Efficacy Of Rapid Maxillary Expansion Research Articles

Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: A CBCT study.

Rapid maxillary expansion (RME) has been proposed as an effective treatment for pediatric obstructive sleep apnea (OSA) and maxillary restriction in children. This study aimed to evaluate the effect of RME appliances on the nasomaxillary complex dimensions in children with OSA and maxillary constriction. This prospective longitudinal study included 34 children aged 8-12 years with maxillary restriction and OSA confirmed by polysomnography who had completed RME therapy. The nasomaxillary complex is segmented into the nasal cavity, maxillary sinuses, and nasopharynx. The effect of RME on nasomaxillary complex dimensions was assessed pre and posttreatment using cone-beam computed tomography, analysis, while a second standard overnight polysomnography (PSG) was performed to assess changes in respiratory parameters. Significant improvements were observed, including inferior maxillary dislocation (S-S1 distance and N-ANS), increased anterior and posterior facial height, and a 5.43 events/h reduction in Apnea-Hypopnea Index (p < .001). The nasal cavity volume increased by 2439 (±584) mm3 (p < .001), nasopharynx size increased by 883 (±479) mm3 (p = .008), mid cross-sectional area increased by 31.74 (±14.50) mm2 (p < .001), and the distance between the right and left maxillary sinuses increased by 8.37 (±3.67) mm (p < .001) all exhibited positive changes, with some insignificant variations in volume change (p = .254). RME treatment was found to be effective in improving nasal cavity and nasopharyngeal dimensions, leading to improved respiratory parameters in children with OSA and maxillary constriction. While these results are promising, considerations about the potential long-term benefits of RME on future growth are important. The study provides valuable insights into the efficacy of RME as a treatment option for this pediatric population.

Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis

Aim: To systematically review international literature related to rapid maxillary expansion (RME) as the treatment for obstructive sleep apnea syndrome (OSAS) in children less than 18 years-old, followed by a meta-analysis of the apnea-hypopnea index (AHI) before and after RME, with or without a previous adenotonsillectomy (AT). Methods: Literature on databases from PubMed, Wiley online library, Cochrane Clinical Trials Register, Springer link, and Science Direct were analyzed up to March 2020. Two independent reviewers (S.G. and R.J.M.) screened, assessed, and extracted the quality of the publications. A meta-analysis was performed to compare AHI values before and after the treatment with RME. Results: Six studies reported outcomes for 102 children with a narrow maxillary arch suffering from OSAS with a mean age of 6.7 ± 1.3. AHI improved from a M ± SD of 7.5 ± 3.2/h to 2.5 ± 2.6/h. A higher AHI change in patients with no tonsils (83.4%) and small tonsils (97.7%) was detected when compared to children with large tonsils (56.4%). Data was analyzed based on a follow-up duration of ≤3 year in 79 children and &gt;3 years in 23 children. Conclusion: Reduction in the AHI was detected in all 102 children with OSAS that underwent RME treatment, with or without an adenotonsillectomy. Additionally, a larger reduction in the AHI was observed in children with small tonsils or no tonsils. A general improvement on the daytime and nighttime symptoms of OSAS after RME therapy was noted in all the studies, demonstrating the efficacy of this therapy.

Efficacy of Rapid Maxillary Expansion Associated With Maxillary Protraction in Patients With Unilateral Complete Cleft Lip and Palate

To evaluate the efficacy of rapid maxillary expansion (RME) and maxillary protraction (MP) in patients with unilateral complete cleft lip and palate (UCLP) using the Goslon yardstick index. Retrospective study. Dental casts of 34 Goslon 3 (G3) and Goslon 4 (G4) patients treated with RME and MP were evaluated which composed the treated sample (S1). The dental cast were taken before the RME (T1) and immediately after the use of face mask for MP was suspended (T2). In order to verify the stability of the treatment, dental casts of 17 of these patients were evaluated 1 year after the treatment was finished (T3). For the control sample (S2), dental casts of 20 untreated G3 and G4 patients were evaluated. At T2, 85.7% of study sample patients initially G3 and 70% of patients initially G4 obtained improvement in occlusal index. At T3, the majority of patients initially classified as G3 and G4 returned to the same classification as in the beginning of the treatment. The evaluation of the control sample showed that patients initially classified as G3, 55.6% continued at this initial index, and 44.4% had it worsened. Those initially G4, 100%, continued at this initial index. The immediate result of RME and MP was satisfactory, and despite the instability of these results, the outcome of this treatment option was better than the untreated sample.

The long-term efficacy of rapid maxillary expansion and facemask therapy in Class III malocclusion

Abstract Aim The aim of the present study was to investigate the long-term efficacy of rapid maxillary expansion (RME) and facemask (FM) therapy in the treatment of Class III malocclusions by comparing Class III subjects treated by RME/FM mechanics with untreated Class III controls at the Western Australian public dental hospital. Materials and methods The lateral cephalograms of 42 (26 males, 16 females) Class III patients treated by RME/FM therapy were analysed and compared with a control sample comprised of 23 (14 males, 9 females) untreated Class III patients. Evaluations were carried out prior to facemask therapy and at a long-term follow-up period of approximately eight to nine years post-treatment. Statistical comparisons were performed using t-tests for unpaired data. Results At long-term follow-up, there were no statistically significant differences between the treated and control groups except in overjet, which was greater in the treated group (p &lt; 0.05). Conclusions These results suggest that the short-term effects on the maxilla in RME/FM therapy are not maintained in the long term. Success in treatment is largely dependent on the patient’s skeletal growth pattern.

Orthodontic treatment of patients with obstructive sleep apnea syndrome (OSAS)

Abstract Introduction The craniofacial skeleton in the growing child is responsive to changing functional demands and environmental factors. Orthopedic modification of facial bones through the application of constant forces over long periods of time has been a mainstay of orthodontic and dentofacial orthopedic therapy. Aim of the study The aim of this study was to evaluate changes in pharyngeal structures after rapid palatal expansion (RPE) and compare them with those after using a removable mandibular advancement device (MAD). Material and methods In order to accomplish function we modified the pattern of neuromuscular activity throught mandible forward position. Results This finding shows that maxillary deficiency and mandibular retrognathism have been reportedly linked to OSA as both etiologic factors and sequelae of prolonged mouth breathing during the period of growth, these illustrate the potential interaction between alteration in respiratory function and craniofacial morphology. Conclusions Craniofacial anatomic defects, including inferior displacement of the hyoid bone, larger gonial angle, smaller anterior cranial base, altered anterior and posterior facial heights, and mandibular deficiency, have been suggested as predisposing factors for upper airway obstruction during sleep. Cephalometry has been used extensively in the fields of orthodontics and anthropology to record craniofacial form. Recently, it has been also suggested that cephalometry could be an adjunctive procedure for assessing craniofacial patterns associated with OSAS. Estimating efficacy of rapid maxillary expansion and mandibular advanced in the treatment of paediatric SDB. This might provide alternatives to primary treatments and/or enhance interdisciplinary treatment planning for the children suffering from OSA. The relationships between maxillofacial malocclusions and upper airway volumes were investigated. Literature studies on the association of upper airway narrowing with dento-skeletal malocclusions have been confirmed by us for the group of patients studied.

Efficacy of Rapid Maxillary Expansion in the Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review With Meta-analysis

ObjectiveThe objective of this study was to assess the efficacy of rapid maxillary expansion (RME) in the treatment of OSAS in children and adolescents. MethodsFive electronic databases were searched systematically: PubMed, Web of Science, LILACS, Embase and Cochrane Library. Selection CriteriaRandomized controlled trials, nonrandomized controlled trials, cohort studies, and systematic reviews published in English, Spanish, or Portuguese between January 2000 and December 2016, performed on children and adolescents younger than 18 years with OSAS who underwent RME, and assessing RME efficacy as measured by the Apnea-Hypopnea Index (AHI) normalization were included. Qualitative assessment of the selected studies was performed using Critical Appraisal Skills Programme checklists. Statistical evaluation included 2 meta-analyses and was based on a random-effects model and Cochran's Q test and I2 statistics to assess heterogeneity across the publications. Electronic searches identified 84 publications. Five publications were considered valid and included in this systematic review. ResultsResults from the meta-analysis show an overall reduction in AHI after RME therapy. ConclusionsIncreasingly the evidence indicates that RME devices reduce AHI in children with OSAS, making RME therapy an appropriate alternative treatment option for these patients.

Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up

ObjectiveThe objective of this study was to prospectively evaluate the long-term efficacy of rapid maxillary expansion (RME) in a group of children with obstructive sleep apnea (OSA). Material and methodThirty-one children diagnosed with OSA were involved in the study. These children had isolated maxillary narrowing and absence of enlarged adenotonsils at baseline. Twenty-three individuals (73% of the initial group) were followed up annually over a mean of 12 years after the completion of orthodontic treatment at a mean age of 8.68 years. Eight children dropped out over time due to either moving out of the area (n = 6) or refusal to submit to regular follow-up (n = 2). Subjects underwent clinical reevaluation over time and repeat polysomnography (PSG) in the late teenage years or in their early 20s. During the follow-up period, eight children dropped out and 23 individuals (including 10 girls) underwent a final clinical investigation with PSG (mean age of 20.9 years). The final evaluation also included computerized tomographic (CT) imaging that was compared with pre- and post-initial treatment findings. ResultsYearly clinical evaluations, including orthodontic and otolaryngological examinations and questionnaire scores, were consistently normal over time, and PSG findings remained normal at the 12-year follow-up period. The stability and maintenance of the expansion over time was demonstrated by the maxillary base width and the distance of the pterygoid processes measured using CT imaging. ConclusionA subgroup of OSA children with isolated maxillary narrowing initially and followed up into adulthood present stable, long-term results post RME treatment for pediatric OSA.

Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children

ObjectivesThe objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago. MethodsAfter general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2). ResultsForty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea–hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI −53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p < 0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p < 0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p < 0.05).Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score. ConclusionStarting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.

Rapid Maxillary Expansion for Obstructive Sleep Apnea: A Lemon for Lemonade?

Rapid Maxillary Expansion for Obstructive Sleep Apnea: A Lemon for Lemonade?

Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up

In view of the positive outcome of orthodontic treatment using rapid maxillary expansion (RME) on sleep-disordered breathing, we generated data on RME in children with obstructive sleep apnea (OSA) by evaluating objective and subjective data over a 36-month follow-up period, to determine whether RME is effective in the long-term treatment of OSA. We selected all patients with dental malocclusions and OSA syndrome (OSAS) confirmed by polysomnography. Ten of the 14 children who completed the 12-month therapeutic trial using RME were enrolled in our follow-up study. The study was performed 24 months after the end of the RME orthodontic treatment. We enrolled all children presented with deep, retrusive or crossbite at the orthodontic evaluation. All subjects underwent an overnight polysomnography at the baseline, after 1 year of treatment and 24 months after the end of the orthodontic treatment. The children's mean age was 6.6 ± 2.1 years at entry and 9.7 ± 1.6 years at the end of follow-up. After treatment, the apnea hypopnoea index (AHI) decreased and the clinical symptoms had resolved by the end of the treatment period. Twenty-four months after the end of the treatment, no significant changes in the AHI or in other variables were observed. RME may be a useful approach in children with malocclusion and OSAS, as the effects of such treatment were found to persist 24 months after the end of treatment.

Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis

There is an agreement among orthodontists that a posterior crossbite relationship should be treated early. The Haas expansion appliance is frequently chosen whenever a maxillary skeletal constriction exists in the deciduous, mixed, or permanent dentition. In this study we evaluated the efficacy of rapid maxillary expansion for 32 children between 5 and 11 years of age, by inspection of anteroposterior radiographs. Our results confirm previous data in the literature that the triangular opening in the frontal alveolar area is greater than in other parts of the midpalatal suture. It is evident that with expansion there is a real orthodontic effect, even at an early age. (A M J O RTHOD D ENTOFAC O RTHOP 1995;107:268-75.)

The effect of rapid maxillary expansion on nasal airway resistance.

There has been a long-standing controversy over the efficacy of rapid maxillary expansion to relieve nasal obstruction and improve respiration. Recently rhinomanometry has provided a discipline for the investigation into nasal airway physiology with quantifiable parameters for evaluation and comparable studies. In this trial, a sample of 26 patients (13 male and 13 female, age range 10.10 to 19.6 years), receiving rapid maxillary expansion as part of their orthodontic mechano-therapy, were appraised for nasal airway resistance before and after expansion. The posterior rhinomanometric technique was used, measuring the respiratory flow between pharynx and the nostrils at a preset pressure difference between these two points. The formula for calculating the resistance is derived from the electrical Ohm's Law and requires that the pressure difference be divided by the flow. Reductions were recorded in all cases with an average of 36.2 per cent (range 11.6-58.6). The correlation between the resistance reductions and the delivered expansions (increases in trans-palatal widths) was weak (r = 0.32). In view of the probable significance of the liminal valve in nasal resistance, expansions in this area were assessed by changes in the trans-alar widths. The correlation between trans-alar increases and the trans-palatal expansions was weak (r = 0.115), as it was between the trans-alar increases and the reductions in nasal airway resistance (r = 0.30).