no significativamente (p> 0.05). Conclusión: La terapia REM, en pacientes en crecimiento, logra separar la sutura palatina media aumentando el tamaño del piso de las fosas nasales y el volumen en el territorio nasofaríngeo. Se necesitan estudios con un tamaño de muestra mayor y un seguimiento a largo plazo para establecer el éxito de esta terapia.

Introduction: One of the treatments indicated for transverse maxillary deficiency is rapid maxillary expansion (REM). This article deals with REM therapy and shows, based on a bibliographic review, the various benefits that it can generate for the patient and the changes in their anatomy. Objectives: To elucidate the effect of REM therapy on the nasopharyngeal airway. Also expose, based on scientific evidence, the changes that it produces in the morphology and resistance on the pharyngeal airway. This through different study methods currently available. Materials and methods: A bibliographic search was carried out in the databases: PubMed, Clinicalkey and Epistemonikos. From a total universe of 77 publications, 12 studies were selected for this review. Results: In the studies carried out using cephalometric radiographs, a significant increase (p < 0.05) in the nasopharyngeal airway space was obtained, particularly in the AD2 and AD-PtV measurements, after orthodontic treatment. On the other hand, AD1 also increased, but not significantly (p > 0.05). Conclusion: REM therapy, in growing patients, manages to separate the middle palatal suture by increasing the size of the floor of the nostrils and the volume in the nasopharyngeal territory. Studies with a larger sample size and long-term follow-up are needed to establish the success of this therapy.

Non-surgical rapid maxillary expansion with mini-implants in adults: a narrative review / Expansión rápida maxilar no quirúrgica con miniimplantes en adultos: una revisión narrativa

Introduction: In recent years, rapid maxillary expansion (RME) in prepubertal growth stages has been deeply investigated; however, its study has recently been increasing in adults without need for surgery. The objective of this review is to present the results reported in the scientific literature about RME in adults. Material and Methods: Six databases were used to carry out the secondary search of the review. The search was performed virtually and studies from the last six years were considered, with a last search performed until November, 2022. Results: A total of 253 studies were found, from which 20 studies were finally selected. RME in adults can result in substantial expansion similar to that obtained in patients who have not yet completed the ossification of the mid-palatal suture. Conclusion: The reviewed scientific literature shows evidence that there are various devices supported by mini-implants as non-surgical treatment options to correct transverse deficiency and help expand the maxilla in adult patients.

Introducción: En los últimos años se ha investigado profundamente la expansión maxilar rápida (ERM) en etapas de crecimiento prepuberal; sin embargo, recientemente se ha ido incrementando su estudio en adultos sin necesidad de cirugía. El objetivo de esta revisión es presentar los resultados reportados en la literatura científica sobre ERM en adultos. Material y Métodos: Se utilizaron seis bases de datos para realizar la búsqueda secundaria de la revisión. La búsqueda se realizó de manera virtual y se consideraron estudios de los últimos seis años, con una última búsqueda realizada hasta noviembre de 2022. Resultados: Se encontraron un total de 253 estudios, de los cuales finalmente se seleccionaron 20 estudios. La ERM en adultos puede dar como resultado una expansión sustancial similar a la obtenida en pacientes que aún no han completado la osificación de la sutura palatina media. Conclusión: La literatura científica revisada muestra evidencia que existen diversos dispositivos apoyados en mini-implantes como opciones de tratamiento no quirúrgico para corregir la deficiencia transversal y ayudar a generar disyunción maxilar en pacientes adultos.

A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions / 北京大学学报(医学版)

OBJECTIVE@#To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask.@*METHODS@#In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis.@*RESULTS@#Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%.@*CONCLUSION@#RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.

Correção da deficiência transversal maxilar utilizando o expansor de níquel-titânio LEAF Expander® com o protocolo para expansão lenta: relato de caso clínico / Correction of maxillary transverse deficiency using the LEAF Expander® nickel-titanium expander with the protocol for slow expansion: a case report

Este trabalho teve como objetivo o relato do caso clínico de uma paciente que compareceu à Faculdade de Odontologia de Araçatuba com características de classe I de Angle e deficiência maxilar transversal, no tratamento foi utilizado o expansor de níquel-titânio LEAF Expander®, fabricado pela Leone, na Itália. Trata-se aparelho que possui inúmeras vantagens por aumentar a adesão do paciente ao tratamento já que não necessita da ativação em domicílio, facilitar o andamento clínico, tendo em vista que o tratamento é menos doloroso e mais fácil que os outros expansores, aumentar a previsibilidade do tratamento, pois as forças contidas nas molas são constantes e pré-determinadas em laboratório (450g de força). Mediante a análise de modelos, documentações fotográficas e do estudo do caso clínico, concluiu-se que o tratamento realizado utilizando o protocolo padrão de expansão lenta da maxila apresentou-se como uma ferramenta inovadora e eficiente no tratamento da deficiência maxilar transversal(AU)

This study aimed to report the clinical case of a patient who attended the Faculty of Dentistry of Araçatuba with Angle class I characteristics and transverse maxillary deficiency. Leon, Italy. It is a device that has numerous advantages for increasing patient adherence to treatment since it does not require activation at home, facilitating clinical progress, given that the treatment is less painful and easier than other expanders, increasing predictability treatment, as the forces contained in the springs are constant and predetermined in the laboratory (450g of force). Through the analysis of models, photographic documentation and the study of the clinical case, it was concluded that the treatment performed using the standard protocol of slow maxillary expansion presented itself as an innovative and efficient tool in the treatment of transverse maxillary deficiency(AU)

Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

Revisión de los principales manejos ortodónticos interceptivos y correctivos no quirúrgicos de la maloclusión clase III / Review of the main non-surgical interceptive and corrective orthodontic management of Class III malocclusion

La maloclusión clase III se considera un reto en la práctica de todo ortodoncista. Una de las principales dudas al respecto reside en ¿cuándo es el mejor momento para intervenir? Exis- ten dos enfoques en el manejo ortodóntico del paciente: 1) la ortodoncia interceptiva; y 2) la ortodoncia correctiva. La or- todoncia interceptiva busca la prevención del establecimiento de la malolcusión. En este grupo, se encuentra el uso de más- cara facial con disyunción maxilar y el de aparatología fija (2x4 o 2x6). Por otro lado, la intervención correctiva hace re- ferencia al camuflaje de las características que trae consigo la maloclusión clase III ya establecida; dentro de este enfoque se encuentran las extracciones de piezas, el uso de minitornillos extraalveolares y la filosofía MEAW. Se puede concluir que el adecuado manejo de la maloclusión clase III radica en el oportuno y correcto diagnóstico, que debe realizarse a través de la minuciosa inspección de las características y hallazgos intra y extraorales de los pacientes (AU)

Class III malocclusion is considered a challenge in the practice of every orthodontist. One of the main questions is: when is the best time to intervene? There are 2 approaches to the orthodontic management of the patient: 1) interceptive orthodontics, and 2) corrective orthodontics. Interceptive or- thodontics seeks to prevent the establishment of malocclusion by means of the use of a facial mask with maxillary disjunc- tion, or the use of fixed appliances (2x4 or 2x6). Corrective intervention refers to camouflaging the characteristics of a Class III malocclusion that is already established. This ap- proach uses tooth extraction, extra-alveolar mini screws or the MEAW philosophy. To conclude, proper management of Class III malocclu- sion is based on timely, correct diagnosis, which must be made through careful inspection of the characteristics and intraoral and extraoral findings in patients (AU)

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial / Efeitos da expansão maxilar na função auditiva e vocal em pacientes sem fissura labiopalatina e com fissura labiopalatina e deficiência maxilar transversa: um estudo controlado multicêntrico e randomizado

Abstract Introduction The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. Objective This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. Results Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. Conclusion Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

Resumo Introdução A associação entre o tratamento da deficiência maxilar transversa e a recuperação das funções auditivas e vocais ganhou atenção nos últimos anos. Objetivo Avaliar os efeitos da expansão rápida da maxila na função auditiva e vocal em crianças sem fissura labiopalatina e com fissura labiopalatina bilateral com deficiência maxilar transversa. Método Foram recrutados para este estudo 53 pacientes (26 sem fissura e 27 com fissura labiopalatina bilateral; média de 11,1 ± 1,8 anos) que necessitam de expansão rápida da maxila para correção de arcos maxilares estreitos. Oito subgrupos foram estabelecidos com base no grau de perda auditiva. Registros audiométricos e timpanométricos de tons puros foram obtidos para cada indivíduo em quatro períodos. Os primeiros registros foram obtidos antes da expansão rápida da maxila (T0), o segundo após a expansão (T1) (média de 0,8 meses), o terceiro após três meses (T2) (média de 3 meses) e o quarto no fim do período de retenção (T3) (média de 6 meses). Anova e o teste post-hoc de Tukey HSD foram usados para análise dos dados. Além disso, a análise da voz foi feita com um programa PRAAT atualizado em um laboratório de fala computadorizadaem T0 e T2. Foi usado um teste t de amostras pareadas para comparação dos valores médios dos parâmetros de voz em T0 e T2 nos dois grupos. Resultados O tratamento com expansão rápida da maxila produziu um aumento significativo nos níveis auditivos e nos volumes da orelha média de todos os pacientes sem fissura e pacientes com fissura labiopalatina bilateral e níveis auditivos normais e com perda auditiva condutiva leve, durante os períodos de observação T0-T1, T1-T2, T0-T2 e T0-T3 (p < 0,05). Aumento significativo foi observado nos volumes da orelha média direita durante os períodos T0-T1, T0-T2 e T0-T3 em pacientes sem fissura e com perda auditiva moderada. Para a análise de voz, diferenças significantes foram observadas apenas entre a frequência fundamental média T0 e T2 (F0) e a porcentagem de jitter (p < 0,05) no grupo sem fissura. No grupo com fissura, não foram observadas diferenças significantes para nenhum parâmetro de voz entre os períodos T0 e T2. Conclusão A correção da anatomia palatal pela expansão rápida da maxila tem um efeito benéfico tanto na melhoria da audição quanto na função normal da orelha média em pacientes sem fissura e com fissura labiopalatina bilateral. Da mesma forma, a expansão rápida da maxila influencia significativamente a qualidade da voz em pacientes sem fissura, sem efeito significativo em pacientes com fissura labiopalatina bilateral.

VEGF and fgf-2 released in palatal suture after rapid maxillary expansion (RME)

Abstract Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (FGF-2) have the ability to increase vascular proliferation and permeability. The aim of this study was to quantify the release of two diffusible angiogenic growth factors (VEGF and FGF-2) after rapid maxillary expansion (RME). Thirty animals were randomly assigned to two groups. Control group (5 rats - intact suture) and Experimental groups (25 rats with RME) which were evaluated in different periods of treatment. Five animals were euthanized in different periods of healing at 0, 1, 2, 3, 5 and 7 days after RME. RT-PCR was used to evaluate the gene expression of angiogenic growth factors released on different periods of study. Data were submitted to statistical analysis using ANOVA followed by Tukey test and significance was assumed at a=0.05. RT-PCR showed that mRNAs of VEGF and FGF-2 were expressed in intact palatal suture tissue. mRNAs of VEGF and FGF-2 was upregulated in early periods (24 h) after RME (p<0.001 and p<0.01, respectively). The molecular levels of VEGF never returned to its original baseline values, and FGF-2 expression decreased up to day 5 (p<0.001) and suddenly increased at day 7, returning to its original level. RME increased VEGF secretion, but decreased FGF-2 secretion when compared to intact tissue. The results showed that these angiogenic growth factors are released and regulated in the palatal suture tissue after RME and could make an important contribution to the knowledge of overall reparative response of the suture tissue during the bone remodeling process.

Resumo Fator de crescimento endothelial (VEGF) e fator de crescimento de fibroblasto (FGF-2) tem a capacidade de aumentar a proliferação e permeabilidade vascular. O objetivo deste estudo foi quantificar a liberação dos dois fatores de crescimento (VEGF e FGF-2) após expansão rápida da maxilla (ERM). Trinta animais foram divididos aleatoriamente em dois grupos. Grupo Controle (5 ratos - sutura intacta) e grupos Experimentais (25 ratos submetidos a ERM) que foram avaliados em períodos diferentes de tratamento. Cinco animais foram eutanaziados em diferentes períodos de avaliação aos 0, 2, 3, 5 e 7 dias após ERM. RT-PCR foi usado para avaliar a expressão gênica dos fatores de crescimento liberados nos diferentes períodos de estudo. Os dados foram submetidos à análise estatística usando ANOVA seguido do pós-teste de Tukey com nível de significância de a=0.05. RT-PCR mostrou que os RNAm de VEGF e FGF-2 estavam expressos na sutura palatina mediana intacta. Os RNAm de VEGF e FGF-2 foram estimulados nos períodos iniciais (24h) após ERM (p<0.001 e p<0.01, respectivamente). Os nívies moleculares de VEGF nunca retornaram aos valores originais, e a expressão de FGF-2 reduziu até o dia 5 (p<0.001) e de repente aumentou até o dia 7, retornando aos níveis originais. ERM aumentou a secreção de VEGF, mas diminuiu a secreção de FGF-2 quando comparado ao tecido intacto. Os resultados mostraram que estes fatores de crescimento são liberados e regulados na sutura palatina mediana após ERM e podem ser de importante contribuição para o entendimento da resposta reparadora geral do tecido da sutura durante o processo de remodelação óssea.

Tomographic analysis of midpalatal suture prior to rapid maxillary expansion

ABSTRACT Introduction: In Orthodontics and Facial Orthopedics, the timing of treatment onset may be critical and individual analysis should be applied to promote a favorable treatment planning. In this study, individual analysis of midpalatal suture (MS) and palatal measurements were performed in teenagers and young adult patients treated with rapid maxillary expansion (RME). Description: Twenty-six patients submitted to RME with a tooth-supported appliance (Hyrax) were evaluated. The inclusion criteria were: minimum age of 14 years, presenting all posterior teeth, diagnosed with transverse maxillary discrepancy, and with a clinical indication for maxillary expansion. The pretreatment CBCT scans of these patients were assessed to obtain the stages of MS maturation (MSM); density ratio (MSD); and palatal length, thickness (anterior, intermediate and posterior) and sagittal area. Results: The maturation stages present were C, D or E; the density ranged from 0.6 to 1, and lower density (MSD < 0.75) and higher density (MSD ≥ 0.75) groups were determined. Individuals with higher MSD presented smaller sagittal area, compared to the lower density group. Individuals in D and E MSM stages presented smaller sagittal area and intermediate thickness, compared to stage C. Conclusions: Smaller palatal sagittal area was observed in the high MSD groups and in the stages D and E of MSM.

RESUMO Introdução: Em Ortodontia e Ortopedia Facial, o momento de início do tratamento pode ser crítico, e uma análise individual deve ser aplicada para promover um planejamento de tratamento favorável. No presente estudo, foram realizadas a avaliação individualizada da sutura palatina mediana (SPM) e medições no palato de adolescentes e adultos jovens tratados com expansão rápida da maxila (ERM). Descrição: Foram avaliados vinte e seis pacientes submetidos à ERM com aparelho dentossuportado (Hyrax). Os critérios de inclusão foram: idade mínima de 14 anos, apresentando todos os dentes posteriores, diagnosticado com discrepância transversa da maxila e com uma indicação clínica para expansão maxilar. A tomografia computadorizada de feixe cônico (TCFC) pré-tratamento desses pacientes foi avaliada para obter os estágios de maturação da SPM (MSPM), densidade da SPM (DSPM), comprimento do palato, espessura (anterior, intermediária e posterior) e área sagital. Resultados: Os estágios de maturação presentes foram C, D ou E; a densidade variou de 0,6 a 1, e foram determinados grupos de baixa (DSPM < 0,75) e alta densidade (DSPM ≥ 0,75). Indivíduos com maior DSPM apresentaram menor área sagital, em comparação com o grupo de densidade mais baixa. Indivíduos nos estágios D e E de MSPM apresentaram menor área sagital e espessura intermediária, comparados aos indivíduos no estágio C. Conclusão: Uma menor área sagital palatina foi observada nos grupos de alta DSPM e nos estágios D e E de MSPM.

Skeletal posterior crossbite in patient with mandibular asymmetry: an alternative solution

ABSTRACT Introduction: Skeletal posterior crossbite (SPCB) has a multifactorial etiology, as it may be caused by parafunctional habits, atypical position of the tongue, tooth losses and maxillary or mandibular transverse skeletal asymmetries. Skeletal involvement may lead to facial changes and an unfavorable aesthetic appearance. The treatment of SPCB diagnosed in an adult patient should be correctly approached after the identification of its etiologic factor. Surgically-assisted rapid maxillary expansion (SARME), one of the techniques used to correct SPCB in skeletally mature individuals, is an efficient and stable procedure for the correction of transverse discrepancies that may be performed in the office or in a hospital. Objective: This study discusses the results of asymmetrical SARME used to correct unilateral SPCB associated with transverse mandibular asymmetry. Conclusion: The treatment alternative used in the reported case was quite effective. At the end of the treatment, the patient presented adequate occlusion and facial aesthetics.

RESUMO Introdução: A mordida cruzada posterior esquelética (MCPE) apresenta etiologia multifatorial, podendo ser causada por hábitos parafuncionais, posição atípica da língua, perdas dentárias e assimetrias esqueléticas transversais da maxila ou da mandíbula. Alterações faciais podem estar presentes quando há envolvimento esquelético, levando a estética desfavorável. O tratamento da MCPE, quando diagnosticada no paciente adulto, requer abordagem correta, com identificação do fator etiológico. Entre as técnicas utilizadas para correção da MCPE em pacientes esqueleticamente maduros, cita-se, em especial, a Expansão Rápida de Maxila Assistida Cirurgicamente (ERMAC). Essa modalidade tem se mostrado bastante eficiente na correção dos problemas transversais, apresenta estabilidade e pode ser realizada em ambiente ambulatorial ou hospitalar. Objetivo: O objetivo do presente trabalho será discutir os resultados da ERMAC assimétrica para correção da MCPE unilateral associada a assimetria transversal da mandíbula. Conclusão: A alternativa de tratamento utilizada no caso relatado mostrou-se bastante eficiente. Ao fim do tratamento, o paciente apresentou adequada oclusão e boa estética facial.

Miniscrew-assisted rapid palatal expansion (MARPE): how to achieve greater stability. In vitro study

ABSTRACT Objective: Assess the influence of mono- and bicortical anchorage and diameter of mini-implants (MIs) on the primary stability of these devices. Methods: 60 self-drilling MIs were distributed in six groups according to diameter (1.5mm, 1.8mm or 2.0mm) and type of anchorage (monocortical and bicortical) in bovine rib. The primary stability was evaluated by insertion torque, micromobility and pull-out strength tests. ANOVA and/or Tukey analysis were used to conduct intergroup comparisons (p< 0.05). Non-parametric statistics (Kruskal-Wallis and Mann-Whitney) were performed when normality was not found (p< 0.05). Results: MIs with larger diameters and bicortical anchorage showed greater primary stability regarding insertion torque (p< 0.05) and micromobility (p< 0.05). Only MI diameter had an effect on the pull-out strength test. Larger diameter MIs presented better retention in pull-out strength tests (p< 0.001), regardless of mono- or bicortical anchorage. Conclusions: MI primary stability is dependent on its diameter and type of anchorage. Bicortical anchorage showed greater stability when compared with monocortical anchorage, independently of other variables.

RESUMO Objetivo: Avaliar a influência da ancoragem mono e bicortical e do diâmetro dos mini-implantes (MIs) na estabilidade primária desses dispositivos. Métodos: 60 MIs autoperfurantes foram distribuídos em seis grupos, de acordo com o diâmetro (1,5 mm, 1,8 mm ou 2,0 mm) e tipo de ancoragem (monocortical e bicortical), e inseridos em costela bovina. A estabilidade primária foi avaliada pelos testes de torque de inserção, micromobilidade e resistência à tração. ANOVA e/ou análise de Tukey foram usadas para realizar comparações intergrupos (p< 0,05). Estatística não paramétrica (Kruskal-Wallis e Mann-Whitney) foi realizada quando a normalidade não foi encontrada (p< 0,05). Resultados: MIs com diâmetros maiores e ancorados bicorticalmente apresentaram maior estabilidade primária em relação ao torque de inserção (p< 0,05) e micromobilidade (p< 0,05). Apenas o diâmetro do MI influenciou os resultados do teste de resistência à tração. MIs de maior diâmetro apresentaram melhor retenção nos testes de resistência à tração (p< 0,001), independentemente da ancoragem mono ou bicortical. Conclusões: a estabilidade primária do MI é dependente de seu diâmetro e tipo de ancoragem. A ancoragem bicortical apresentou maior estabilidade quando comparada à ancoragem monocortical, independentemente das demais variáveis.

Influence of different types of rapid maxillary expansion on root resorption: a systematic review / 华西口腔医学杂志

OBJECTIVES@#This study aimed to assess the influence of different types of rapid maxillary expansion on root resorption (RR).@*METHODS@#Literature searches were carried out electronically in five English and two Chinese databases. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, and case-control studies were included. The data were extracted by three authors. The risk of bias in the RCTs and nonrandomized studies were assessed in accordance with corresponding scales.@*RESULTS@#Among the 400 articles identified, seven were included for the final analysis. Three studies were graded as high value of evidence, while two and another two studies were graded as moderate value and low value, respectively. According to the available evidence, the tooth-borne maxillary expansion caused more obvious RR of anchorage teeth than the bone-borne one. In addition, the Haas-type palatal acrylic pads could not effectively reduce the degree of RR. The difference in the design of the retainer between the tooth-borne maxillary expansion (the use of a band or wire framework to connect the anchorage tooth) did not cause the difference in the incidence and degree of RR.@*CONCLUSIONS@#Clinical evidence suggested that bone-borne maxillary expansion may decrease the amount of RR, while the amounts of resorption did not significantly differ between Haas and Hyrax and between different retainer types of Hyrax.

Modified Arnold expander: an alternative for mandibular arch expansion

ABSTRACT Introduction: Due to the anatomical constraints of the mandible, mandibular dental arch usually serves as a guideline to determine the required changes in the maxillary transverse dimension. The Schwarz appliance and the Lip Bumper are the traditional orthodontic appliances for mandibular arch expansion in patients with borderline amounts of crowding, and/or transverse discrepancy. However, they often require patient cooperation, which may be a concern for orthodontists in daily practice. Objectives: This article illustrates a simple fixed orthodontic device as an alternative to achieve mandibular arch expansion in patients with moderate tooth-size/arch-length discrepancy. The four reported cases refer to 8 to 10-year-old patients in the mixed dentition, with an Angle Class I or Class II malocclusion, transverse deficiency in both arches, moderate crowding and/or posterior crossbite, combined with compromised smile aesthetics. The patients were treated with rapid maxillary expansion (RME) using Hass expander appliance and the modified Arnold expander (MAE). Conclusion: This low-cost compliance-free orthodontic appliance provided dentoalveolar decompensation by means of uprighting the posterior teeth, with minimal or no adjustments during treatment. The final results were achieved in only three to four months, and fulfilled all treatment objectives, such as an increase in the arch perimeter and width, and a better teeth alignment.

RESUMO Introdução: Devido aos limites anatômicos da mandíbula, a arcada dentária inferior geralmente serve como guia para determinar as alterações necessárias na dimensão transversal da maxila. O aparelho de Schwarz e o Lip Bumper são os aparelhos usados tradicionalmente para expansão da arcada inferior em pacientes com quantidades limítrofes de apinhamento e/ou discrepância transversal. No entanto, eles requerem a cooperação do paciente, o que pode ser uma preocupação para os ortodontistas na prática diária. Objetivos: O presente artigo ilustra uma alternativa diferente de aparelho fixo para se obter a expansão da arcada inferior em pacientes com discrepância moderada de tamanho dentário e/ou comprimento da arcada. Os quatro casos relatados referem-se a pacientes com 8 a 10 anos de idade, na dentição mista, com má oclusão de Classe I ou II de Angle, deficiência transversal em ambas as arcadas, apinhamento moderado e/ou mordida cruzada posterior, apresentando comprometimento da estética do sorriso. Os pacientes foram tratados com expansão rápida da maxila (ERM), usando aparelho expansor de Hass, e expansor Arnold modificado (EAM). Conclusão: O EAM, que é um aparelho de baixo custo e não depende da colaboração do paciente, promoveu uma descompensação dentoalveolar por meio da verticalização dos dentes posteriores, necessitando de mínimo ou nenhum ajuste durante o tratamento. Os resultados pretendidos foram alcançados em três a quatro meses e cumpriram todos os objetivos do tratamento, como aumento do perímetro e largura da arcada, assim como o melhor alinhamento dos dentes.

Dentoalveolar Effects Following Maxillary Expansion: Comparison Between Dental and Skeletal Anchorage

ABSTRACT Objective: To compare the dento-alveolar effects between dental and skeletal anchored expansion devices to achieve maxillary expansion in different groups of patients: pure dental anchorage was used in growing patients and skeletal anchorage in adult patients. Linear, angular and volumetric parameters have been analysed. Material and Methods: 22 patients has been selected from the total archive of patients treated in the Orthodontics Department of the University of Ferrara, Italy, divided into 3 groups according to the appliance used to obtain the transversal maxillary correction. Digital files of the upper arch were obtained from scans performed using an intro-oral scanner before treatment (T0) and at the end of expansion (T1). Therefore, linear, angular and volumetric measurements have been performed. Results: There is a highly significant statistic variation of the 3-3, 4-4 and 6-6 diameter as a function of time. There was a statistically significant variation of the palatal vault angle and of the 6-6 distance at the cusp level as a function of time. Moreover, it appears that these parameters are reduced in the group with skeletal anchored expander. No tooth considered have encountered a statistically significant change in tip and torque values, no matter the type of RPE and the treatment time. For all patients, we have recorded the superimposition of the maxillary dental cast before and after treatment. Conclusion: In all patients, we obtained a resolution of the maxillary transverse deficit. Patients treated by pure skeletal anchored devices have recorded a less variations of palatal vault angle and the distance between first molar cusps, as if the expansion was gained more parallel. The expansion obtained showed reduced dental side effects, as tip and torque values haven't changed in a statistically significant way.

Spontaneous Transversal Changes of Lower Arch Following Palatal Skeletal Expansion

ABSTRACT Objective: To evaluate how the lower arch spontaneously change after upper rapid palatal expansion in a group of patients with transversal skeletal deficit. Material and Methods: Twenty-four patients treated by the same orthodontist with a rapid palatal expander (RPE) bounded on a deciduous molar have been selected. The sample was divided into two groups: no treatment was provided for group one, while group two was treated using a lip bumper or Schwarz appliance. For each patient, dental casts were collected when the RPE was bounded (T0) and at the end of treatment, 9 months ± 3 months later (T1). Each outcome was analyzed, providing descriptive statistics, main effects significance tests and post-hoc analyses with the objective to evaluate the variations between pre-treatment (TO) and post-treatment (T1) of each of them. Results: If the linear measurements are considered, a significant beneficial effect on both arches is observed. However, the upper arch always shows a major increase of all values at T1 with respect to the lower arch. Even though the post-hoc tables indicate that time differences are all statistically significant across considered partitions, the lower arch's increase is more pronounced in group two, where patients were treated in both arches. If the angular measurements are concerned, the increase of lingual crown inclination was found in all patients, independently from the type of treatment in lower arch. Conclusion: All patients show normalization of upper diameters, regardless of whether the lower arch was treated or not.