Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study.

OBJECTIVES: This study assessed the dental and skeletal effects of pure bone-borne, non-surgical maxillary expansion, using a modified force-controlled polycyclic protocol. METHODS: Records of 17 adult patients, mean age 24.1 years; range 18-39 years, who had undergone maxillary expansion using a bone-borne Quad-expander (with 4 mini-screws), were analysed. In all patients, 0.17 mm/day of expansion was completed for 1 week, followed by a cyclic protocol of expansion of forward and backward turns until the force needed to turn the expander was below 400 cN, assessed weekly. After this, expansion continued at a rate of 0.17 mm/day until the desired amount of expansion was achieved. Cone beam computer tomography scans were taken pre- and post-expansion. RESULTS: The mid-palatal suture was successfully opened in 100% of patients included in this study. Axially, the amount of skeletal opening at the posterior nasal spine was 61% of the anterior nasal spine. Expansion was pyramidal in the coronal plane. Significant increases at the dental and skeletal levels were achieved, with changes at the skeletal level reaching 73%. The alveolar bone angle increased more than the angular changes at the molars and premolars. LIMITATIONS: This is a retrospective study with short-term results. CONCLUSION: The Quad-expander, with a force-controlled polycyclic expansion protocol, effectively produced a significant increase in maxillary width in skeletally mature subjects in the short term.

Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial.

BACKGROUND: The introduction of bone-anchored maxillary protraction eliminated the side effects of facemask in the early treatment of patients with maxillary retrusion. This study aimed to evaluate the effects of miniscrew-anchored maxillary protraction (MAMP) and compare them with the growth changes in an untreated control group in growing patients with Class III malocclusion. METHODS: Forty growing patients with Class III malocclusion and retrognathic maxilla were randomly allocated into two groups: treated and control groups. In the treated group, patients were treated with full-time intermaxillary Class III elastics (C3E) anchored by a hybrid hyrax (HH) in the maxilla and a bone-supported bar in the mandible. Protraction was stopped after obtaining a positive overjet. Cephalometric radiographs were acquired before and after the treatment. Data were statistically analyzed on an intention-to-treat basis. Intergroup comparisons were also made using analysis of covariance with the readings at T0 as a covariate. RESULTS: Forty patients agreed to participate, and 30 of them completed the study (treated group, n = 17; control group, n = 13). The average treatment duration was 11.9 months. MAMP resulted in a significant maxillary advancement (A-VR, 4.34 mm) with significant control over the mandibular growth. No significant increase in the mandibular plane angle was found in the treated group compared with the control group. The upper and lower incisors showed significant protrusion in the treated group. CONCLUSIONS: Within the limitations of this study and high attrition rate, the MAMP protocol can effectively increase maxillary forward growth with good control over the growth of the mandible antero-posteriorly and vertically.

A retrospective comparison of two protocols for correction of skeletal Class III malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask.

BACKGROUND: This study compared the skeletal and dental effects of a hybrid maxillary expander with mandibular miniplates (HE-MP) and Class III elastics to conventional tooth-borne rapid maxillary expander and face mask (RME-FM) in skeletal Class III treatment. METHODS: This retrospective study included 36 skeletal Class III patients. Eighteen patients (mean age 10.24 ± 1.31 years) were treated with a hybrid expander, two mandibular L-shaped miniplates and full-time Class III elastics (HE-MP group). Their results were compared to a group of patients treated with conventional RME-FM (n = 18; mean age 10.56 ± 1.41 year). Radiographs were taken before (T1) and after treatment (T2). All patients were in cervical maturation stages CS1-CS3 at T1. The measured outcomes were the changes in sagittal and vertical skeletal and dental cephalometric measurements. RESULTS: Treatment time was approximately 15.5 ± 2.8 months with the HE-MP and 11.85 ± 3.41 months for the RME-FM. The Class III malocclusion was corrected in both groups with significant changes. The maxilla advanced more in the HE-MP group, with an increase in SNA of 4.26° ± 2.15° compared to 1.14 ± 0.93 in the RME-FM group (p < 0.001). The effect on the mandible was similar in both groups, while the overall skeletal change was significantly greater with HE-MP, with an increase in the ANB of 5.25° ± 2.03° and a Wits appraisal increase of 6.03 ± 3.13 mm, as opposed to 2.04° ± 1.07° and 2.94 ± 1.75 mm with the RME-FM (p < 0.001). Dental changes were significantly higher with RME-FM, with an increase in incisor inclination (U1-SN) of 5.02° ± 3.93° (p < 0.001), with no significant changes in the HE-MP group. The mandibular incisors retroclined by 5.29° ± 3.57° at L1-MP with the RME-FM, while they advanced slightly with the HE-MP by 2.87° ± 5.37° (p < 0.001). CONCLUSION: The use of skeletal anchorage for maxillary expansion and protraction significantly increases skeletal effects and reduces dental side effects compared to tooth-borne maxillary expansion and protraction. These results need to be investigated in the long term.

Advantages and disadvantages of the three-dimensional metal printed orthodontic appliances.

Orthodontic digitalization has progressed steadily. Recently, three-dimensional metal printing has revolutionized the way appliances are designed and manufactured. The process offers several advantages over the conventional analog process for both the orthodontic team and the patients. This article aims to explore the process of three-dimensional metal printing and give an insight into the advantages as well as potential limitations and disadvantages of this new technology.

Direct printed removable appliances: A new approach for the Twin-block appliance.

Removable appliances are an important part of orthodontic treatment. The Twin-block is widely used for Class II correction. Traditionally, an impression, bite registration, and mounted plaster casts are required to fabricate the acrylic appliance, which usually requires a specialized laboratory. This makes the process expensive and also time-consuming. This paper aims to present an innovative approach for the virtual design and direct printing of removable orthodontic appliances, particularly the Twin-block, that can be done in-office without the need for casts or a specialized laboratory.

Maxillary space closure using a digital manufactured Mesialslider in a single appointment workflow.

New digital technologies, many involving three-dimensional printing, bring benefits for clinical applications. This article reports on the clinical procedure and fabrication of a skeletally anchored mesialization appliance (Mesialslider) using computer-aided design/computer-aided manufacturing (CAD/CAM) for space closure of a congenitally missing lateral incisor in a 12-year-old female patient. The insertion of the mini-implants and appliance was performed in a single appointment. Bodily movement of the molars was achieved using the Mesialslider. Anchorage loss, such as deviation of the anterior midline or palatal tilting of the anterior teeth, was completely avoided. CAD/CAM facilitates safe and precise insertion of mini-implants. Further, mini-implants can improve patient comfort by reducing the number of office visits and eliminating the need for orthodontic bands and physical impressions.

Procedure using CAD/CAM-manufactured insertion guides for purely mini-implant-borne rapid maxillary expanders.

With traditional rapid palatal expansion (RPE), orthopaedic forces are transmitted to the skeletal structures via the anchor teeth potentially leading to several unwanted dental side effects. To prevent these issues, tooth-bone-borne or purely bone-borne expanders were introduced using mini-implants in the palate. In this paper, the digitally planned Quadexpander is described which permits palatal expansion with only skeletal anchorage. The use of virtual insertion planning allows for insertion in areas of ideal bone, while avoiding roots and vital structures as well as the possibility of insertion into sites which would otherwise not be considered usable. A second advantage of digital planning is that mini-implants and the expander can be inserted in just one appointment.

Dentoskeletal changes due to rapid maxillary expansion in growing patients with tooth-borne and tooth-bone-borne expanders: A randomized clinical trial.

OBJECTIVES: To compare, using cone-beam computed tomography, the dentoskeletal changes in rapid maxillary expansion with tooth-bone-borne (Hybrid Hyrax) and tooth-borne (Hyrax) appliances. SETTING AND SAMPLE POPULATION: Forty-two patients who met the eligibility criteria (aged 11-14 years; transverse maxillary deficiency, posterior crossbite, and presence of upper first premolars and molars) were screened and allocated into two groups: HHG (treatment with Hybrid Hyrax) and HG (treatment with Hyrax). MAIN OUTCOME MEASURES: The primary outcomes included nasomaxillary dimensional changes. CBCT was performed before and 3 months after the activation phase. Measurements were performed using Dolphin® . Baseline data were compared using one-way ANOVA. For intergroup comparison, ANCOVA was used to analyze the initial age, appliance activations (mm), and mid-palatal suture maturation data as covariates. Statistical significance was set at 5%. RESULTS: The premolar region in HHG showed increased skeletal changes than in HG, with the difference being 1.5 mm (0.5; 2.6) in the nasal cavity (P = .004), 1.4 mm (0.3; 2.5) in the nasal floor (P = .019), and 1.1 mm (0.2; 2.1) in the maxilla (P = .022). The molar region in HHG showed increased skeletal changes with the difference being 0.9 mm (0.2; 1.5) in the nasal cavity (P = .005), and 0.9 mm (0; 1.8) in the maxilla (P = .042) than in HG. Premolar inclination was higher in HG. CONCLUSION: Hybrid Hyrax showed more skeletal changes and fewer dental side effects, especially in the first premolar region. The amount of activation influenced the higher nasal skeletal changes in the Hybrid hyrax group.

Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination.

Bone-borne rapid maxillary expansion distraction devices are used to achieve a more skeletal expansion and to avoid dental side effects of conventional expanders such as tipping of anchorage teeth. In this article, we report the use of a prefabricated expander fixed on 2 mini-implants in the anterior palate. This allows for the insertion of the mini-implants and the expander to occur without the need for an impression or any laboratory procedures. Especially when aligners are going to be used, the use of a mini-implant-borne expander seems to be reasonable because the expander can be left in place as a skeletal retainer during the aligner finishing.

Is there an ideal insertion angle and position for orthodontic mini-implants in the anterior palate? A CBCT study in humans.

INTRODUCTION: Orthodontic mini-implants are frequently used to provide additional anchorage for orthodontic appliances. The anterior palate is frequently used owing to sufficient bone quality and low risk of iatrogenic trauma to adjacent anatomical structures. Even though the success rates in this site are high, failure of an implant will result in anchorage loss. Therefore, implants should be placed in areas with sufficient bone quality. The aim of the present study was to identify an optimal insertion angle and position for orthodontic mini-implants in the anterior palate. METHODS: Maxillary cone-beam computed tomographic (CBCT) scans from 30 patients (8 male, 22 female, age 18.6 ± 12.0 years) were analyzed. To assess the maximum possible length of an implant, a 25-reference-point grid was defined: 5 sagittal slices were extracted along the median plane and bilaterally at 3 mm and 6 mm distances, respectively. Within each slice, 5 dental reference points were projected to the palatal curvature at the contact point between the cuspid (C) and first bicuspid (PM1), midpoint of PM1, between PM1 and PM2, midpoint of PM2, and between PM2 and the first molar (M1). Measurements were conducted at -30°, -20°, -10°, 0°, 10°, 20°, and 30° to a vector placed perpendicular to the local palatal curvature. Statistical analysis was conducted with the use of R using a random-effects mixed linear model and a Tukey post hoc test with Holm correction. RESULTS: High interindividual variability was detected. Maximum effective bone heights were detected within a T-shaped area at the midpoint of PM1 and contact point PM1-PM2 (P < 0.01). Within the anterior region a posterior tipping was advantageous, whereas in the posterior regions an anterior tipping was beneficial (P < 0.01). In the middle of the median plane, tipping did not reveal a significant influence. No gender- or age-related differences were observed. CONCLUSIONS: Within the limitations of this study, optimal insertion positions were found within a T-shaped area at the height of PM1-PM2 in the anterior palate. In general, a posterior tipping was beneficial at anterior positions, and an anterior tipping appeared beneficial at posterior positions. High interindividual variation was found and should be carefully considered by the clinician.

Early Class III treatment with Hybrid-Hyrax - Facemask in comparison to Hybrid-Hyrax-Mentoplate - skeletal and dental outcomes.

BACKGROUND: Protraction of maxilla is usually the preferred and more commonly used treatment approach for skeletal Class III with a retrognathic maxilla. The aim of this study was the comparison of the skeletal and dental effects of two skeletally borne appliances for maxillary protraction: a) Hybrid-Hyrax in combination with facemask (FM), b) Hybrid-Hyrax in combination with Mentoplate (ME). METHODS: Thirty four Patients (17 facemask, 17 Mentoplate) were investigated by means of pre- and posttreatment cephalograms. The two groups matched with regard to treatment time, age gender and type of dentoskeletal deformity before treatment. RESULTS: Both groups showed a significant forward movement of A-point (FM GROUP: SNA + 2.23° ± 1.30°- p 0.000*; ME: 2.23° ± 1.43°- p 0.000*). B-Point showed a larger sagittal change in the FM Group (SNB 1.51° ± 1.1°- p 0.000*) compared to the ME group (SNB: - 0.30° ± 0.9°- p 0.070). The FM group showed a significant increase of the ML-NL + 1.86° ± 1.65° (p 0.000*) and NSL-ML + 1.17° ± 1.48 (p 0.006*). Upper Incisor inclination did not change significantly during treatment in both groups as well as the distance of the first upper Molar in relation to A-point. CONCLUSION: Both treatments achieve comparable rates of maxillary protraction, without dentoalveolar side effects. Skeletal anchorage with symphysial plates in the mandible provides greater vertical control and might be the treatment of choice in high angle patients.

Surgically assisted rapid maxillary expansion in lingual orthodontics - optimizing of coupling and timing : Best oral presentation from the 21st Meeting of German Society of Lingual Orthodontics.

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. Treatment times in such cases are often long with adult patients usually requesting invisible appliances. Lingual appliances can provide the mechanical control required as well as fulfil the aesthetic demands in such cases. However lingual appliances are usually custom made and indirectly bonded. Due to tooth movement following surgery there is usually a long delay before impressions can be made for customized lingual appliances. This results in a long delay before alignement and leveling can be commenced post-surgery. CASE PRESENTATIONS: Three cases are presented here demonstrating the simultaneous placement of bone anchored expansion devices for surgically assisted rapid maxillary expansion with customized lingual appliances. CONCLUSIONS: The combination of the two procedures allows the alignement and leveling to commence very soon after surgery significantly reducing treatment times. The design of the appliances and the clinical procedures are described and discussed.

A novel method for treatment of Class III malocclusion in growing patients.

BACKGROUND: Management of Class III malocclusion is one of the most challenging treatments in orthodontics, and several methods have been advocated for treatment of this condition. A new treatment protocol involves the use of an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol, in conjunction with full-time Class III elastic wear and coupled with the use of temporary anchorage devices (TADs). The aim of this study was to evaluate the dento-skeletal and profile soft tissue effects of this novel protocol in growing participants with retrognathic maxilla. METHODS: Fourteen growing participants (7 males and 7 females; 12.05 ± 1.09 years), who displayed Class III malocclusions with retrognathic maxilla, were recruited. Pre-treatment records were taken before commencing treatment (T1). All participants had a hybrid mini-implant-supported rapid maxillary expansion (MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. Full-time bone-anchored Class III elastics, delivering 400 g/side, were then used for maxillary protraction. When positive overjet was achieved, protraction was ceased and post-treatment records were taken (T2). Linear and angular cephalometric variables were blindly measured by one investigator and repeated after 1 month. An error measurement (Dahlberg's formula) study was performed to evaluate the intra-examiner reliability. A paired-sample t test (p < 0.05) was used to compare each variable from T1 to T2. RESULTS: Treatment objectives were achieved in all participants within 8.5 weeks of protraction. The maxilla significantly protracted (SNA 1.87°± 1.06°; Vert.T-A 3.29± 1.54 mm p < 0.001), while the mandibular base significantly redirected posteriorly (SNB -2.03° ± 0.85°, Vert.T-B - 3.43± 4.47 mm, p < 0.001 and p < 0.05 respectively), resulting in a significant improvement in the jaw relationship (ANB 3.95°± 0.57°, p < 0.001; Wits 5.15± 1.51 mm, p < 0.001). The Y-axis angle increased significantly (1.95° ± 1.11°, p < 0.001). The upper incisors were significantly proclined (+ 2.98°± 2.71°, p < 0.01), coupled with a significant retroclination of the lower incisors (- 3.2°± 3.4°, p < 0.05). The combined skeletal and dental effects significantly improved the overjet (5.62± 1.36 mm, p < 0.001) and the soft tissue Harmony angle (2.75° ± 1.8°, p < 0.001). CONCLUSIONS: Class III elastics, combined with the Alt-RAMEC activation protocol of the MARPE appliance, is an efficient treatment method for mild/moderate Class III malocclusions. The long-term stability of these changes needs further evaluation.

Does systemic administration of casein phosphopeptides affect orthodontic movement and root resorption in rats?

OBJECTIVES: To assess the potential effects of casein phosphopeptides (CPPs) on orthodontically induced iatrogenic root resorption (OIIRR) and orthodontic teeth movement. MATERIALS AND METHODS: Forty Wistar rats (aged 11 weeks) were randomly divided into experimental group (EG; n = 20) that received a diet supplemented with CPP and control group (CG; n = 20) devoid of diet supplement. A 150 g force was applied using nickel titanium (NiTi) coil that was bonded on maxillary incisors and extended unilaterally to a maxillary first molar. At Day 28, animals in both groups were euthanized. Volumetric assessment of root resorption craters and linear measurement of maxillary first molars movement were blindly examined using a micro-computed tomography scan. RESULTS: Nine rats were excluded from the experiment due to loss during general anesthesia or appliances' failure. Intra-operator reproducibility was high in both volumetric and linear measurements, 92.8 per cent and 98.5-97.6 per cent, respectively. The results reveal that dietary CPP has statistically insignificant effect on the overall OIIRR and orthodontic movement. CONCLUSIONS: CPP seems to have statistically insignificant effect on the volume of OIIRR and orthodontic movement in rats. A long-term study with larger sample size using a different concentration of CPP is required to clarify the dentoalveolar effect of CPP.

The short-term skeleto-dental effects of a new spring for the intrusion of maxillary posterior teeth in open bite patients.

BACKGROUND: The technology surrounding temporary skeletal anchorage devices has improved in leaps and bounds. However, no specific auxiliary exists for the intrusion of molars in conjunction with these devices and currently clinicians are forced to make do with available force delivery materials. A new intrusion auxiliary, the Sydney Intrusion Spring (SIS), was designed to facilitate intrusion without frequent need for reactivation or tissue irritation. METHODS: The subjects consisted of 16 adolescent patients (12 females and 4 males) with an average age of 13.1 years (range 12.2 to 14.3 years). All patients were in the permanent dentition with an anterior open bite of ≥2 mm. Four self-drilling miniscrews were placed into the posterior maxillary buccal alveolar bone. The intrusion appliance consisted of a bonded acrylic appliance and the SIS, activated to produce an initial intrusive force of 500 g. Cone beam computed tomograms were taken after miniscrew placement and at the end of active intrusion. Rendered lateral cephalograms were produced and measurements were taken and compared. RESULTS: All study objectives were achieved in 4.91 months (range 2.5 to 7.75 months). The mean molar intrusion was 2.9±0.8 mm (P<.001), resulting in over bite increase of 3.0±1.5 mm (P<.001). The intrusion led to a 2.6°±1.3° (P<.001) clockwise occlusal plane rotation and a 1.2°±1.3° (P<.01) counter-clockwise rotation of the mandible. Dental measurements showed a significant uprighting and elongation of the incisors. There was no significant extrusion of the lower molars. CONCLUSION: The SIS is an effective appliance for the intrusion of maxillary posterior teeth, in conjunction with miniscrews.

Skeletal and dental outcomes of a new magnetic functional appliance, the Sydney Magnoglide, in Class II correction.

INTRODUCTION: The purpose of this prospective study was to evaluate the dentoskeletal effects of a new magnetic functional appliance, the Sydney Magnoglide (Macono Orthodontic Lab, Sydney, Australia), after both active treatment with the appliance and comprehensive fixed appliance therapy, compared with a group of untreated Class II controls. METHODS: Thirty-four consecutively treated Class II Division 1 patients treated with the Sydney Magnoglide followed by fixed appliances were compared with 30 untreated Class II controls with the same initial dentoskeletal Class II features and matched for age and sex. Lateral cephalograms were taken before treatment, immediately after functional appliance therapy, and after comprehensive fixed appliance therapy. Cephalometric analyses included the Pancherz analysis and linear and angular measurements. The comparisons were made with Student t tests (P <0.05). There were 3 dropouts, for a final sample for statistical analysis of 31 subjects. RESULTS: There was no statistically significant difference between the treated and control groups before treatment. Treatment with the Sydney Magnoglide and comprehensive fixed appliance therapy normalized the overjet and corrected the Class II relationship in all treated subjects. The ANB angle showed a reduction of 1.0°, as opposed to an increase of 0.3° in the untreated controls, and was associated with a statically significant improvement in the SNB angle (P <0.05). There was a significant gain of 2.3 mm in mandibular length in the treated group compared with the control group (P <0.01). CONCLUSIONS: The outcomes of this prospective study demonstrate that the compliance-free Sydney Magnoglide is an effective functional appliance for Class II correction.

The application of skeletal anchorage in the correction of anterior open bite and skeletal Class III malocclusion: a paradigm shift.

In recent years orthodontic treatment has been revolutionized by the introduction of skeletal anchorage or temporary anchorage devices (TADs). Many malocclusions, which have been previously only treatable through orthognathic surgery, such as skeletal open-bites, can now be managed non-surgically with less biological cost to the patient. Furthermore the recent application of TADs in the treatment of growing skeletal Class III patients is not only minimizing the need for obtrusive appliances, such as head gear and face masks, but it is also proving to deliver better and superior results to conventional growth modification protocols with more patient acceptance and less need for compliance. This overview covers the applications of TADs in the treatment of skeletal open bites and skeletal Class III malocclusions with reference to current evidence and clinical case presentations.