Maxillary Expansion In Children Research Articles

Changes in the mandibular arch after rapid maxillary expansion in children: A three-dimensional analysis using digital models

Abstract Objective: This retrospective study quantitatively evaluated and compared the change in distance between mandibular first molars before and after rapid maxillary expansion (RME) using digital models. Materials and Methods: Twenty-seven (n = 27) plaster models (16 females and 11 males, between 6 and 9 years old) from patients treated at the Interceptive Orthodontic Clinic of the Pontifical Catholic University of Paraná (PUCPR, Curitiba, Brazil) were used. The initial (T1) and final (1 year after, T2) dental casts were scanned. The distances between the mandibular first molars were measured and compared using Geomagic Foundation software (Rock Hill, SC, USA). The central fossa of each mandibular molar was used as the reference point. The mandibular arch perimeter was measured using Orthoviewer (3Shape, Copenhagen, Denmark). Results: The intermolar width increased by 0.23 mm and by 0.75 mm in the arch perimeter. In two patients the intermolar width increased more than 2 mm, and in five patients the values from the initial measurements decreased. Conclusions: RME does not increase mandibular intermolar width distance or the mandibular arch perimeter in growing patients treated with Haas-type palatal expanders when evaluated using digital models.

Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study.

The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency. Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured. Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed. SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.

Can rapid maxillary expansion cause auditory improvement in children and adolescents with hearing loss? A systematic review.

To evaluate whether the use of palatal expansion techniques can influence hearing loss in children and adolescents with previous hearing impairment. Electronic searches in PubMed, Scopus, Web of Science, The Cochrane Library, Lilacs, OpenGrey, and Google Scholar were performed with a controlled vocabulary and free-text terms relating to palatal expansion and hearing loss. No language or time restrictions were imposed. Clinical trials that focused on human patients treated with rapid or semirapid maxillary expansion in children and teenagers with hearing loss were included. Data extraction was undertaken by two authors, with conflict resolution by a third author. Risk of bias assessment and data extraction were performed on the selected studies. Seventy-four citations were retrieved by the search. Initially, 12 studies were selected according to the eligibility criteria, but three studies were excluded because of the presence of adults, absence of hearing level evaluation, and oversampling, resulting in nine studies. The mean improvement in hearing levels varied from 2 to 19 dB among the studies. The risk of bias varied from low to moderate risk. The evidence indicated that there was a hearing improvement after maxillary expansion in patients with hearing loss in the evaluated studies, although more controlled and randomized studies are necessary to investigate this issue further.

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.

Maxillary expansion in children with obstructive sleep apnea (OSA): meta-analysis

Introduction Obstructive Sleep Apnea (OSA) in childhood leads to physical impairment and psychomotor important. Thus, it must be recognized and treated early, in an attempt to prevent or mitigate the consequences, as they may be harmful to the proper development of the child. The adenotonsillectomy, and in selected cases, the Continuous Positive Airway Pressure (CPAP) have been the treatments of choice for OSAS in children, without having absolute success in treating this syndrome. Minimally invasive treatments have been proposed more recently, intra-oral devices, extra-oral and speech therapy. Objective: To perform a meta-analysis of maxillary expansion in OSA in children. Materials and methods Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus and Medline. Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies in nonsyndromic children 0 to 12 years of age (3) polysomnography with apnea- hypopnea index (AHI) before and after treatment; and (4) maxillary expansion treatment. The quality of the studies selected was evaluated by assessing their methodologies. Treatment effects were combined by meta-analysis with the random-effects method. Results The total sample of these articles was 116 children with a mean age of 6.7 years. Of the six items assessed four underwent two periods of follow-up. Mean AHI in the first follow-up was −4.958 ( p p Conclusion Meta-analysis of six international papers, we concluded that maxillary expansion in children with OSA is an effective method in the treatment of this syndrome being supplementary maintained in the medium term. Further studies are needed to assess whether this effectiveness remains in adulthood. Acknowledgement FAPESP process 2012/00092–0.

Radiographic assessment of maxillary incisor position after rapid maxillary expansion in children with clinical signs of eruption disorder

In this study we assessed the influence of rapid maxillary expansion (RME) on the intraosseous vertical position and inclination of the impacted incisors diagnosed at an early developmental stage on panoramic radiographs and subsequently treated by surgical removal of the obstacle. Following surgical removal of the obstacles to incisor eruption (T1), a group of 34 subjects (mean age 8 years 11 months ± 11 months) underwent RME, while a group of 28 subjects (mean age 9 years 1 month ± 1 year) was monitored after surgery without further treatment. At T2 (on average 10 months after T1), the prevalence rate of subjects with erupted incisors was recorded. The measurements were taken on the panoramic radiographs at T1 and T2 to assess the vertical position and angulation of delayed unerupted incisors. At T2, impacted incisors erupted in 82.4% of the patients in the RME group versus 39.3% of those in the monitored group (χ(2) =8.45, p<0.001). All the patients treated with RME showed an improvement in the vertical and angular position of the unerupted teeth. Logistic regression revealed RME therapy as the only significant predictive variable (p<0.001) for successful eruption of the delayed incisors at T2. RME in early mixed dentition appears to be an effective procedure to increase the prevalence rate of impacted maxillary incisor eruption.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

ObjectiveThe aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. Material and MethodsFacial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. ResultsFrom the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. ConclusionRME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

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.

NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome

Objective To evaluate NREM sleep microstructure in children with obstructive sleep apnea syndrome (OSAS) before and after one year of rapid maxillary expander (RME) treatment by means of the cyclic alternating pattern (CAP). Methods Nine children with OSAS aged 4–8 years (6 males, mean age 6.4 ± 1.97 years) and age-matched normal controls were included. All subjects underwent an overnight polysomnography in the sleep laboratory after one adaptation night, as a baseline evaluation; children with OSAS were recorded again after one year of RME treatment. Results After one year of treatment the OSAS group showed a longer duration of time in bed and sleep period time, a reduction in number of stage shifts compared to baseline recordings, and the apnea–hypopnea index decreased significantly. At baseline, the OSAS group had a higher CAP rate during slow-wave sleep and an increased A2 index compared to normal controls. After one year of RME application, children with OSAS showed an increase in CAP rate associated with an increase of A1 index during slow-wave sleep. Conclusions RME treatment almost normalized sleep architecture and improved sleep respiratory disturbances; however, sleep microstructure and respiratory parameters did not completely recover. The persistence of increased CAP rate in slow-wave sleep associated with an increase of A1 index might reflect a partial failure of orthodontic treatment. On the other hand, the rebound of A1 subtypes might be an indirect sign of an attempt to normalize sleep that has been disturbed by the respiratory events.

Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up

Objectives: To assess the outcome of rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome (OSAS) in children, we studied 16 patients (mean age 6.6 ± 2.0; 9 males) with dental malocclusion, a body mass index ≤85 percentile, and OSAS confirmed by polysomnography. Methods: At baseline and after the trial, all patients underwent physical examination, standard polysomnography and orthodontic assessment. The Brouillette questionnaire investigating symptoms of OSA was administered to parents before and during the trial to assess the clinical severity of their sleep-disordered breathing. Two treated patients were lost to follow-up and excluded from the final study. Results: In the 14 treated subjects who completed the study and follow-up, polysomnography showed a significant decrease in the apnea-hypopnea index ( p = 0.005), hypopnea obstructive index ( p = 0.002) and arousal index ( p = 0.001). Questionnaire responses before and after treatment showed a significant decrease in the severity of symptoms. Conclusion: A rapid maxillary expander is an effective appliance for treating children with OSAS.

Initial Results Regarding Force Exertion during Rapid Maxillary Expansion in Children

We developed a method to measure the forces occurring during rapid maxillary expansion and carried out the University of Ulm rapid maxillary expansion method, similar to that of Chatellier and Chateau, in ten patients. The forces occurring on the maxilla increased up to 120 N. There was considerable variation in force level from patient to patient. After "rupture" of the midpalatal suture, the forces decreased. The remaining forces seemed to be the result from stress on soft tissue and bone.

Rapid maxillary expansion in children with obstructive sleep apnea syndrome.

To evaluate the effect of rapid maxillary expansion on children with nasal breathing and obstructive sleep apnea syndrome. Recruitment of children with maxillary contraction, without of adenoid hypertrophy, with a body mass index < 24 kg/m2, with obstructive sleep apnea syndrome demonstrated by polysomnography, and whose parents signed informed consent. Otolaryngologic and orthognathic-odontologic evaluation with clinical evaluation, anterior rhinometry and nasal fibroscopy, panoramic radiographs, anteroposterior and laterolateral telecephalometry were performed at entry and follow-up. Rapid maxillary expansion (ie, active phase of treatment) was performed for 10 to 20 days; maintenance of device (for consolidation) and orthodontic treatment on teeth lasted 6 to 12 months. 31 children (19 boys), mean age 8.7 years, participated in the study. The mean apnea-hypopnea index was 12.2 events per hour. At the 4-month follow-up, the anterior rhinometry was normal, and all children had an apnea-hypopnea index < 1 event per hour. The mean cross-sectional expansion of the maxilla was 4.32 +/- 0.7 mm. There was a mean increase of the pyriform opening of 1.3 +/- 0.3 mm. Rapid maxillary expansion may be a useful approach in dealing with abnormal breathing during sleep.