Impact Of Rapid Maxillary Expansion Research Articles

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 < 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 < 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.

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.

Impact of Rapid Maxillary Expansion on Adenotonsillar Hypertrophy in Children

Impact of Rapid Maxillary Expansion on Adenotonsillar Hypertrophy in Children

Impact of rapid maxillary expansion on palatal morphology at different dentition stages

ObjectiveRapid maxillary expansion (RME) is an established and frequently used procedure to overcome maxillary constriction. In-depth studies about morphological changes of the alveolar process and its immediate surroundings are missing. Therefore, the aim of the present study was to examine the treatment effects of a dentally anchored, rapid maxillary expander at different dentition stages upon palatal width, height and shape.Material and methodsThe dental casts of 114 patients—taken immediately before and after RME—were three-dimensionally analysed. Depending on the dentition stage, the patients were divided into two groups (each n = 57, group 1, early mixed dentition; group 2, late mixed or permanent dentition).ResultsThe width increases were highly significant, both in the overall and in the individual groups (p < 0.001). While the width increase was greater in the posterior area than anteriorly in the early group, the widening in the late group happened significantly greater anteriorly than posteriorly. Palatal height increased anteriorly and posteriorly in both groups to a significant extent (p < 0.001). The height increase was more pronounced in the anterior region than in the posterior region in the late group. The palatine index according to Kim revealed a change in palatal morphology both anteriorly and posteriorly in the early group but only anteriorly in the late group.ConclusionsMaxillary expansion occurs more parallel in early treatment compared to V-shaped opening in the later treatment approach.Clinical relevanceRME is more advantageous in an early dentition.

Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review.

BackgroundRapid maxillary expansion (RME) is an orthodontic procedure used to correct transverse maxillary deficiency. Due to the anatomical relationship between the palate and the nasal cavity, RME promotes an increase in nasal dimensions, which should hypothetically improve nasal respiratory function. Objective: This review aimed to systematically verify studies that assessed the effects of RME on nasal patency in mouth-breathing children and adolescents. Material and MethodsAn electronic search was performed in the MEDLINE databases via OVID, Scopus and EMBASE. The terms were: “children and adolescents”, “rapid maxillary expansion” and “mouth breathing”. The search was conducted in October 2019, according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The assessment of the quality of the studies was conducted by two evaluators, using the Fowkes & Fulton´s guidelines for critical appraisal of medical research. Results475 titles were identified and 18 articles were selected. All of them showed high methodological quality, but without randomized clinical trials. The instruments evaluated were: teleradiography, frontal postero-anterior radiography, computed tomography, acoustic rhinometry and computed rhinomanometry. ConclusionsThis review shows that RME promotes the enlargement of dental arches and of the nasal and maxillary structures, with improved mouth breathing in the short term. However, its long-term benefits could not be proved so far. More robust results of the effectiveness of RME in mouth breathing can be achieved with meta-analysis studies, with a consensual definition of the long-term follow-up period after RME. Key words:Child, adolescent, maxillary expansion, palatal expansion, mouth breathing.

Effects of rapid maxillary expansion on temporomandibular joints.

To evaluate the impact of rapid maxillary expansion (RME) on the condylar position, disc joint, joint space, and interarticular relationship in growing patients. A systematic search was performed in nine databases. The clinical studies selected included those with pre- and post-magnetic resonance, conventional computed tomography or cone beam tomography in growing patients. Risk of bias assessment was performed using the Cochrane Collaboration tool for controlled clinical studies and National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment for Before-After Studies With No Control Group. Initially, 4303 records were identified. Only eight studies fulfilled the criteria and were included in the qualitative analysis. Of those, two were controlled clinical studies with a risk of uncertain to high bias. The remaining papers had a low to moderate risk of bias. Results showed that RME in children and adolescents promoted the following: remodeling in the head and or condylar branch, changes in condylar position and joint space, maintenance of improved symmetry between the condyles, and no ability to modify the position or shape of the articular disc. RME in growing patients is able, in the short term, to modify the condyle-fossa relationship but does not change the position or shape of the articular disc. The intercondylar symmetric relationship is maintained or improved. Although the NHLBI score shows low to moderate risk of bias, the clinical relevance of these review findings is limited by Cochrane and Grades of Recommendation, Assessment, Development and Evaluation scores.

Short-term impact of rapid maxillary expansion on ectopically and normally erupting canines.

The purpose of this study was to evaluate the short-term impact of rapid maxillary expansion (RME) on the eruption paths of ectopically and normally erupting maxillary canines in the mixed dentition. Thirty-two patients with 49 ectopically erupting canines (EEC group; age, 9.53±1.10years) and 18 patients with 27 normally erupting canines (NEC group; age, 9.25±1.06years) underwent RME. Thirty-six subjects with 54 normally erupting canines composed the untreated control group (UC group; age, 9.03±0.72years). Horizontal, vertical, and angular positions of canines and adjacent teeth were evaluated in the expanded (EEC and NEC groups) and unexpanded (UC group) patients using panoramic radiographs taken at 2 times with a 1-year interval. The radiographic evaluation methods included score ranking and proportional measurements to minimize panoramic radiograph limitations. Statistical comparisons were performed among the groups (P<0.05). Before expansion, the EEC group's canines were significantly closer to the midline, more distant from the occlusal plane, and more mesially angulated than those in the UC group. After expansion, the canine positions in the EEC and UC groups were similar, whereas the NEC group had a more favorable canine position for eruption. The EEC and NEC groups showed similar canine positional changes, whereas the UC group had the smallest changes. The positions of teeth adjacent to the canine were also significantly affected by RME, and these changes may be associated with improvement of the ectopic canine position. The changes produced by RME reduced the percentage of ectopic eruption paths and maintained the nonectopic eruption percentage.

Impact of rapid maxillary expansion on nasomaxillary complex volume in mouth-breathers.

ABSTRACTObjective: To assess the volumetric changes that occur in the nasomaxillary complex of mouth-breathing patients with transverse maxillary deficiency subjected to rapid maxillary expansion (RME). Methods: This was a controlled, prospective intervention study involving 38 mouth-breathing patients presenting with transverse maxillary deficiency, regardless of malocclusion type or race. Twenty-three of them comprised the experimental group, which was composed of 11 (47.8%) boys, and 12 (52.2%) girls, with a mean age of 9.6 years, ranging from 6.4 to 14.2 years and standard deviation of 2.3 years; and 15 of them comprised the control group, composed of 9 (60%) boys and 6 (40%) girls with an mean age of 10.5 years, ranging from 8.0 to 13.6 years, and standard deviation of 1.9 years. All patients were scanned (CT) according to a standard protocol: Initial CT (T1), and CT three months thereafter (T2), and the patients in the experimental group were treated with RME using a Hyrax expander for the correction of maxillary deficiency during the T1-T2 interval. The CT scans were manipulated using Dolphin® Imaging version 11.7 software for total and partial volumetric assessment of the nasomaxillary complex. Results: The results revealed that in the experimental group there was a significant increase in the size of the structures of interest compared to the control group, both in general aspect and in specific regions. Conclusions: Rapid maxillary expansion (RME) provided a significant expansion in all the structures of the nasomaxillary complex (nasal cavity, oropharynx, right and left maxillary sinuses).

The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects

The aim of this prospective cohort study was to determine the effects of rapid maxillary expansion (RME) on the first molar roots of cleft lip and palate subjects along different root development stages. Thirty participants with unilateral cleft lip and palate were divided into three groups (n=10), according to the type of expander used: Hyrax, iMini and Fan-type. A cone beam CT scan was performed before (T1) and 3months after stabilization of the appliance (T2). Measurements of root lengths of the first permanent maxillary molars were taken to evaluate root development and external apical root resorption (EARR). Roots presenting open apexes before treatment exhibited a statistically significant increase in root length after treatment (P<.001). Conversely, there were no significant changes in the root length of roots that had closed apexes at the beginning of treatment (P>.05). Furthermore, there were no differences among groups, or correlation between cleft side and gender was found vis-à-vis to changes in the root length (p>.05). Orthopaedic forces of RME were neither able to interrupt the root development process nor to cause EARR in cleft subjects. As the RME is the most common orthodontic procedure in patients with cleft lip and palate, understanding its impact on dental structures is of fundamental importance.

Impacts of rapid maxillary expansion on nasal breathing in children with maxillary constriction: A review article

Background: Rapid maxillary expansion (RME) is a dentofacial orthopaedic procedure reported to be used in young patients to treat constricted maxillary arches and considered also a useful treatment option in children with obstructive sleep apnea syndrome. The purpose of this article is to explore the impacts of RME on breathing problems in children secondary to maxillary constriction. Methods: Electronic Medline database search was conducted between1946 to 2015 to evaluate the effects of rapid maxillary expansion on breathing issues due to maxillary constriction. The search was restricted to articles published in English and children younger than 18 years old. The initial 50 articles were reviewed and 7 relevant studies were selected in this article. Results: Seven studies assessed the impact of rapid maxillary expansion on breathing issues due to maxillary constriction. Results revealed that nasal airway resistance was reduced, nasal volume was increased and nasal respiration has improved. Furthermore, improvement in symptoms of obstructive sleep apnea syndrome was demonstrated in various studies after the use of rapid maxillary expansion. Conclusion: Rapid maxillary expansion could be an effective procedure in widening nasal cavities and decreasing nasal airway resistance which can lead to improvement in nasal breathing. Furthermore, it can be a useful therapy in children with obstructive sleep apnea syndrome.

Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study

Background and purposeThere is limited literature discussing the three dimnesional (3D) impact of rapid maxillary expansion (RME) on upper airway. The purpose of this prospective Cone Beam Computerised Tomography (CBCT) based study is to assess the immediate 3D effects and to correlate the volumteric changes in the upper naspharyngeal airway spaces secondary to RME. Materials and methodsSeventeen participants (8 male, 9 female, with a mean age of 12.6 ± 1.8 years), who required RME for the management of narrow maxillary arch, were recruited for this study. The prescribed expansion regimen was quarter turn (0.25 mm), twice a day until over-expansion was achieved. The mean period for the active phase was 14 days with a range of 12–21 days. Pretreatment (T1) and immediate post-expansion (T2) CBCT images were obtained and then processed using ITK snap and OnDemand3D softwar packages. Paired t-test and Interclass Correlation Coefficient (ICC) were used to assess the reproducibility of the measurements, student t-test (P < 0.05) and Pearson Correlation Coefficient (PCC) were applied to evaluate the volumetric changes in the nasopharyngeal airway spaces, linear dentolaveolar changes and correlate these changes. Main findingsThough, the data of one patient was excluded from the study, owing to major differences (>5 degrees) in the head and neck posture between T1 and T2 CBCT scans, the study' findings shows that bonded RME is an effective dentoalveolar expander in growing patients (P= 0.01) with an average expansion of 3.7 mm and 2.8 mm in males and females respectively. Likewise, the upper nasopharynx (UNP) expanded significantly (15.2% in males and 12% in females). In comparison, the upper retropalatal space (URP) was significantly reduced, by almost one sixth of its original volume, more in males than females, 11.2% and 2.8% respectively. A strong direct correlation between the maxillary sinus volumetric changes, and between appliance expansion and dentoalveolar expansion were evident (PCC = 0.86, 0.75, respectively). There was also a moderate correlation between changes in the UNP and URP spaces. ConclusionsRME was found to be an effective dentoalveolar expander and significantly augment the UNP and minimize the URP space. A similar comparative clinical study with long-term follow-up would be beneficial in accurately deteremining the clinical impact of RME on the airway and breathing as well as the stability of these effects.

Impact of rapid maxillary expansion in unilateral cleft lip and palate patients after secondary alveolar bone grafting: review and case report

The purpose of this article was to analyze the effects and short-term stability of rapid maxillary expansion performed after secondary alveolar bone grafting in unilateral cleft lip and palate (UCLP) patients. Two UCLP patients with severe maxillary constriction who had previous bone grafting were involved in this study. A hyrax rapid expansion appliance was placed on 4 abutment teeth and activated twice daily. An opening of the midpalatal suture was found on the posttreatment occlusal radiographs, which was clinically confirmed by the diastema. Posteroanterior cephalometric tracing analysis demonstrated significant increases in maxillary and dental arch width. No obvious radiographic alteration was observed in the grafted areas.