Bilateral Posterior Crossbite Research Articles

Evaluation of dentoskeletal effects of surgically assisted rapid maxillary expansion using computed tomography

Introduction: Patients with transverse maxillary deficiency may have unilateral or bilateral posterior crossbite, crowded and rotated teeth and narrow palate. The treatment for adults is surgically assisted rapid maxillary expansion, a procedure that results in changes not only to bones, but also to teeth, nasal cavity, air space, lips and surrounding soft tissues. Objective: This study evaluated dentoskeletal changes in patients that underwent surgically assisted rapid maxillary expansion (SARME). Methods: Cone beam computed tomography (CBCT) scans were obtained before and after SARME. The thickness of buccal and lingual cortical bone and the angle of the long axis of posterior maxillary teeth were measured. Data were analyzed statistically. Results showed changes in thickness of buccal and lingual cortical bone and tooth movement and tipping. Conclusion: Tooth tipping increased and buccal bone thickness decreased, although osteotomies were used.

Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography

The aim of this study was to update the midpalatal suture classification after surgically assisted rapid maxillary expansion (SARME) using computed tomography (CT). Thirty-five patients with a transverse maxillary deficiency and unilateral or bilateral posterior crossbite underwent SARME with osteotomy of the pterygoid apophysis of the sphenoid. CT was performed before installation of the Hyrax expander appliance and after the final activation. Opening of the midpalatal suture was classified into three types: type I, total midpalatal suture opening from anterior nasal spine (ANS) to posterior nasal spine (PNS); type II, partial midpalatal suture opening from ANS to the transverse palatine suture, with partial or non-existent opening of the midpalatal suture posterior to the transverse palatine suture; type III, complete maxillary opening from ANS, but not of PNS, because a paramedian fracture completed the opening of the hard palate. Type I was observed in 42.8% of the patients, type II in 40%, and type III in 17.2%. Opening of the transverse palatine suture was found in all midpalatal suture opening patterns and was more frequent in type III, followed by type II and type I. CT was used to update the classification of midpalatal suture patterns, with the inclusion of type III: total opening of the hard palate due partly to opening of the midpalatal suture and partly to a paramedian fracture.

Advantages of Interceptive Orthodontic Treatment; Rapid Maxillary Expansion in Children with Malocclusion Resulting from Mouth Breathing Habits

Background: One of the causes of malocclusion in developing children is the practice of mouth breathing. Morphological disturbances may occur during the growth phase in children with chronic mouth breathing. This resulting in the unfavorable development of dentofacial and craniofacial complexes. Mouth breathing in children as a condition has come to the attention of health care professionals. Malocclusion incidence will be decreased and eventually eliminated with the early identification and treatment of these poor oral habits. Purpose: The study determines the benefits of interceptive orthodontics Rapid Maxillary Expansion treatment in children with malocclusion caused by the habit of mouth breathing. Methods: Data were gathered by searching and analyzing literature from electronic databases PubMed, Wiley, and Science Direct in the 2012 and 2022 publication period. Interceptive orthodontics; rapid maxillary expansion; mouth breathing; malocclusion and children keywords were used to conduct the systematic search of the data. Results: One of the most frequent malocclusions is caused by the practice of mouth breathing which narrows the maxillary arch. Some of the characteristic features are decreased distance between nasal cavity’s lateral walls, bilateral or unilateral posterior crossbite, crowding of the anterior teeth, and deep palate.

A New Approach to Diagnosis to Posterior Cross Bite: Intraoral Photography and Wala Ridge.

A posterior crossbite is an occlusion disorder that occurs in the transverse plane. It occurs when the buccal cusps of the upper premolars and molars engage lingually with the buccal cusps of the lower teeth. It can be unilateral or bilateral (involving one or more teeth) in the primary, mixed, or permanent dentition. A crossbite may appear in early dentition stages and it can be dental or functional. It can lead to skeletal crossbite in mixed dentition. Therefore, early diagnosis and treatment are crucial. Material and methods: The selected sample included 204 patients in growing stage divided into two groups: a study group of 102 patients with posterior crossbite and a control group of 102 patients without malocclusion. To analyze the pathology, intraoral frontal photographs and study models were taken, in which the bone component was measured from the Wala Ridge. Results: The use of the photographs to study the Wala Ridge was confirmed. The mean maxillary width was 57.8 mm (SD 1.7) and mandibular width was 56.4 mm (SD 1.7) for the control group, with a maxillomandibular difference of 1.4 mm (SD 0.7); and 52.7 mm (SD 3.7) and 55.5 mm (SD 3.6), respectively, with a maxillomandibular difference of −2.8 mm (SD 1.4) for the study group. A higher maxillomandibular discrepancy was observed in patients with a posterior crossbite that involved more than one tooth in addition to the permanent first molar. It was also higher in patients with bilateral posterior crossbite. Conclusions: Intraoral frontal photography can be used as a diagnostic method to measure the maxillomandibular difference using the Wala Ridge.

Emoji as promising tools for emotional evaluation in orthodontics

BackgroundEmoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions.MethodsOnline surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1–crowding, C2–anterior open bite, C3–interincisal diastema, C4–increased overjet + deep bite (Class II div. 1), C5–anterior crossbite (Class III), C6–ideal occlusion, C7–unilateral posterior crossbite, C8–anterior open bite plus bilateral posterior crossbite plus crowding, and C9–deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji.ResultsThe frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05).ConclusionsEmoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Marpe - An Effective Treatment Modality for Transverse Discrepancy Correction in Young Adults: A Case Report

Growth in maxilla occurs either by apposition of bone at the suture or by surface remodeling . Many studies have reported that by the late teens, interdigitation and areas of bony bridging across the suture develop to the point that maxillary expansion becomes impossible. Conventional expanders were effective in children and young adolescents but when used during late adolescent and adulthood it caused more of dental tipping and less to no skeletal expansion. The inclusion of mini screws in conventional rapid palatal expanders converts it into a MARPE appliance. The Mini screw warrants greater skeletal expansion, keeping the dental expansion and associated unwanted effects to a minimum. The objective of this case report is to show the correction of bilateral posterior crossbite in an adult patient using Miniscrew Assisted Rapid Palatal expansion followed by fixed orthodontic appliance therapy. Keywords: MARPE; Rapid palatal expansion; Maxillary skeletal expansion

Occurrence Of Cross-Bite Among School Children In Jeddah City; An Observational Study

Cross-bite is the most crucial orthodontic discrepancy affecting several children worldwide. It progresses in the child&#39;s growing stage, which results in functional limitations and compromised esthetics in a few cases. 334 school children were utilized and distributed into two age groups; 6-9 and 9-12 years. Several types of cross-bites were investigated among the study groups anterior cross-bite, unilateral posterior cross-bite, and bilateral posterior cross-bite. The gathered data was anal

Orthognathic surgery-first approach with lingual appliances: a case report

Abstract Background A surgery-first approach has many advantages related to a shortened treatment time and an immediate facial aesthetic improvement compared to a three-stage conventional orthognathic surgery protocol. Objective The aim of this case report was to describe the treatment of a 21-year-old, female, patient who presented with a skeletal Class III malocclusion, maxillary retrusion, a negative overjet, an anterior and bilateral posterior cross-bite, and a vertical facial pattern highlighted by a high mandibular plane angle. Methods Orthodontic treatment was performed using self-ligating lingual appliances and a surgery-first approach. The active treatment time was 16 months. Results and conclusion Successful treatment results were achieved using a combination of an orthognathic surgery-first approach and lingual appliances in a patient with high aesthetic expectations.

Maxillary Skeletal Expansion with the Assistance of Ortho Implants: A Clinical Case Report

Introduction: The maxillary skeletal expander (MSE) with the assistance of ortho implants is used to perform rapid palatal expansion in patients who are no longer growing. This case report describes a 15-year-old boy with a bilateral posterior crossbite caused by transverse maxillary deficiency. Methods: A 10-mm MSE was placed with four ortho implants. The MSE was activated once per day for 20 days. Subsequently, a fixed appliance (MBT) was placed as corrective treatment. Results: An approximate expansion of 8 mm was achieved using the MSE. The posterior crossbite was corrected by increasing the transverse dimensions of the maxilla. An adequate inter-arch relationship similar to the class I molar and canine relationships was achieved, as were a 2-mm overjet and 2-mm overbite. Conclusions: The use of the MSE with the assistance of ortho implants is an alternative method of treatment that can be beneficial for patients who are no longer growing. This method avoids the use of surgical expansion and is less invasive, more economical, and more comfortable for the patient.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial

This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children. Eighty participants aged 8-10years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n=40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1month after the appliance removal (T3). Generalized mixed models were used for data analysis (α=0.05). Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P=0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P=0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P=0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. Correction of the transverse maxillary deficiency by RPE in children aged 8-10years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. This trial was not registered. The protocol was not published before trial commencement. This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code001.

Effects of Rapid Maxillary Expansion on the Temporomandibular Joint: A Bone Scintigraphy Study.

The purpose of this study is to assess the effects of rapid maxillary expansion on metabolic activity in the temporomandibular joints of young adult patients using scintigraphy. The images belonging to temporomandibular joints were obtained from the retrospective scintigraphic records taken from 17 adult females (16.1 and 18.8 years of age and the mean age was 17.3±0.86 years) who had non-functional bilateral posterior crossbite, deep palatal vault and dental crowding, and had been treated with rapid maxillary expansion. Bone scintigraphy images were collected at three-time intervals: at the beginning of treatment (T1), during the opening of the mid palatal suture (T2), and at the end of screw activation (T3). Alteration in bone activity in the temporomandibular joint regions were evaluated in sagittal and transaxial slices. To determine the differences between the intervals, repeated analysis of variance and Bonferroni multiple comparison tests were applied. In the right and left temporomandibular joint regions, significantly increased metabolic activity was exhibited between T1-T2 (p<0.001). At the time of opening the maxillary mid-palatal suture, the metabolic activity increased approximately 60% compared to the initial status. At the end of the active expansion period (T3), the change in metabolic activity was approximately 20% reduced compared to T2. Metabolic activity intensification occurs in the regions of interest in the temporomandibular joint during rapid maxillary expansion. After mid-palatal suture opening, activity noticeably decreased (T2-T3). This decrease in bone activity suggests that the temporomandibular joint complex adapts to rapid maxillary expansion forces.

The Application of Pendulum as a Space Regainer in Orthodontic Treatment

Background: The process of distalization in orthodontic treatment is often very difficult. The most common method is the use of cervical headgear. However, due to poor patient compliance, it leads to poor treatment outcomes. Treatment alternatives that require minimal compliance include Jones jig, magnets, and pendulum. Objective: This study aimed to perform distalization of a maxillary molars on a bilateral Class II molar relationship patient with a crowded maxillary arch. Case Report: A 10-year-old female with a Class II molar relationship, bilateral posterior crossbite, and nonerupted upper canines was treated with a rapid palatal expander (RPE), pendulum appliance, and fixed appliance. The crowding in the maxillary arch and spacing in the mandibular arch were eliminated, and transverse discrepancies were corrected. Conclusion: Pendulum appliance is very effective in creating spaces for the eruption of canines and ectopic premolars. Pendulum appliances have been introduced for a long time and have proven successful for molar distalization and space regainer and require minimal patient cooperation. Like other distalization appliances, distal tipping of the molars and mesial movement of the premolars could be observed.

Mini Hyrax vs Hyrax expanders in the rapid palatal expansion in adolescents with posterior crossbite: a randomized controlled clinical trial

PurposeThe aim of this study was to compare the dental effects, impact on quality of life, and pain perception of adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion.MethodsThirty-four adolescents aged 11 to 16 years, with maxillary transverse deficiency (unilateral or bilateral posterior crossbite), were randomly allocated into two groups, Mini Hyrax group and Hyrax group (1:1 ratio). Dental effects were evaluated by digitally superimposed pretreatment and postretention three-dimensional intraoral scans on the palatal rugaes using the software 3DSlicer. Impact on quality of life was assessed with the OHIP-14 questionnaire applied in the pretreatment, posttreatment and postretention. Visual analog scale was applied 24, 48, and 72 h and 7 days after the first activation of the expander.ResultsThirty of the 34 adolescents recruited completed the study. There were no statistically significant differences in dentoalveolar effects between groups. OHIP-14 scores across time among Mini Hyrax wearers were similar to those of the Hyrax wearers. The inter-group comparisons showed no difference between groups with respect to the OHIP-14 scores in posttreatment and postretention (p > 0.05). There were no differences in pain perception between groups. Considering intra-group comparison, the reduction in pain perception among adolescents in the Mini Hyrax group was gradual. Among adolescents in the Hyrax group, a statistically significant reduction between 48 and 72 h was observed.ConclusionThere were no significant differences in dental effects, impact on quality of life and pain perception between adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion.

Characteristics and Association of Gender to Dental and Occlusal Anomalies in Malaysian Primary School Children

Aim: To describe the distribution and association of dental and occlusal anomalies to gender in children of mixed and early permanent dentition. Methods: It is a cross-sectional study with stratified random sampling based on the main ethnic composition involving 413 subjects aged between 9 and 11 years old enrolled in 7 national primary schools in Sungai Buloh, Selangor. A calibrated operator carried out clinical examinations, and study models were fabricated. All dental and occlusal anomalies were recorded accordingly and were analysed using SPSS version 21.0. Pearson chi-square test was used to determine the gender-based differences for various parameters. Results: The reported dental anomalies were supernumeraries and clinically missing teeth (impacted or hypodontia) with a prevalence of 1.5% and 6.3%, respectively. The occlusal abnormalities were: crowding (54.0%), sagittal discrepancies (overjet; increased, reduced, and reversed overjet: 55.5%), vertical discrepancies (overbite; increased, reduced, and open bite: 37.5%) and transverse discrepancies (unilateral and bilateral posterior crossbite: 5.1%). Gender-based differences were not statistically significant to all reported dental and occlusal anomalies (p&gt;0.05). Conclusions: Children in the mixed and early permanent dentition showed various dental and occlusal anomalies with crowding being the highest anomaly. Gender was not associated with any type of dental or occlusal characteristics in the studied population.

Effects of maxillomandibular advancement surgery on a skeletal Class III patient with obstructive sleep apnea: A case report

This case report describes the successful surgical treatment of a patient diagnosed with obstructive sleep apnea (OSA). A 55-year-old Caucasian male patient with a body mass index (BMI) of 25.6 kg/m2 sought treatment with a chief concern of excessive daytime sleepiness and fatigue. An initial polysomnography report showed moderate OSA with an apnea-hypopnea index (AHI) of 21.2 events/h, and Epworth Sleepiness Score (ESS) of 12/24. The patient was initially prescribed with CPAP treatment but was unable to tolerate treatment after a few months. Clinical and radiographic examination revealed a concave facial profile with maxillary retrognathism. Intraoral examination revealed generalized gingival recession, missing upper lateral incisors and lower first premolars, anterior crossbite, and maxillary transverse deficiency with bilateral posterior crossbite. The lateral cephalogram showed a narrow posterior airway space at the level of the base of the tongue. The patient was treated with maxillomandibular advancement (MMA) surgery to improve airway obstruction. Results showed balanced facial esthetic and stable occlusion with a complete resolution of the patient’s OSA and a post-operative improvement of AHI from 21.2 to 0.7 events/h and ESS from 12/24 to 3/24. The lowest oxyhemoglobin saturation during sleep was improved to 97%, and the BMI decreased from 25.6 to 25.2 kg/m2. These results suggest that MMA surgical procedure can be used as a definitive treatment for patients with maxillomandibular deficiency and OSA.

Orthodontic management of compromised first permanent molars with bilateral posterior crossbite, severe crowding and impacted maxillary canines.

Background: A unique clinical challenge presents when dealing with a compromised first permanent molars with bilateral posterior crossbite, severe crowding and impacted maxillary canines with skeletal class II base malocclusion patient.&#x0D; Case presentation: 14-year-old female patient had dental Class II skeletally, complicated with increase overjet, badly destructed permanent mandibular 1st molars constricted maxillary arch. Extraction of 1st molars followed by expansion have been planned to relieve crowding. Extraction of 1st molars in this time (furcation of 3rd molars start to develop) help in replacement by 2nd molars. In the progression of treatment,&#x0D; Conclusion: A well-balanced and esthetic occlusion by edge wise orthodontic treatment has been archived in this case.&#x0D; Bangladesh Journal of Medical Science Vol.20(4) 2021 p.926-929

A postero-anterior cephalometric evaluation of different rapid maxillary expansion appliances

The purpose of the study was to evaluate dental and skeletal changes induced by tooth-bone-borne, tooth-tissue-borne, and tooth-borne rapid maxillary expansion (RME) appliances using postero-anterior (PA) cephalometric radiographs. A total of 54 patients' (25 boys, 29 girls) PA cephalometric radiographs who had bilateral posterior crossbite and RME treatment were included and divided into three groups according to the type of appliance used during treatment: tooth-bone-borne RME appliance (hybrid Hyrax) (7 boys, 11 girls, mean age 13.28 ± 1.20 years), tooth-tissue-borne RME appliance (TTB) (8 boys, 10 girls, mean age 13.08 ± 1.06 years) and tooth-borne RME appliance (Hyrax) (10 boys, 8 girls, mean age 12.05 ± 1.35 years). Pretreatment (T0) and posttreatment (T1) PA cephalometric radiographs were analyzed with Dolphin software v. 11.7 (Chatsworth, CA). The comparisons of the groups were performed with Two-way analysis of variance. P < 0.05 was considered statistically significant. Significant and equal increase of right molar relationship and upper intermolar molar widths occurred in all groups. Dental midline discrepancy showed significant increase in only hybrid Hyrax group between T0 and T1. Significant increases were reported for lateronasal width in hybrid Hyrax and tooth-tissue-borne groups (P < 0.05). Both skeletal and dental changes were observed after RME in all groups. However, the greatest skeletal changes were seen in hybrid Hyrax and tooth-tissue-borne groups.

Clear Expansion Plate: A Novel Technique

Abstract Objectives Posterior crossbite is one of the most common orthodontic problems in primary and mixed dentition that induces deleterious and permanent effects on dentition, dentoskeletal structures, and esthetics. Early correction of unilateral and bilateral posterior crossbite is necessary to prevent these problems. Early intervention with removable Schwarz appliance is one of the useful appliances to correct posterior crossbite, but it has its own disadvantages. Materials and Methods In this article, we have presented a new appliance and method of fabrication to aid the expansion of the maxilla. Results The presented “clear expansion plate” that is made by thermoplastic sheets maintains all of the positive properties of the Schwarz plate and has several additional advantages. Conclusion After being tested in clinical trials, traditional expansion plate can be replaced by clear expansion plate.

Treatment Effect of Combined Surgical Maxillary Expansion and Mandibular Setback in Skeletal Class III

The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.

Evaluation of the Soft Tissue Changes after Rapid Maxillary Expansion Using a Handheld Three-Dimensional Scanner: A Prospective Study.

Facial soft tissue esthetics is a priority in orthodontic treatment, and emerging of the digital technologies can offer new methods to help the orthodontist toward an esthetic outcome. This prospective study aimed to assess the soft tissue changes of the face after six months of retention following Rapid Maxillary Expansion (RME). The sample consisted of 25 patients (13 females, 12 males, mean age: 11.6 years) who presented with unilateral or bilateral posterior crossbite requiring RME, which was performed with a Hyrax expander. 3D facial images were obtained before treatment (T0) and at the end of a six-month retention period after the treatment (T1) using a structured-light 3D handheld scanner. Linear and angular measurements were performed and 3D deviation analyses were done for six morphological regions of the face. Significant changes in various areas of the nasal and the upper lip regions were observed. Based on the results of the study and within the limitations of the study, RME with a Hyrax expander results in significant morphological changes of the face after a six-month retention period.