ABSTRACT
OBJECTIVES: To compare patient-reported experience between a Penn expander activated every other day vs twice daily. MATERIALS AND METHODS: A total of 30 patients aged 12-16 years with transverse maxillary deficiency were recruited from the outpatient clinic, Faculty of Dentistry, Alexandria University (February 2019-December 2020). They were randomly allocated to two groups using block randomization (block size of six) and an allocation ratio of 1:1, which was concealed using opaque, sealed, sequentially numbered envelopes. Both groups received Penn expanders anchored by four palatal miniscrews. The slow maxillary expansion (SME) group activated the appliance once every other day. The rapid maxillary expansion (RME) group activated the appliance twice daily. Outcome measures were pain, pressure, headache, dizziness, speech difficulty, chewing difficulty, and swallowing difficulty scores rated by the participants on an 11-point numeric rating scale (NRS) at the following four time points: before appliance insertion (t1), after first activation (t2), after 1 week of activation (t3), and after last activation (t4). RESULTS: Data of 24 patients in the SME group (n = 12, mean age = 14.30 ± 1.37 years) and RME group (n = 12, mean age = 15.07 ± 1.59 years) were analyzed. Median scores for all outcomes were in the bottom quartiles of the NRS. No difference was found between the two groups at t1 or t2. Significantly higher scores for all variables, except dizziness and headache, were reported in the RME group at t4. CONCLUSIONS: Activation of miniscrew-supported expanders resulted in mild to moderate discomfort and functional limitation. Slow activation resulted in a better overall patient experience compared with rapid activation.
ABSTRACT
OBJECTIVES: To compare between skeletal and dentoalveolar effects of slow and rapid activation of miniscrew-supported expanders. MATERIALS AND METHODS: A total of 30 patients were randomly allocated to two groups using block randomization and the allocation ratio 1:1. Both groups received maxillary expanders anchored using four miniscrews. Activation protocol was once every other day in the slow expansion (SME) group and twice daily in the rapid expansion (RME) group. Cone-beam computed tomography (CBCT) scans were obtained before expansion and after removal of the expanders. Transverse skeletal and dentoalveolar changes were measured using CBCT. RESULTS: A total of 12 patients in the SME group (mean age, 14.30 ± 1.37 years) and 12 patients in the RME group (mean age, 15.07 ± 1.59 years) were analyzed. RME showed significantly greater widening of the mid-palatal suture at the level of first molars (mean difference [SME - RME] = -0.61 mm), and a greater increase in right and left molar buccal inclination (mean difference= -3.83° and -2.03°, respectively). Percentage of skeletal expansion relative to the jackscrew opening was not significantly different between the groups. Palatal inflammation was evident following appliance removal. Miniscrew mobility and bending were observed with RME. CONCLUSIONS: Both SME and RME were effective in correcting skeletal transverse maxillary deficiency. However, RME resulted in more buccal tipping of maxillary molars and in miniscrew failures and bending.
ABSTRACT
OBJECTIVE: Treatment planning in the mixed dentition is important for proper tooth alignment. A mixed dentition analysis, should accurately predict the mesiodistal widths of unerupted permanent teeth. The aim of the present study was to determine which sum of mesiodistal widths (MDW) of permanent teeth will be the best predictor for MDW of unerupted permanent canines and premolars. STUDY DESIGN: The study was conducted on 102 Egyptians, 51 males and 51 females, mean age 16.7 +/- 0.5 years with fully erupted permanent teeth, and intact proximal surfaces. Dental casts were obtained and scanned to produce digital images that were used on a specially designed software program to measure the MDW of permanent teeth. Casts were divided into training and validation sets, where 9 models of tooth combinations were used to develop a regression equation that describes the relation between them and sum of MDW of erupted maxillary or mandibular canines, first and second premolars. The validation set was used to test the accuracy of the proposed equation. RESULTS: R2 of regression models ranged from 0.3 (for models #2, 4, 5 and 8) to 0.36for model #1. The highest regression in model #1 (sum of MDW of lower first permanent molars and upper central incisors) indicated a high linear association between the sum of MDW of tooth combination model #1 and the MDWofmaxillary and mandibular permanent canines and premolars. There was no significant difference between the actual and the predicted MDW when the proposed equation was checked for its accuracy in the entire validation set (p > 0.05). CONCLUSION: The combination of the sums of lower permanent first molars and upper permanent central incisors was the best predictor for the MD W of both maxillary and mandibular permanent canines and premolars. The newly proposed prediction equation may be considered clinically useful for mixed dentition analysis in Egyptian subjects.
