Maxillary Expansion In Children Research Articles

Oral health-related quality of life after rapid maxillary expansion in children:

Oral health-related quality of life after rapid maxillary expansion in children:

Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study

The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P<0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P<0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Three Dimensional Skeletal, Dentoalveolar and Airway Space Changes after Slow Maxillary Expansion in Children

The aim of this study was to investigate the effects of slow maxillary expansion (SME) on the dentoalveolar, skeletal, upper airway, and maxillary sinus using cone-beam computed tomography (CBCT). Twenty-three orthodontic patients (mean age 8.93 ± 1.61 years) who were treated with maxillary expansion using banded hyrax in the Department of Pediatric Dentistry at Jeonbuk National University Dental Hospital were included. According to the expansion speed applied, they were divided into two groups: SME (12 subjects, mean age 8.92 ± 1.45 years) and rapid maxillary expansion (RME, 11 subjects, mean age 8.94 ± 1.84 years). CBCT were obtained before (T0) and after (T1) the treatment and were analyzed with InVivo5 software (Anatomage, San Jose, CA, USA). Descriptive statistics showed no significant differences between the two groups in age, sex, or skeletal maturity. There were significant increases in maxillary width at the dentoalveolar and skeletal levels for both groups. Upper airway volume revealed a significant increase of 38.59% in the SME group and 28.72% in the RME group. However, there was no significant difference between SME group and RME group in all measurements. This study suggested the efficacy of SME in growing patients. SME was effective in increasing not only dentoalveolar and skeletal measurements but also airway volume. Therefore, pediatric dentists should select an appropriate expansion method considering the physiological aspects of periodontal tissues and discomfort in growing children.

Morphological Changes of the Epipharynx as a Result of Rapid Maxillary Expansion in Children

Rapid maxillary expansion（RME）is a technique used to treat dental malalignment. Consensus has yet to be reached changes in the epipharyngeal region associated with RME. The objective of this study was to ascertain the morphological changes that occur in the epipharyngeal region as a result of RME. In the present study, a comparative investigation of the pharyngeal tonsils and the epipharyngeal airway on lateral cephalograms scanned before and after RME was therefore performed. Fourteen patients who underwent orthodontic treatment for dental malalignment by RME were included. The mean length of pharyngeal tonsil（A）was 114.65 pixels before RME and 108.64 pixels after RME. The mean value of epipharyngeal space（N）was 210.72 pixels before RME and 233.95 pixels after RME. The mean A/N ratio was 0.547 before RME and 0.466 after RME. The mean pharyngeal tonsil（Pt）area was 16181.14 pixels before RME and 16407.71 pixels after RME. The mean airway（Air）area was 12488.96 pixels before RME and 16040.64 pixels after RME. The mean Pt / Ep（Ep = Pt + Air）area was 0.570 before RME and 0.502 after RME. In this study showed that the A/N and Pt/Ep ratios decreased significantly after RME. The N and Air area values also increased significantly, but there were no significant changes in the A and Pt area values. It was concluded that the decrease in the A/N and Pt/Ep ratios were due to the changes in the N and Air area values.

Cephalometric changes after maxillary expansion in children and adolescents with Angle class III malocclusions: systematic review and clinical implications

It is consensus that Class III treatment is clinically challenging considering, mainly, bone growth. Its diagnosis requires correct assessment of maxillary and mandible involvement since treatment must be directed to the bone base responsible for the malocclusion in order to correct it and provide improvement in the facial pattern. One of the main academic gaps in this subject is the approach to its treatment. In this context, this study aimed to group randomized clinical trials (RCTs) on cephalometric changes observed after maxillary expansion in these dental-skeletal disharmonies. RCTs published in English whose subjects were children and adolescents with Angle class III malocclusion and maxillary atresia were collected. In addition, at least one of the randomized groups should have maxillary (palatal) expansion and the measurement of cephalometric changes observed after palatal expansion as intervention. After inserting the PICO strategy and performing the systematic search, a total of 708 results were retrieved, of which 416 came from Scopus, PubMed, Cochrane, and Web of Science databases. When analyzing cephalometric results, mainly associated with the use of face mask, and considering the limiting factors of this review, it is clear that this type of intervention has become a viable option in clinical practice; however, new qualitative and meta-analytical reviews should be carried out in view of the publication of new randomized clinical trials in order to infer more accurate results and with greater power of evidence.

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

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

Changes in the Mandible Following Rapid Maxillary Expansion in Children with Class II Malocclusion: A Systematic Review.

Objective: The aim of this systematic review was to determine whether rapid maxillary expansion (RME) allows favorable changes in the mandible during the treatment of class II malocclusion before the growth spurt. Methods: A search of Pubmed/Medline, the Science Direct, and the Google Scholar database was performed. The keywords used were: orthodontics, rapid maxillary expansion, class II, and growing patients. Relevant articles were assessed for quality according to Cochrane guidelines, and then changes in SNA, SNB, ANB, NL-NSL (or SN-SNP.SNA), and ML-NSL (or SN-Go-Gn) relationships were analyzed. Results: The selection process brought forth five articles, including 162 patients (91 females, 71 males) for detailed analysis. The quality of the evidence (GRADE) for comparisons and outcomes was assessed as moderate for SNB and ANB and as low or very low for other variables. Conclusions: The results of this systematic review showed that there is a small body of moderate-quality evidence for statistically and clinically favorable changes in SNB and ANB angles and a small body of low-quality evidence for changes in vertical parameters after RME.

Condylar Changes after Maxillary Expansion in Children with Cleft Lip and Palate-A Three-Dimensional Retrospective Study.

Background: The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function. Mandibular asymmetry and respective condyle adaptation may be an etiological factor in temporomandibular disorder. This study aims to evaluate the effects of maxillary expansion on the position and angulation of the condyles as well as the intercondylar distance in children with cleft lip and palate. Methods: Twenty-five individuals with cleft lip and palate who underwent maxillary expansion were selected. Condylar changes were evaluated by cone beam computed tomography using the Pullinger and Hollender formula. To determine the statistically significant differences between the variables, the Student t-test and the Benjamini–Hochberg correction method for multiple comparisons were used. Results: No statistically significant differences between angulation and condylar position before and after maxillary expansion were found. The intercondylar distance tended to increase in growing individuals with cleft lip and palate after maxillary expansion. Conclusions: Intercondylar distance shows a tendency to increase after expansion regardless of the cleft phenotype. No differences were found in angulation and condylar position with the changes in occlusion resulting from maxillary expansion.

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).

Rapid maxillary expansion in children, an update

Introduction: Rapid maxillary expansion (RME) increases oxygen saturation in children with Obstructive Sleep Apnea (OSA) in the short and long term. Objective: To analyze the current literature about rapid maxillary expansion, its effects on anatomical structures, midpalatal suture opening (MPS) and obstructive sleep apnea. Methodology: Articles published at MEDLINE/PubMed and Science Direct were analyzed, with an emphasis on the last 5 years. Articles were evaluated with the PRISMA and AMSTAR guidelines. The search was carried out using the words

Perceived pain during rapid maxillary expansion in children with different expanders.

To evaluate and compare the intensity of pain caused by rapid maxillary expansion (RME) with two expanders: Hyrax and Haas type, in growing patients. Thirty-nine patients (23 girls and 16 boys) with an average age of 9.3 years (SD = 1.39 years) were randomized into two groups and treated with Hyrax- and Haas-type expanders. In both groups, initial activation of the expander screw was one full turn on the first day followed by 2/4 of a turn two times a day (morning and night) for 7 days. Inclusion criteria were patients presenting with a posterior crossbite or maxillary atresia between 7 and 12 years old. To evaluate the intensity of pain during the active phase of the treatment, a combination of the Numerical Rating Scale and Wong-Baker Faces Pain Scale was used. Mann-Whitney test was used to compare the two treatment groups. There was significant inverse correlation between days following insertion and pain. During the expansion period, 100% of the children reported some pain. Hyrax expander subjects reported greater pain than those treated with the Haas-type expander only on the first day. The level of pain remained greater in girls throughout treatment. Pain was reported regardless of the type of expander and was higher in the Hyrax group only on the first day of activation.

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.

A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial.

This study compared the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME) using cone-beam computed tomography (CBCT). To evaluate the skeletal and dentoalveolar effects produced by two different maxillary expansion protocols. Eligibility criteria included maxillary transverse deficiencies in children (mean age, 8.18years old), randomly assigned to either RME or SME. At the outcome analysis phase, a sample of 29 subjects were analysed (RME group, N=16 and SME group, N=13). CBCT scans taken before expansion and 6months later were evaluated. Five posterior and 6 anterior transverse measurements were made at different vertical levels. Treatment changes were analysed using paired t tests; independent t tests were used to compare the two groups. There were statistically significant (P<.05) increases in maxillary width at the skeletal, alveolar, and dental levels for both groups, with significantly smaller increases at the more superior than inferior levels. The RME group exhibited statistically larger width increases than the SME group for all measures except interorbital width, anterior alveolar process width, and intercanine width. The group differences were greater for anterior than posterior apical base widths. Rapid maxillary expansion produced greater orthopaedic effects than slow maxillary expansion, with the greatest effects occurring in the anterior apical base.

Oropharyngeal Airway Changes after Rapid Maxillary Expansion in Children with Bilateral left Lip and Palate

Purpose: To assess the effect of rapid palatal expansion (RPE) on the oropharynx in individuals (age range from 9 to 14) with complete bilateral cleft lip and palate (BCLP). Methods: Forty CBCT scans of 20 twenty complete BCLP individuals who had undergone rapid maxillary expansion maxillary before alveolar cleft grafting. Sample was divided into 2 groups according to the type of expander used. Scans were examined before expansion, and 3 months after expansion. Oropharyngeal 3D`volume was measured at both times for each study group. Results: All post scans showed statistically significant increase in volume when compared to the pre scans using ANOVA variance test. However, no difference was detected between both groups. Conclusion: RME increases the volume of the oropharyngeal airway regardless of the type of fixed expander.

Nasal Chamber Changes Following Rapid Maxillary Expansion in Children with Bilateral Cleft Lip and Palate

Purpose: The aim was to study the skeletal effect of rapid palatal expansion (RPE) on the anterior and posterior nasal width in a sample of Egyptian children (age range 9.4-14.3 years, mean 11.16 years) with bilateral cleft lip and palate (BCLP). Methods: Twenty Egyptian children with complete BCLP exhibiting maxillary transverse deficiency were divided randomly into; Group 1 received a fixed fan expander and Group 2 a hyrax expander. Cone-beam computed tomography (CBCT) images were taken before T1 and 3 months after expansion T2, just before the alveolar cleft grafting (ACG) surgical procedure. Linear and angular measurements were assessed to measure the degree of change on the anterior and posterior nasal chamber widths, dentition, and dental arch. Results: Repeated measure ANOVA with a between variable analysis was used to examine the effect of the two expanders on the dental arch and anterior nasal width as well as posterior nasal width. Statistically significant increase in dentoalveolar measurements were found in each group, nasal widths showed no statistically significant differences before and after expansion. Conclusion: increase in nasal width were found to be statistically insignificant following RME.

Change in Nasal Airflow, Associated with the Treatment of Rapid Maxillary Expansion in Children with Maxillary Compression

Maxillary compression malocclusion in horizontal or transverse plane, is in early age, of multifactorial origin, due to the lack of development of the maxilla. It is one of the most common malformations in orthodontics

Rapid maxillary expansion in children with nocturnal enuresis: A randomized placebo-controlled trial.

To investigate whether rapid maxillary expansion (RME) is a useful treatment method for nocturnal enuresis (NE) and whether the treatment effect is due to placebo. The study also aimed to identify prognostic variables in patients responding to treatment. Thirty-eight children with therapy-resistant NE were recruited and randomized into two groups: the intervention group or placebo group. Both groups were treated with RME, but the placebo group received treatment with a sham appliance for 2 weeks before having the actual treatment. A medical history focused on micturition habits, previous treatment, heredity, and sleep disorders was taken. Daytime voided volumes and nocturnal urine production during wet nights were recorded before the intervention. Of the 38 patients recruited, two dropped out as one patient was unable to take dental impressions and one refused to have the appliance fitted. There was a statistically significant reduction of wet nights after the RME treatment (P < .001). No significant reduction was found after the placebo treatment (P < .40). Eleven patients (35%) had their enuresis frequency reduced by >50%. Large voiding volume and a wide maxilla at baseline had a strong association with positive treatment outcome. RME has a modest effect on children with therapy-resistant NE. The treatment outcome does not seem to be due to a placebo effect of the appliance. A wide maxillary width and large voiding volume at baseline seem to be positive predictors regarding response to treatment.

A 3-D evaluation of transverse dentoalveolar changes and maxillary first molar root length after rapid or slow maxillary expansion in children.

ABSTRACTObjective: The objective of the present study was to conduct a randomized clinical trial comparing the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME). Maxillary permanent first molar root length and tooth movement through the alveolus were studied using cone-beam computed tomography (CBCT). Methods: Subjects with maxillary transverse deficiencies between 7 and 10 years of age were included. Using Haas-type expanders, children were randomly assigned to two groups: RME (19 subjects, mean age of 8.60 years) and SME (13 subjects, mean age of 8.70 years). Results: Buccal cortical, buccal bone thicknesses and dentoalveolar width decreased in both groups. In the RME group the greatest decrease was related to distal bone thickness (1.26 mm), followed by mesial bone thickness (1.09 mm), alveolar width (0.57 mm), and the buccal cortical (0.19 mm). In the SME group the mesial bone thickness decreased the most (0.87 mm) and the buccal cortical decreased the least (0.22 mm). The lingual bone thickness increased in the RME and SME groups (0.56 mm and 0.42 mm, respectively). The mesial root significantly increased in the RME group (0.52 mm) and in the SME group (0.40 mm), possibly due to incomplete root apex formation at T1 (prior to installation of expanders). Conclusions: Maxillary expansion (RME and SME) does not interrupt root formation neither shows first molar apical root resorption in juvenile patients. Although slightly larger in the RME group than SME group, both activation protocols showed similar buccal bone thickness and lingual bone thickness changes, without significant difference; and RME presented similar buccal cortical bone changes to SME.

Skeletal changes after rapid maxillary expansion in children with obstructive sleep apnea evaluated by low-dose multi-slice computed tomography

ObjectiveThe objective of this study was to evaluate the skeletal effects of rapid maxillary expansion (RME) therapy performed using teeth as anchors, in obstructive sleep apnea (OSA) children, by low-dose computed tomography (CT) of the midpalatal suture opening, maxillary base width, nasal cavities width, first molar angulation and, unlike most studies in the literature, on the pterygoid processes distance. MethodsFourteen children (mean age 8.68 years) with OSA presenting a malocclusion characterized by upper-jaw contraction had 16-Multislice CT (MSCT) scans taken before (T0) and after (T1) RME. All exams were performed using a rigid protocol to ensure reproducibility of image collection over time, with a 16-row MSCT scanner equipped with a Dentascan reconstruction program. Scanning parameters were as follows: scout view in the anteroposterior (AP) and laterolateral (LL); 1.25-mm slice thickness with 0.6-mm collimation from the dentoalveolar and basal areas of the maxilla up to the nasal cavity, parallel to the palatal plane; 80 kV, 100 mA with an 11.25-mm table speed/rotation, rotation time 0.6 s. Matrix size was 512 × 512. ResultsOpening of the midpalatal suture was demonstrated in all cases. The results showed statistically significant T0 to T1 increments in all treated cases and clear imaging findings. ConclusionUse of three-dimensional (3D)-CT for follow-up studies requires a very rigid protocol to maintain reproducible positions in the scanner over time. The images confirm the real remodeling of craniofacial structure. However, to be valid such an imaging approach needs great attention to reproducibility of anatomic images over time. The changes in volume of the UA, even with a rigid protocol, cannot be affirmed with 3D-CT. There is a need to improve the definition of markers using this imaging approach when performing longitudinal studies; currently this issue is unresolved.

Nasal function before and after rapid maxillary expansion in children: A randomized, prospective, controlled study

ObjectivesChildren can well detect and respond to odours in order to have information about food and environment.Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency. MethodsN-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6–11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6–11 years) whose members remained under observation for the period of the study. ResultsConsidering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group.Considering the control group, no significant differences were found for any of the considered variables during the time of the study.Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005). ConclusionRapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.