Effects Of Rapid Maxillary Expansion Research Articles

Does the face mask increase the impact of rapid maxillary expansion on sagittal airway dimensions?

Airway dimensions associated with the transversal and sagittal position of the maxilla are affected by orthodontic treatment. The objective of this study was to compare the effects of rapid maxillary expansion (RME) and RME followed by face mask (FM) therapies on the airway space and investigate whether application of the FM increases the short-term and long- term impact of RME on sagittal airway dimensions. A total of 26 patients were divided into two groups. Group I included 14 adolescents treated with RME (3 males, 11 females; mean age: 12.2 11 ± 2.1 years), and Group II included 12 adolescents treated with RME followed by FM therapy (7 males, 5 females; mean age: 11.6 ± 1.3 years). Sagittal and vertical skeletal measurements, as well as ten linear cross-sectional airway measurements, were calculated from pretreatment, posttreatment, and postretention cephalometric radiographs. RME followed by FM resulted in a significant increase in the SNA angle, ANB angle, and Wits parameter by the forward movement of the maxillary bone. A significant increase in the vertical dimensions was also observed. Regarding the airway measurements in both groups, significant oropharyngeal increases were revealed, and these were maintained in the follow-up period. However, there were no other significant differences in the short-term and long-term results obtained for Groups I and II. The dimensions of the airway were significantly affected by both therapies. However, no additional effect of FM was observed.

Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective.

Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.

Three dimensional evaluation of the effect of rapid maxillary expansion on maxillary sinus volume

AimTo compare the maxillary sinus volume (MSV) of posterior cross bite (PCB) patients before and after rapid maxillary expansion (RME) by cone-beam computed tomography (CBCT). MethodsA total of 24 patients’ CBCT scans that underwent RME therapy for their orthodontic treatment were used. CBCTs were obtained before (T1), immediately after (T2), and 6 months after (T3) RME. MSVs were calculated by using the 3D module of Dolphin 11.0 software. Repeated measures ANOVA (RMANOVA) was used to identify the MSV differences. ResultsThe results showed no significant differences between the right and left MSVs of the T1 group (p>.05). No significant differences were found between the right and left side MSV of the T2 group (p>.05). There were no significant differences between the right and left side MSV of the T3 group (p>.05). According to the intergroup comparisons, the RMANOVA test results revealed statistically significant right (F = 459.37, p<.001), left (F = 409.34, p<.001), and mean (F = 489.33, p<.001) MSV differences between groups. Multiple comparisons of the right, left, and mean MSV between the T1 and T2, T2 and T3, and T1 and T3 groups with Bonferroni's test revealed no significant differences between the T1 and T2 (p>.05) and T2 and T3 (p>.05) groups. However, significant differences were found in the right (p<.05), left (p<.05), and mean (p<.05) MSV between the T1 and T3 groups. The right, left, and mean MSV of the T3 group were significantly higher than those of the T1 group. ConclusionNo significant change was detected in the MSV immediately after RME. However, MSV was significantly increased at the end of the retention period.

Effects of rapid maxillary expansion on head and cervical posture in growing patients: A systematic review

To identify and qualify the evidence of published studies evaluating whether rapid maxillary expansion (RME) treatment modifies the head and cervical posture in growing patients. Electronic database searches were conducted until January 2021 using PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and LILACS. Grey literature was explored using ClinicalTrials, OpenGrey and Google Scholar. Trials involving participants who underwent RME were included. Risk of Bias (RoB) assessment was conducted using the Cochrane tool for randomized trials and the Methodological Index for Non-randomized Studies (MINORS) for non-randomized trials. The certainty level of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluation tool (GRADE). Six clinical trials were included. The RoB scores had unclear and high risks of bias. Low certainty of evidence suggested that the effects following RME include a decrease in craniocervical angulation, as well as a very low certainty of evidence for a decrease in head elevation, an increase in cervical lordosis, and an increase in the inclination of the cervical spine. There is low and very low evidence that RME alters the head and cervical posture in growing patients. Further investigation regarding long-term effects, possible changes due to somatic growth, and clinical relevance is needed.

A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring

ObjectiveThe present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index. MethodsTwenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed. ResultsThe increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined. ConclusionsThis study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase. Level of evidenceThe article is classified as Evidence Level 3 (Three).

The effects of rapid maxillary expansion and face-mask application on mesio-distal axial inclination and apex flexion of maxillary canine tooth

Background: The aim of this study was to investigate the effects of rapid maxillary expansion (RME) and face-mask application (FMA) on the mesio-distal axial inclination and apex flexion of maxillary canine tooth in mixed dentition. Methods: In this study, panoramic radiographs of 38 patients were used. In the study group, there were 19 patients who treated with RME and FMA. The control group comprised 19 patients who did not applied treatment. In the study group, radiographs were separated at the before (T0) and after (T1) RME and FMA. Radiographs for the control group were separated before (T0) and after (T1) maxillary canine eruption. The inclination and flexion of maxillary canine were measured on these radiographs. A Shapiro Wilk test was used to test the data for a normal distribution. A Wilcoxon test was used for intra-group comparisons of T0 and T1 measurements and a Mann Whitney U test was used for inter-group comparisons of T1-T0 differences and flexion values. The significance level was considered to be p &amp;lt; 0.05. Results: There was no statistically significant difference (p = 0.748) between the T0 and T1 measurements in the study group but a statistically significant decrease was found in the control group (p = 0.031). There were no statistically significant differences between the groups for T1-T0 (p = 0.271) and flexion (p = 0.583) measurements. Conclusion: RME and FMA does not have a significant effects on mesio-distal axial inclination and the apex flexion of maxillary canine tooth in mixed dentition.

Three-dimensional image study of accelerated maxillary expansion in oral breathing kids

ObjectiveTo evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved. Methods120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software. ResultsThe experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change. ConclusionRapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood. Level of evidenceThe soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Effect of rapid maxillary expansion on the apnoea-hypopnoea index during sleep in children. Systematic review

BackgroundRapid maxillary expansion (RME) treatment is prescribed in patients with maxillary compression, achieving increases in transverse palate and nasal cavity dimensions together with an increase in the distance between the pterygoid processes. Sleep apnoea-hypopnoea syndrome (SAHS) in children is often associated with anatomical risk factors and treatment may involve surgery, drugs, dentofacial orthopaedics, myofunctional and positional approaches. Material and MethodsThe aim of this systematic review it to obtain scientific evidence of the effect of RME on the apnoea-hypopnoea index (AHI) in growing patients. PubMed, Cochrane Library and EMBASE were the online databases used for the search. The scientific publications selected met the following inclusion criteria: articles published from 2011 to May 2021; growing patients undergoing rapid maxillary expansion surgery; and studies with records of AHI before and after rapid maxillary expansion using polysomnography or respiratory polygraphy. ResultsSeven articles that provided the necessary quality of scientific evidence were finally selected. The review followed the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, and the GRADE approach for rating the certainty of evidence. Data analysis was performed using Numbers 4.3 and ReviewManager (RevMan) 5.4.1 software and GRADEpro and Mendeley online platforms. ConclusionsThe results show a reduction in AHI following RME therapy in growing patients. More research is needed with larger sample sizes, more specific inclusion criteria and standardised data sharing. Key words:Rapid maxillary expansion, maxillary distraction, sleep apnoea, children.

Immediate skeletal effects of rapid maxillary expansion at midpalatal suture opening with Differential, Hyrax and Haas expanders.

The aim of this study was to test the null hypothesis that there is no difference at the midpalatal suture opening after rapid maxillary expansion (RME) using Expander with Differential Opening (EDO), Hyrax-type and Haas-type expanders. Occlusal radiographs of 52 patients (19 males and 33 females; average age= 9.46?1.20 years) treated with RME were divided into three groups, according to the expander used: EDO (n=17), Hyrax-type (n=21) and Haas-type (n=14). The evaluated variables were: A) Distance between the maxillary central incisors at the incisal edge; B) Distance between the alveolar ridges at the midpalatal suture; C) Suture opening at 10-mm distance from the crest to posterior, at the midpalatal suture; D) Suture opening at 20-mm distance from the crest to posterior, at the midpalatal suture; and E) Suture opening at 30-mm distance from the crest to posterior, at the midpalatal suture. To assess the normality of variables, the Shapiro-Wilk test was performed. For intergroup comparison, ANOVA with a significance level of 5% was used. At the region A, Hyrax-type (4.66 mm) and EDO (4.87 mm) groups presented larger openings than the Haas-type group (3.43 mm). In regions B and C, EDO showed a statistically significant greater opening than the Haas-type group. In region D, a smaller opening of the midpalatal suture was observed in the Haas-type group, compared to the Hyrax-type and EDO groups. EDO and Hyrax-type produced greater immediate skeletal effects, compared with Haas-type, but these differences were about 1 mm and might not be clinically significant.

Effects of rapid maxillary expansion on hearing loss and otitis media in cleft palate children.

Otitis media with effusion (OME), recurrent acute otitis media and conductive hearing loss (CHL) are significantly prevalent in children with cleft palate (CP) and cleft lip and palate (CLP). Rapid Maxillary Expansion (RME) appears to have a positive effect also on middle ear disorders in these patients. The study aims to offer a prospective evaluation of RME effects in a group of patients with CP/CLP in terms of OME, CHL. A prospective observational study was conducted. Thirty-four CP, CLP and submucosa cleft patients who received orthodontic indication to RME treatment for OME or conductive hearing loss in a tertiary institutional Care Unit of San Paolo Hospital, Milan (IT), were included. Twenty-two patients matched for age and with analogous inclusion criteria except for indication to RME treatment were enrolled in the control group. Clinical otolaryngological evaluation, pure tone audiometry and tympanogram were performed at the beginning of treatment (T0), at the end of the expansion (T1) and at 6-month follow-up (T2). Air-bone gaps and tympanogram results at each time interval. In the main group, RME allowed a statistically significant improvement of air-bone gaps (according to frequency, p < 0.001-0.089 T0 vs. T1 and < 0.001-0.044 T0 vs. T2, Friedman's test) and tympanometry results (p = 0.002 T0 vs. T1 and p < 0.001 T0 vs. T2, Friedman's test). Improvements were stable during follow-up and were significantly better in the main group than in the control group. CHL and middle ear effusion improved significantly overtime during RME and after 6months of follow-up.

Three-dimensional zygomatic changes after rapid maxillary expansion in growing patients.

To assess the effects of rapid maxillary expansion (RME) treatment on the zygomatic bone complex (ZBC). In this single-center retrospective study, pre- and posttreatment cone-beam computed tomography (CBCT) images of 38patients treated with RME were analyzed to investigate changes in the coordinates of the ZBC landmarks. At the start of treatment (T0), the patients' mean age was 11.1 ± 3.8years (range 8.3-14.9years). Cohen'sd test was used to evaluate statistical differences. There were statistically significant differences between T0 and T1 (P < 0.01) in the measurement values for the maxillary transverse width (ΔT: 3.18 ± 2.58, d: 1.23), frontozygomatic sutures (ΔT: 1.09 ± 0.56, d: 0.43), lowest point of the zygomaticomaxillary sutures (ΔT: 3.16 ± 1.78, d: 0.78), frontomaxillary angular parameter (right side ΔT: 2.81 ± 1.63, d: 1.73; left side ΔT: 2.52 ± 1.20, d: 2.10), frontozygomatic angular parameter (right side ΔT: 2.81 ± 1.63 d: 1.07; left side ΔT: 2.21 ± 2.79, d: 0.61), anterior intermaxillary distance (ΔT: 2.11 ± 1.42, d: 0.99), interzygomaticotemporal distance (ΔT: 2.00 ± 2.42, d: 0.99), and zygomatic angular parameter (right side ΔT: 2.06 ± 1.29, d: 1.6; left side ΔT: 2.02 ± 1.86, d: 1.09). After RME in growing patients, the zygomatic bone showed pyramidal expansion in the coronal plane and parallel palatal expansion in the axial plane. In addition, significant lateral relocation of the zygomatic bone occurred. The zygomatic bone tended to rotate outward in conjunction with the maxilla, with atypical center of rotation close to the superior side of the frontozygomatic suture. These results shed light on the patterns of skeletal expansion in the zygomatic bone associated with RME in growing patients.

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.

Fractal Perspective on the Rapid Maxillary Expansion Treatment; Evaluation of the Relationship Between Midpalatal Suture Opening and Dental Effects

ObjectiveThis retrospective study investigates the relationship between the midpalatal suture opening and the dental effects of Rapid Maxillary Expansion (RME) treatment using fractal analysis. MethodsThe participants of this study were selected from the patients who underwent Cone Beam Computed Tomography(CBCT) scans in 2019 and were treated with banded type Maxillary Expander. This study included 20 participants (with a mean age of 10.64±10.64, ranging from 8 to 13 years): 12 males and 8 females. Patients went through CBCT scan and images taken were analyzed using the ImageJ program. The following parameters were measured and analyzed before and after RME treatment: fractal dimensional value of Midpalatal suture(MPS), Distobuccal(DB), Mesiobuccal(MB), Palatal(P), Total distance, Cortical bone and linear values of External maxilla, Internal maxilla, Palatal roots, distance of Central fosses and angular values of Tipping value of 16 and 26. We used Spearman's nonparametric test for non-normal variables to investigate the correlation between changes in MPS and other variables. ResultsThe results showed a strong positive correlation between the MPS and Right MB (0.34, p<0.05) and Left MB (0.59, p<0.05) variables and a strong negative correlation between the MPS and the External maxillary variables (-0.53, p<0.05). ConclusionThe results of the study have shown a strong correlation between right and left MB and External Maxilla. RME caused a reduction in buccal alveolar bone thickness and a slight reduction in MPS thickness in growing patients. Therefore, we suggest that fractal analysis can be used to evaluate the skeletal and dental effects of RME in patients.

Effect of Rapid Maxillary Expansion on Upper Airway Morphology: A Retrospective Comparison of Normal Patients versus Patients with Enlarged Adenoid Tissue.

Objectives The present study evaluated the effect of rapid maxillary expansion (RME) on the morphology of the upper airway (UA) by calculating cross-sectional areas and volumes and comparing the effect in patients with a normal-sized adenoid with the effect in patients with an enlarged adenoid. Study design: Seventeen patients met the inclusion criteria. We constructed 3D models of the UA on cone-beam computed tomography images to calculate cross-sectional areas and volumes at the levels of the nasopharyngeal, retropalatal, and retroglossal airways. Patients were divided into two groups: group 1 was comprised of patients with an adenoidal nasopharyngeal (AN) ratio < 0.6 and group 2 with an AN ratio ≥ 0.6. Paired samples t-tests assessed any area and volumetric changes of the UA after RME. Changes in degree of nasal obstruction, calculated as the AN ratio, was then compared for the two groups. An independent samples t-test compared volumetric changes in the nasopharynx between the two groups before and after RME. Results Changes in cross-sectional areas and volumes of the UA due to RME were not significant. The effects of RME on AN ratio (11 % vs 0 %) and nasopharyngeal volume (36.8 % vs 5.97%) were somewhat larger in group 2 patients who had adenoid-associated nasal obstruction compared with group 1 patients with a normal-sized adenoid; however, the differences were not significant. Conclusions After RME, the patients with an enlarged adenoid had more increases in nasopharyngeal volume compared with those with normal adenoid, despite there was no significant difference.

Three-dimensional soft tissue evaluation after rapid maxillary expansion and mandibular midline distraction osteogenesis.

To evaluate the effects of rapid maxillary expansion (RME) and mandibular midline distraction osteogenesis (MMDO) on facial soft tissues using three-dimensional (3D) images. A total of 20 patients (average age 15.86 ± 2.17 years) were treated with RME and MMDO using tooth-borne distractors. Three-dimensional photographs of each patient were taken with a stereophotogrammetry system at baseline (T0), at the end of the distraction period (T1), and at the end of the consolidation period (T2). All data were analyzed using a dependent-samples t-test at a significance level of 5%. Total and lower face height increased after MMDO (P < .05). Nasal and mouth width increased after RME as compared with baseline (P < .05). The labiomental angle increased at T1 and decreased at T2 (P < .05). After MMDO, the convexity angle increased while the mandibular angle decreased (P < .05). Upper and lower lip angles increased after RME (P < .05). The distance from the lower lip to the E plane increased after MMDO and decreased after RME (P < .05). The MMDO and RME procedures provide an efficient nonextraction treatment alternative for transverse maxillomandibular deficiency. MMDO may improve the facial soft tissue profile in the transverse and vertical axis of the mandibular region.

The effect of rapid maxillary expansion on the upper airway\u2019s aerodynamic characteristics

BackgroundThe effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation.MethodsThis retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio < 0.6 and group 2 encompassing those with an AN ratio ≥ 0.6. CFD simulation at inspiration and expiration were performed based on the three-dimensional (3D) models of the UA segmented from the CBCT images. The aerodynamic characteristics in terms of pressure drop (ΔP), maximum midsagittal velocity (Vms), and maximum wall shear stress (Pws) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1.ResultsThe aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum Vms (m/s) decreased from 2.79 to 2.28 at expiration after RME (P = 0.057).ConclusionThe aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.

Correlation between the transverse dimension of the maxilla, upper airway obstructive site, and OSA severity.

Acquiring a better comprehension of obstructive sleep apnea physiopathology can contribute to improving patient selection for surgical treatments. We hypothesize that maxillary transverse deficiency restricts the space available for the tongue, leading to upper airway obstruction during sleep. Our primary hypothesis was that maxillary transverse deficiency increases the prevalence of tongue collapse during drug-induced sleep endoscopy (DISE). The secondary hypothesis was that maxillary transverse deficiency will also increase the prevalence of circumferential collapse at the velopharynx. The exploratory hypothesis was that maxillary transverse deficiency is associated with increased obstructive sleep apnea severity. The objectives of this study were to correlate maxillary morphometric measurements with (1) the anatomic level of obstruction during DISE and (2) the apnea-hypopnea index on polysomnography. We made a cross-sectional analysis of patients with obstructive sleep apnea undergoing DISE in search of positive airway pressure alternative treatment. Maxillary measurements were collected from a computed tomography scan (interpremolar distance, intermolar distance [IMD] and sella-nasion A point angle), findings from DISE, and sleep study variables from polysomnography. Correlation between computed tomography, DISE, and polysomnography data was assessed using Pearson's correlation, and receiver operating characteristic curves were determined for each facial measurement. Sixty-nine patients were included in the study. The group with velopharyngeal circumferential collapse had mean IMD = 26.30 mm (25.5-31.45), and the group with anteroposterior collapse had mean IMD = 29.20 mm (26.8-33.10; P = .040). The group with complete tongue-base obstruction had mean interpremolar distance = 26.40 mm (25.1-28) and IMD = 26.30 mm (25.6-28.4), and the group without obstruction had mean interpremolar distance = 28.7 mm (27.2-30; P = .003) and IMD = 34.06 mm (32.1-37; P < .001). The receiver operating characteristic curve determined an IMD cutoff of 29.8 mm for predicting tongue-base obstruction. The maxillary transverse deficiency, identified by reduction in interpremolar distance and IMD, predicted the occurrence of complete tongue-base obstruction, complete concentric collapse at the velopharynx, and multilevel obstruction during DISE. We did not find an association between the maxillary measurements and obstructive sleep apnea severity. These associations hold some promise in ultimately supplanting insights previously available only through DISE.

Age-related changes in the effect of rapid maxillary expansion on the position of labially impacted maxillary canines: A case-control study

The early diagnosis and interception of potential maxillary canine impaction is the most desirable approach for correcting their path of eruption. However, there is still a lack of evidence regarding the effect of rapid maxillary expansion (RME) on labially impacted canines. This study aimed to investigate the age-related effect of RME on labially impacted maxillary canines in order to reduce the risk of their impaction in the mixed dentition and to examine the proper timing of interceptive treatment. All patients aged 7-10years were treated with an RME appliance using the same protocol. The distance to the occlusal plane, axis to the midline, and distribution in different sectors-depending on the patients' age-were evaluated for maxillary canines before and after treatment on panoramic radiographs in order to detect changes in the position of the impacted canines. These geometric measurements in the impacted canines were also validated by observing the nontreated canines at each age. Significant differences existed between the impacted canines and the erupted canines in all 3 categories in all age groups. RME treatment modulated the position of the impacted canines in all age groups. Interestingly, a statistically significant difference before and after RME in all categories was detected in patients aged<8years. A discriminant analysis also showed a positive association of RME treatment with the risk of labially impacted canines. The standardized regression coefficients showed that the angulation of the maxillary canine was the most important predictor for impaction. Our findings indicate that RME treatment in the early mixed dentition was effective for managing labially impacted maxillary canines. An age of 7-8years with early mixed dentition might be the most appropriate timing for therapeutic intervention on the basis of RME treatment for buccal canine impaction.

The effect of rapid maxillary expansion in children: a meta-analysis

IntroductionCraniofacial growth is modified by chronic mouth breathing. Rapid maxillary expansion leads to separation of the mid-palatal suture, improving the occlusion and the upper airway size. AimSystematically evaluate scientific articles on the effects of rapid maxillary expansion on airway dimensions and classify the quality of the evidence of the information. MethodsSearches on PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE, as well as in the grey literature were performed. The articles found were selected and evaluated both for the risk of bias (ROBINS-I) and for the quality of evidence (GRADE). ResultsOf the 309 works found, 26 papers were selected for full reading, of which 22 were excluded. Data compilation and analysis were performed in four papers, two being controlled non-randomized clinical trials and two non-randomized and uncontrolled clinical trials. No randomized clinical trial was found. ConclusionsThe meta-analysis found an increase in the internasal and inter-zygomatic distances and oropharyngeal volume after rapid maxillary expansion, which, together with clinical findings, makes the recommendation favorable to the intervention. The quality of the evidence for each outcome was considered very low.

Rapid Maxillary Expansion May Improve Condyle-Fossa Relationship and Intercondylar Symmetry

Effects of rapid maxillary expansion on temporomandibular joints: A systematic review. Torres D, Lopes J, Magno MB, Cople Maia L, Normando D, Leão PB. Angle Orthod. 2020 Feb 10. https://doi.org/10.2319/080619-517.1. Epub ahead of print. PMID: 32039632. None. The authors have no actual or potential conflicts of interest. Systematic review.