Bone-borne Rapid Maxillary Expansion Research Articles

External root resorption and rapid maxillary expansion in the short-term: a CBCT comparative study between tooth-borne and bone-borne appliances, using 3D imaging digital technology

BackgroundThe aim of the study was to analyze and compare external root resorption (ERR) in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME).MethodsThe sample included 40 subjects who received tooth-borne RME (TB group, average age: 13.1 ± 1.08 years) or bone-borne RME (BB group, average age: 14.5 ± 1.11 years) and Cone-beam computed tomography (CBCT) scans before treatment (T0) and after 3-month of retention (T1). A specific 3D Imaging technology was used to generate 3D models of posterior dentition (M1 = maxillary first molars, P2 = second premolars, P1 = first premolar) and calculate volumetric data (mean and percentage values) and shape changes, the latter obtained from deviation analysis between the radicular models at different time points. Evaluation of radicular length changes was performed for each tooth. Data were statistically analysed to perform intra-timing and inter-groups comparisons.ResultsA significant reduction of radicular volume and length was found in posterior dentition in both groups (p < 0.05), and the M1 (volume) and its palatal root (length) were mostly involved in this response. No differences were found between M1, P1 and P2 (p > 0.05) when volumetric changes were calculated as percentage of the total volume. Deviation analysis revealed that the radicular areas mostly affected by shape change were the apex and bucco-medial side. The amount of ERR was significantly greater in TB group compared to BB group.ConclusionsBB-RME treatment could reduce the amount of ERR at the post-expansion stage.

Comparative Evaluation of Skeletal and Dental Effects of Mini-Implant Assisted and Corticopuncture-Facilitated Rapid Palatal Expansion in Adults: A Randomized Clinical Study

Abstract Introduction: Conventional rapid maxillary expansion (RME) in adults is difficult due to increased skeletal maturity of the midpalatal suture. Surgically assisted rapid palatal expansion (SARPE) treatment is recommended for adults with strongly consolidated sutures but has lesser acceptance due to its invasive nature. Mini-implant-assisted rapid palatal expansion (MARPE) produced dentoalveolar side effects along with some skeletal effects in adults while being highly successful in adolescents and young adults. A lesser invasive technique combined with a purely bone-borne-rapid-maxillary-expansion appliance (BBRME) is suggested in this study to achieve maximum skeletal effects and minimize the dentoalveolar side effects of expansion in adults with completely fused midpalatal sutures as an alternative to SARPE. Aim: This study aims to evaluate and compare skeletal and dental effects of mini-implant assisted, and corticopuncture-facilitated rapid palatal expansion in adults. Material and Methods: A randomized clinical study was performed on 18 patients (mean age 20.77 years) who were randomly divided into two groups: Group A (Corticopuncture-facilitated BBRME) and Group B (conventional MARPE). Pretreatment (T0) and postexpansion (T1) skeletal and dental effects of both the groups were analyzed using cone-beam computed tomography imaging. Results: A student’s paired t-test was used to evaluate the difference in expansion achieved between the two groups (T1-T0). Group A (BBRME with corticopunctures) showed increased transverse widths at the basal bone, nasal base, and jugal processes. Group B (conventional MARPE) showed increased inclination of the posterior teeth indicating dental tipping. Both groups were successfully treated with their respective protocols but dentoalveolar side effects were significantly less in group A (BBRME) suggesting a better prognosis in BBRME group. Conclusions: Greater skeletal changes were seen in group A (BBRME) (P &lt; 0.05*) than in group B. Group B (MARPE) showed more dental side effects like dental tipping and lesser skeletal expansion. Corticopuncture-facilitated bone-borne RME (BBRME) is a viable and efficient method of maximizing skeletal expansion in adults with fully obliterated midpalatal sutures.

External root resorption (ERR) and rapid maxillary expansion (RME) at post-retention stage: a comparison between tooth-borne and bone-borne RME

BackgroundThe study aimed to compare external root resorption (ERR) three-dimensionally in subjects treated with tooth-borne (TB) versus bone-borne (BB) rapid maxillary expansion (RME). Forty subjects who received tooth-borne RME (TB group, average age 13.3 years ± 1.10 years) or bone-borne RME (BB group, average age 14.7 ± 1.15 years) were assessed using CBCT imaging before treatment (T0) and after a 6-month retention period (T1). 3D reconstructions of the radicular anatomy of maxillary first molars (M1), first and second premolars (P1 and P2) were generated to calculate volumetric (mean and percentage values) and shape changes (deviation analysis of the radicular models) obtained at each time point. 2D assessment of radicular length changes was also performed for each tooth. Data were statistically analyzed to perform intra-group (different teeth) and inter-group comparisons.ResultsIn both groups, all the investigated teeth showed a significant reduction in radicular volume and length (p < 0.05), with the first molars being the teeth most affected by the resorption process (volume and palatal root length). When volumetric radicular changes were calculated as a percentage of the pre-treatment volumes, no differences were found among the investigated teeth (p > 0.05). Based on the deviation analysis from radicular models superimposition, the areas most affected by shape change were the apex and bucco-medial root surface. Overall, the amount of ERR was significantly greater in the TB group (mm3: M1 = 17.03, P1 = 6.42, P2 = 5.26) compared to the BB group (mm3: M1 = 3.11, P1 = 1.04, P2 = 1.24).ConclusionsDespite the statistical significance, the difference in the amount of ERR of the posterior maxillary dentition between TB-RME and BB-RME remains clinically questionable.

Nasal Septum Changes in Adolescents Treated with Tooth-Borne and Bone-Borne Rapid Maxillary Expansion: A CBCT Retrospective Study Using Skeletal Tortuosity Ratio and Deviation Analysis.

Using three-dimensional (3D) images, this study evaluated the impact of Rapid Maxillary Expansion (RME) on changes in Nasal Septal Deviation (NSD). Cone-beam computed tomography (CBCT) scan of 40 children with transverse maxillary deficiency, who received tooth-borne (TB) RME or bone-borne (BB) RME, were included in this investigation. Two CBCT scans were performed: one before to appliance installation (T0) and one after a 6-month retention period (T1). The analysis was performed by dividing the actual length of the septum by the desired length in the mid-sagittal plane to measure NSD based on the tortuosity ratio (TR). Subjects in the TB group showed a statistically significant reduction (p &lt; 0.05) of the TR value from T0 to T1, according to the paired Student t test. Subjects in the BB group showed similar findings, with a statistically significant reduction (p &lt; 0.05) of the TR value from T0. No statistically significant differences were found between the mean changes of TR between TB group and BB group. RME may have some effects in reducing the degree of NSD; however, no differences were found between RME performed with TB and BB anchorage systems.

Three-dimensional assessment of palatal area changes after posterior crossbite correction with tooth-borne and tooth bone-borne rapid maxillary expansion.

To assess and compare the three-dimensional treatment changes in palatal surface area and volume using either tooth-borne (TB) or tooth bone-borne (TBB) rapid maxillary expanders and to evaluate the long-term effects of the two devices and the incidence of the relapse between the groups. A total of 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (standard deviation [SD], 1.3), or the TBB group, mean age 9.5 years (SD, 1.2). Study casts were taken before, directly after, 1 year after, and 5 years after expansion. Study casts were digitized, superimposed, and evaluated. Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. Changes in palatal volume, palatal surface area, and palatal projection area within and between the groups up to 5 years after expansion followed the same pattern and did not show any statistically significant differences between the groups. Relapse was seen in 15% of the patients. It seemed that open-bite and a Class III growth pattern could be assumed as prognosis-deteriorating factors in regard to stability of the treatment. There were no significant differences between the TB and TBB groups in palatal volume, palatal shell area, or palatal projection area directly after expansion or at 1 year and 5 years after expansion, which implies that the two devices gave rise to the same immediate and long-term outcomes.

Short-Term and Long-Term Changes of Nasal Soft Tissue after Rapid Maxillary Expansion (RME) with Tooth-Borne and Bone-Borne Devices. A CBCT Retrospective Study.

The objective of the study was to assess the changes in nasal soft tissues after RME was performed with tooth-borne (TB) and bone-borne (BB) appliances. Methods. This study included 40 subjects with a diagnosis of posterior cross-bite who received tooth-borne RME (TB, average age: 11.75 ± 1.13 years) or bone-borne RME (BB, average age: 12.68 ± 1.31 years). Cone-beam computed tomography (CBCT) was taken before treatment (T0), after a 6-month retention period (T1), and one year after retention (T2). Specific linear measurements of the skeletal components and of the soft-tissue region of the nose were performed. All data were statistically analyzed. Results. Concerning skeletal measurements, the BB group showed a greater skeletal expansion of the anterior and posterior region of the nose compared to the TB group (p < 0.05) immediately after RME. Both TB and BB RME induce a small increment (>1 mm) of the alar base and alar width, without significant differences between the two expansion methods (p > 0.05). A high correlation was found between skeletal and soft-tissue expansion in the TB group; instead, a weaker correlation was found in the BB group. Conclusion. A similar slight increment of the alar width and alar base width was found in both TB and BB groups. However, the clinical relevance of these differences, in terms of facial appearance, remains questionable.

Comparison of changes in skeletal, dentoalveolar, periodontal, and nasal structures after tooth-borne or bone-borne rapid maxillary expansion: A parallel cohort study

This parallel cohort study aimed to assess the dentoalveolar, skeletal, periodontal, and airway effects of tooth-borne (hyrax) and computer-guided miniscrew-supported rapid palatal expansion appliances. Thirty-six subjects were randomly allocated into 2 groups. Eighteen subjects (mean age, 12.2 years; male-to-female ratio, 10:8) were assigned to receive treatment with the hyrax appliance (group A), and 18 subjects were treated with the computer-guided miniscrew-supported appliance (group B). The same type of expansion screw and expansion protocol was used in both groups. Linear and angular measurements of skeletal, dentoalveolar, periodontal, and nasal floor changes were performed on the pretreatment and posttreatment cone-beam computed tomography images (6-month follow-up). Descriptive statistics and the independent Student t test were used for the statistical analysis. Intraoperator reliability was evaluated using a 2 sample t test. The level of significance was P≤0.05. Ten subjects were censured because posttreatment cone-beam computed tomography imaging was not performed because of the coronavirus disease 2019 pandemic. In the remaining 26 subjects, increases in linear measurements were observed in both groups. The transversal skeletal increase was greater and statistically significant in the group treated with the bone-borne expander (P≤0.05). The dentoalveolar transverse diameters were greater in the tooth-supported expander group, with no statistically significant difference between the groups. The buccal inclination of the maxillary first molar was observed in the group with the tooth-borne expander, with a statistically significant difference between the 2 groups. A slight reduction of buccal and palatal thicknesses at the level of the maxillary first molars was observed in both groups, smaller in the skeletal expander group, with a statistically significant difference between the 2 groups only on the right buccal cortical plate. The width of the nasal floor increased more in the group with skeletal expander with a statistically significant difference of 2 mm. Computer-guided miniscrew-supported maxillary expanders allowed a greater transversal increase of the nasal-maxillary skeletal structures by reducing the dentoalveolar side effects of the tooth-supported devices.

Three-dimensional assessment of the spheno-occipital synchondrosis and clivus after tooth-borne and bone-borne rapid maxillary expansion.

To assess changes in spheno-occipital synchondrosis after rapid maxillary expansion (RME) performed with conventional tooth-borne (TB) and bone-borne (BB) appliances. This study included 40 subjects with transverse maxillary deficiency who received TB RME or BB RME. Cone-beam computed tomography images (CBCT) were taken before treatment (T0), and after a 6-month retention period (T1). Three-dimensional surface models of the spheno-occipital synchondrosis and basilar part of the occipital bone were generated. The CBCTs taken at T0 and T1 were registered at the anterior cranial fossa via voxel-based superimposition. Quantitative evaluation of Basion displacement was performed with linear measurements and Euclidean distances. The volume of the synchndrosis was also calculated for each time point as well as the Nasion-Sella-Basion angle (N-S-Ba°). All data were statistically analyzed to perform inter-timing and intergroup comparisons. In both groups, there was a small increment of the volume of the synchondrosis and of N-S-Ba° (P < .05). Basion showed a posterosuperior pattern of displacement. However, no significant differences (P > .05) were found between the two groups. Although TB and BB RME seemed to have some effects on the spheno-occipital synchondrosis, differences were very small and clinically negligible.

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.

Evaluation and Comparison of Root Resorption Resulting from Traditional and Bone-borne Rapid Maxillary Expansion Appliances Using Cone-beam Computed Tomography

Evaluation and Comparison of Root Resorption Resulting from Traditional and Bone-borne Rapid Maxillary Expansion Appliances Using Cone-beam Computed Tomography

Three-dimensional stereophotogrammetric analysis of facial soft tissues following bone-borne rapid maxillary expansion

Three-dimensional stereophotogrammetric analysis of facial soft tissues following bone-borne rapid maxillary expansion

The impact of tooth-borne vs computer-guided bone-borne rapid maxillary expansion on pain and oral health–related quality of life: A parallel cohort study

The primary aim of this study was to investigate and compare perceived pain intensity and oral health-related quality of life (OHRQOL) results during the activation phase of rapid maxillary expansion (RME), with tooth-borne and bone-borne devices. In addition, a secondary aim of this study was to evaluate the correlation between pain scales and the shortened Oral Health Impact Profile (OHIP-14) questionnaire. Thirty-six subjects (16 girls and 20 boys) with a mean age of 12.3years (standard deviation, 0.82years) were randomized into 2 groups. Group A received treatment with hyrax appliance, and group B received a computer-guided skeletal RME appliance. The same type of expansion screw and screw activation or expansionprotocol were used. Two rating scales were used to assess the subject's pain during the activation phase of RME: a Graphic Rating Scale for Pain (GRS) and the Wong-Baker Faces Pain Scale (FPS). The OHIP-14 was used to evaluate the impact of RME on OHRQOL before the beginning of the treatment at day 3 and day 7 follow-ups. Painkillers were forbidden during the active phase of RME. Descriptive statistics, Student t test, and Pearson correlation were used. Significance was set at P≤0.05. A total of 36 subjects, divided into 2 groups, were treated in the study. Regarding the level of pain, the Student t test showed statistically significant higher pain in group B-although only on the first day of screw activation (GRS, P=0.01; FPS, P<0.01). For the following days, there were no significant differences in pain levels between groups. The OHIP-14 showed no statistically significant difference at baseline (P=0.32) and day 3 (P=0.88) and day 7 (P=0.85) follow-ups between the 2 groups. The Pearson correlation coefficient showed a statistically significant association between the 2 different scales of pain (GRS and FPS) but not a statistically significant correlation between GRS and FPS scales and OHIP-14. A higher perceived pain intensity in the patients treated using a bone-borne computer-guided skeletal RME appliance was limited to the first day of screw activation. There were no statistically significant differences between the 2 types of treatment in terms of their impact on OHRQOL and no statistically significant correlation between pain scales and the OHIP-14 questionnaire.

Evaluation of the changes of orbital cavity volume and shape after tooth-borne and bone-borne rapid maxillary expansion (RME)

ObjectiveTo assess and compare volumetric and shape changes of the orbital cavity in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME).Study designForty adolescents with bilateral maxillary cross-bite received tooth-borne (TB group = 20; mean age 14.27 ± 1.36 years) or bone-borne (BB group = 20; mean age of 14.62 ± 1.45 years) maxillary expander. Cone-beam computed tomography (CBCT) were taken before treatment (T1) and 6-month after the expander activation (T2). Volumetric and shape changes of orbital cavities were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student’s t tests were used to 1) compare T1 and T2 volumes of orbital cavities in TB and BB groups, 2) compare volumetric changes and the percentage of matching of 3D orbital models (T1-T2) between the two groups.ResultsBoth TB and BB groups showed a slight increase of the orbital volume (0.64 cm3 and 0.77 cm3) (p < 0.0001). This increment were significant between the two groups (p < 0.05) while no differences were found in the percentage of matching of T1/T2 orbital 3D models (p > 0.05). The areas of greater changes were detected in the proximity of the frontozygomatic and frontomaxillary sutures.ConclusionTB-RME and BB-RME would not seem to considerably affect the anatomy or the volume of the orbital cavity in adolescents.

Evaluation of pulp cavity/chamber changes after tooth-borne and bone-borne rapid maxillary expansions: a CBCT study using surface-based superimposition and deviation analysis.

To compare volume and shape changes of pulp chamber of maxillary posterior teeth between tooth-borne and bone-borne maxillary expansions in adolescents. This study included 36 adolescents with bilateral maxillary crossbite who received tooth-borne rapid maxillary expansion (TB group, average age 14.4years) or bone-borne rapid maxillary expansion (BB group, average age 14.7years). Cone beam computed tomography (CBCT) was taken before treatment (T1) and after a 6-month retention period (T2). Volumetric and shape changes of pulp chamber of maxillary first molars and premolars were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student's t tests were used to (1) compare T1 and T2 volumes of pulp chambers in TB and BB groups and (2) assess differences between the two groups in the post-treatment volumetric changes and in the percentage of matching of 3D pulp models. All investigated teeth showed a reduction of pulp volume, being this difference significant in both TB (p < 0.0001) and BB (p < 0.0001) groups. The volumetric reduction was greater in the TB group; also, subjects in the TB group showed a lower percentage of matching between T1 and T2 pulp models (p < 0.0001). The area most affected by shape change was that of pulp horns. TB expander could induce a higher volumetric reduction of pulp chamber of posterior teeth compared with BB expander, in the short term. The present findings add new information concerning the effects of RME protocols on pulp tissue.

Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review

The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.

Comparison of symmetry of rapid maxillary expansion using a tooth-borne or a bone-borne distractor

Background: There are differences in the distraction pattern of tooth-borne versus bone-borne rapid maxillary expansion. However, patients suffer especially from visible asymmetric distraction of the two maxillary segments. These have not yet been described. Objectives: We investigate the asymmetry in distraction of the two maxillary segments before and after expansion. Methods: We measured dental landmarks on 21 study casts preoperatively and directly after expansion with tooth-borne or bone-borne rapid maxillary distraction. The three-dimensional differences in distraction between the two maxillary segments were calculated. Findings: In this study group, there was no significant difference in the symmetry/asymmetry of rapid maxillary expansion using a tooth-borne the two maxillary segments seem to have another cause i.e. the operation technique than the device used for distraction. The study group is continuously increased to gain further results.

Changes in nasal volume after surgically assisted bone-borne rapid maxillary expansion

The purposes of this study were to detect, locate, and examine the changes in transverse nasal width, area, and volume from bone-borne, surgically assisted rapid maxillary expansion (SARME) with the Dresden distractor by using computer tomography (CT). Sixteen patients (average age, 28.7 years) underwent axial CT scanning before and 6 months after SARME. They also underwent CT fusion on specific bony structures. The nasal bone width was examined in the coronal plane. The cross-sectional images of the nasal cavity were taken of the area surrounding the apertura piriformis, the choanae, and in between. We calculated cross-sectional areas and nasal volume according to these data. All but 2 patients had an increase in nasal volume of at least 5.1% (SD, 4.6%). The largest value of 35.3% (SD, 45.8%) was measured anteriorly on the nasal floor, decreasing cranially and posteriorly. This correlated with the V-shaped opening of the sutura palatina. There was no significant correlation between increase in nasal volume and transversal expansion. Because most of the air we breathe passes over the lower nasal floor, SARME is likely to improve nasal breathing.

Three-dimensional evaluation of surgically assisted implant bone-borne rapid maxillary expansion: A pilot study

The purpose of this study was to evaluate 3-dimensional changes in dental, alveolar, and skeletal structures caused by a bone-borne implant-supported rapid maxillary expansion device (Dresden distractor). Axial computed tomography scans of 10 patients (mean age, 25.3 years) treated with the Dresden distractor were examined. Scans were taken immediately before and 9 months after expansion. Distances in all 3 dimensions were calculated for 38 skeletal, alveolar, and dental landmarks with respect to the reference point ELSA (point equidistant to both foramina spinosa). In the transverse dimension, a V-shaped opening of the suture was shown; the greatest amount of opening was anteriorly directed, with convergence of the suture opening in the posterior aspect of the palate. The expansion of the maxillary dental arch showed a V pattern similar to the opening of the suture. In the frontal view, expansion caused a wedge-shaped opening with its base at the central incisors and the estimated center of rotation next to the frontonasal suture. The alveolar processes tipped buccally (9.9 degrees to 13.3 degrees) as did the molars (2.5 degrees to 3.5 degrees) and the premolars (3.0 degrees to 3.9 degrees). Less tipping of teeth compared with skeletal tipping (about 6 degrees to 9 degrees less) is related to the torque effect of the fixed appliance. The Dresden distractor is a minimally invasive bone-borne expansion appliance that protects teeth by inducing more skeletal than dental changes. This might be a precondition for stable postsurgical occlusion.