Need For Orthognathic Surgery Research Articles

Craniomandibular transverse tomographic evaluation after anterior open bite orthodontic treatment with miniplates anchorage

BackgroundSkeletal anterior open bite (SAOB) represents one of the most complex and challenging malocclusions in orthodontics. Orthodontic treatment supported by miniplates enable to reduce the need for orthognathic surgery. Transverse dimension may be affected by intrusion biomechanics. This study aims to assess transverse bone alterations in patients with SAOB who underwent orthodontic treatment with absolute anchorage using four miniplates.MethodsA total of 32 patients of both sexes, with an average age of 33.8 years, diagnosed with SAOB and treated orthodontically with four miniplates (one in each hemiarch), were selected for this study. Tomographic examinations were performed before (T1) and after (T2) orthodontic treatment. Linear measurements (width of the maxillary base, maxillary alveolar, maxillary root, maxillary dental cusp, mandibular alveolar) and angular measurements (maxillary intermolar angle) were assessed in these images. The Shapiro-Wilks normality tests were applied to verify data distribution, and the paired t-test was used to compare the initial and final measures obtained.ResultsAmong the evaluated parameters, the maxillary alveolar width, maxillary dental cusp width, mandibular alveolar cusp width, and intermolar angle showed statistically significant differences between T1 and T2 (p < 0.05). However, maxillary base and maxillary root widths showed no significant difference (p > 0.05).ConclusionsIntrusion and distalization with miniplates in SAOB therapy may lead to significant expansive changes, due to molars cusps width and buccal inclination increase restricted at the alveolar level.

Artificial intelligence as a prediction tool for orthognathic surgery assessment.

An ideal orthodontic treatment involves qualitative and quantitative measurements of dental and skeletal components to evaluate patients' discrepancies, such as facial, occlusal, and functional characteristics. Deciding between orthodontics and orthognathic surgery remains challenging, especially in borderline patients. Advances in technology are aiding clinical decisions in orthodontics. The increasing availability of data and the era of big data enable the use of artificial intelligence to guide clinicians' diagnoses. This study aims to test the capacity of different machine learning (ML) models to predict whether orthognathic surgery or orthodontics treatment is required, using soft and hard tissue cephalometric values. A total of 920 lateral radiographs from patients previously treated with either conventional orthodontics or in combination with orthognathic surgery were used, comprising n = 558 Class II and n = 362 Class III patients, respectively. Thirty-two measures were obtained from each cephalogram at the initial appointment. The subjects were randomly divided into training (n = 552), validation (n = 183), and test (n = 185) datasets, both as an entire sample and divided into Class II and Class III sub-groups. The extracted data were evaluated using 10 machine learning models and by a four-expert panel consisting of orthodontists (n = 2) and surgeons (n = 2). The combined prediction of 10 models showed top-ranked performance in the testing dataset for accuracy, F1-score, and AUC (entire sample: 0.707, 0.706, 0.791; Class II: 0.759, 0.758, 0.824; Class III: 0.822, 0.807, 0.89). The proposed combined 10 ML approach model accurately predicted the need for orthognathic surgery, showing better performance in Class III patients.

Need for orthognathic surgery in cleft patients from Northern Finland.

Northern Finland has a unique distribution of clefts compared to the rest of Europe and Finland. This may reflect the need for orthognathic surgery among Northern Finland's patient pool. The aim of this study was to compare previously operated patients aged 18 years or older with cleft lip, cleft lip and alveolus, cleft lip and palate, cleft palate and to evaluate the need for orthognathic surgery in order to achieve a stable and functional occlusion. Materials and methods: The study group consisted of all 18-years-old cleft patients treated in the Oulu Cleft Center. The total amount of patients was 110. The patients were compared retrospectively using patients' hospital records. The majority of patients did not have any cleft-associated syndrome. The need for maxillary or bimaxillary orthognathic or corrective-jaw surgery was evaluated by the Oulu Cleft Team. A descriptive and statistical analysis was used to determine the need for orthognathic surgery according to sex and cleft type. There were nineteen patients of the total of 110 patients who met the criteria requiring corrective-jaw surgery (17,3%). In total 12 males (25,0%) and 7 females (11,3%) were evaluated for the need of orthognathic surgery. Sixteen of the 19 patients had palatal involvement of the cleft. The need for orthognathic surgery was greater in the cleft lip palate and cleft palate patient groups compared to cleft lip alveolus or cleft lip groups. This study also found that males from Northern Finland need surgery more often than females.

Male-to-female transgenders demonstrated unique perspectives on perceived facial attractiveness and orthognathic surgery need

The esthetic preference and decision concerning undergoing orthognathic surgery in the transgender population have not been reported. The aims of this study were to examine the influence of the sagittal mandibular position on the esthetic perception and perceived surgery need in male-to-female transgenders (MTFTs) compared with male and female laypeople. A questionnaire study was performed by male-to-female transgender, male and female laypeople. Three-dimensional black & white male and female facial images with facial contour angle (FCA) of 3°, 1°, 5°, 9°,13°, 17°, and 21° were shown to the participants. The participants scored the images' perceived facial attractiveness using visual analog scales (VAS) and indicated whether orthognathic surgery was needed. The participants included 85 MTFTs, 85 males, and 85 females. The results revealed that there were significant differences in the VAS scores between the MTFT and male participants. The MTFTs rated the male images with prognathism of 1° and -3°FCA in significantly lower scores compared with the males (P = 0.033, P = 0.010). Female images with prognathism 1°FCA was rated by the MTFTs in significantly lower scores compared with the males (P = 0.041). A significantly higher number of surgery needs was found in the MTFTs compared with the other groups. Gender influences esthetic perception and the decision to undergo orthognathic surgery. MTFTs have a unique perspective on facial esthetics, being more desirous of surgery than males and females. Clinicians should be aware of the ideal expectation in facial esthetics in MTFTs.

Content analysis of AI-generated (ChatGPT) responses concerning orthodontic clear aligners.

To assess the accuracy of ChatGPT answers concerning orthodontic clear aligners. A cross-sectional content analysis of ChatGPT generated responses to queries related to clear aligner treatment (CAT) was undertaken. A total of 111 questions were generated by three orthodontists based on a set of predefined domains and subdomains. The artificial intelligence (AI)-generated (ChatGPT) answers were extracted and their accuracy was determined independently by five orthodontists. The accuracy of answers was assessed using a prepiloted four-point scale scoring rubric. Descriptive statistics were performed. The total mean accuracy score for the entire set was 2.6 ± 1.1. It was noted that 58% of the AI-generated answers were scored as objectively true, 18% were selected facts, 9% were minimal facts, and 15% were false. False claims included the ability of CAT to reduce the need for orthognathic surgery (4.0 ± 0.0), improve airway function (3.8 ± 0.5), achieve root parallelism (3.6 ± 0.5), alleviate sleep apnea (3.8 ± 0.5), and produce more stable results compared to fixed appliances (3.8 ± 0.5). The overall level of accuracy of ChatGPT responses to questions concerning CAT was suboptimal and lacked citations to relevant literature. Ability of the software to offer current and precise information was limited. Therefore, clinicians and patients must be mindful of false claims and relevant facts omitted in the answers generated by ChatGPT.

Systematic Review and Meta-Analysis of the Index of Orthognathic Functional Treatment Need for Detecting Subjects with Great Need for Orthognathic Surgery.

Index of Orthognathic Functional Treatment Need (IOFTN) Identifies patients with greatest need for orthoganthic surgery. This systematic review looks into the available evidence on prevalence of patients with great treatment need (IOFTN 4&5) who had orthognathic surgery in previous studies. Literature search of the major electronic databases was carried out for articles published between 2014 and September 2023, looking for "Index of Orthognathic Functional Treatment Need","Orthognathic Surgery","IOFTN", "Epidemiology" and "Dentofacial Deformity". The prevalence of patients identified with IOFTN grades of 4&5 was calculated. A random-effect model was employed and the Forest and Galbraith plots were produced. The pooled prevalence estimate for subjects with IOFTN scores of 4&5 was calculated. The heterogeneity among studies was assessed with the I2 statistics. In total, 14 retrospective studies conducted between 2015 and 2019 in 7 countries (UK, New Zealand, Iran, Pakistan, Turkey, Malaysia, Japan) were included, reporting on 1339 orthognathic patients. The sample sizes ranged from 30 to 200. Only 7 studies reported on the subcategories of the IOFTN for grades 1, 2&3. The prevalence of orthognathic patients with IOFTN scores of 4 & 5 ranged from 79% to 100%. The heterogeneity I2 statistics was 16%. The pooled prevalence estimate for subjects with IOFTN scores of 4&5 was 92% (95% CI, 0.91-0.94%). According to this meta-analysis, IOFTN successfully identified 92% of patients who underwent orthognathic surgery with a great need for treatment (Grade 4 & 5). To enhance the identification of patients with well-compensated malocclusions, previous orthodontic treatment, or extreme occlusal deviations (e.g., proclination or retroclination of incisors), it would be advantageous to employ additional means alongside IOFTN for assessing orthognathic need in this group.

Clinical Applications of Artificial Intelligence and Machine Learning in Children with Cleft Lip and Palate-A Systematic Review.

Objective: The objective of this systematic review was (a) to explore the current clinical applications of AI/ML (Artificial intelligence and Machine learning) techniques in diagnosis and treatment prediction in children with CLP (Cleft lip and palate), (b) to create a qualitative summary of results of the studies retrieved. Materials and methods: An electronic search was carried out using databases such as PubMed, Scopus, and the Web of Science Core Collection. Two reviewers searched the databases separately and concurrently. The initial search was conducted on 6 July 2021. The publishing period was unrestricted; however, the search was limited to articles involving human participants and published in English. Combinations of Medical Subject Headings (MeSH) phrases and free text terms were used as search keywords in each database. The following data was taken from the methods and results sections of the selected papers: The amount of AI training datasets utilized to train the intelligent system, as well as their conditional properties; Unilateral CLP, Bilateral CLP, Unilateral Cleft lip and alveolus, Unilateral cleft lip, Hypernasality, Dental characteristics, and sagittal jaw relationship in children with CLP are among the problems studied. Results: Based on the predefined search strings with accompanying database keywords, a total of 44 articles were found in Scopus, PubMed, and Web of Science search results. After reading the full articles, 12 papers were included for systematic analysis. Conclusions: Artificial intelligence provides an advanced technology that can be employed in AI-enabled computerized programming software for accurate landmark detection, rapid digital cephalometric analysis, clinical decision-making, and treatment prediction. In children with corrected unilateral cleft lip and palate, ML can help detect cephalometric predictors of future need for orthognathic surgery.

Stability of protraction Facemask/Rapid Maxillary Expansion in skeletal class III malocclusion with maxillary deficiency: Rapid Review

this study aimed to evaluate the stability of PFM/RME outcomes in class III skeletal malocclusionwith maxillary deficiency performed during childhood. Electronic database search conducted from 2011-2020 withcriteria RCT, clinical trials, and cohort studies with a treatment group of class III skeletal malocclusion withmaxillary deficiency patients, using PFM/RME and a minimum of 2 years follow-up. The PFM/RME device hasbeen commonly used for maxillary protraction in cases of maxillary growth deficiency and is used duringchildhood. The stability of the PFM/RME protocol results aims to maintain the best possible treatment results.There were 439 articles from the preliminary search. Six articles were included in this study, two articles were RCTtypes, and the other four were CCT types. Clinical evaluation and cephalometric are used to evaluate skeletal anddentoalveolar changes. 68%-90% of participants maintained overjet until the follow-up period ended. PFM/RMEprotocol reduced the need for orthognathic surgery by 3,5 times compared with a control group with notreatment.PFM/RME treatment can effectively show in the short term from skeletal dan dentoalveolar changes.There were relapses during the long-term follow-up period. Further evaluation and research are needed regardingthe long-term stability of PFM/RME outcomes. KEYWORDS: Class III malocclusion, Growth modification, Maxillary deficiency Protraction facemask (PFM), Rapidmaxillary expansion (RME)

Prognostic Factors for Orthognathic Surgery in Children With Cleft Lip and/or Palate: Dentition and Palatal Morphology.

To determine dental and palatal morphology in children with cleft lip and/or palate (CL/P) and identify morphological prognostic factors for orthognathic surgery (OGS). Retrospective cohort study. Orthodontic department of a university dental hospital. This study included 80 patients with bilateral and unilateral CL/P who had lateral cephalograms at the ages of 7 (T1), 15 (T2) years, and a dental plaster model at T1. Plaster models at T1 were scanned with a three-dimensional (3D) scanner. Morphological features were extracted from 3D models with geometric morphometrics software as principal components (PCs). The combinations of the PCs and other predictive factors (ie, the No. of clefts in the lip and alveolus, the palatal repair method, sex, cephalometric variables at T1, and the No. of missing teeth) were examined by logistic regression to determine the predictability for OGS. The need for OGS and skeletal and dental discrepancies at T2 were examined as outcomes. Shrinkage of the palate, including vertical shallowing and transverse narrowing of the posterior maxilla and cleft-side asymmetry of the anterior maxilla at T1, as well as the No. of clefts in the lip and alveolus, the palatal repair method, male sex, several cephalometric variables for the sagittal and vertical dimensions, and the No. of missing teeth, were found to be predictive factors for OGS. Morphological prognostic factors for OGS in children with CL/P were determined.

Performance of Artificial Intelligence Models Designed for Diagnosis, Treatment Planning and Predicting Prognosis of Orthognathic Surgery (OGS)—A Scoping Review

The technological advancements in the field of medical science have led to an escalation in the development of artificial intelligence (AI) applications, which are being extensively used in health sciences. This scoping review aims to outline the application and performance of artificial intelligence models used for diagnosing, treatment planning and predicting the prognosis of orthognathic surgery (OGS). Data for this paper was searched through renowned electronic databases such as PubMed, Google Scholar, Scopus, Web of science, Embase and Cochrane for articles related to the research topic that have been published between January 2000 and February 2022. Eighteen articles that met the eligibility criteria were critically analyzed based on QUADAS-2 guidelines and the certainty of evidence of the included studies was assessed using the GRADE approach. AI has been applied for predicting the post-operative facial profiles and facial symmetry, deciding on the need for OGS, predicting perioperative blood loss, planning OGS, segmentation of maxillofacial structures for OGS, and differential diagnosis of OGS. AI models have proven to be efficient and have outperformed the conventional methods. These models are reported to be reliable and reproducible, hence they can be very useful for less experienced practitioners in clinical decision making and in achieving better clinical outcomes.

Protraction Headgear Compliance and Orthognathic Surgery in Patients With Cleft Lip and Palate.

Assess cephalometric parameters and the need for orthognathic surgery (OS) and its relationship with compliance in protraction headgear (PHG). Retrospective case series. Hospital cleft-craniofacial center. 23 patients with nonsyndromic cleft lip and palate and history of lip and palate repair. Patients received PHG and orthodontic treatment. Compliant patients were compared to patients that were not. Protraction was applied with 170-gram elastics and patients were instructed to wear for at least 12 hours daily. Cephalometric measurements at initial (T1), post-PHG (T2), and pre-surgical or post-orthodontic treatment (T3) of at least age 15 for females and 17 for males and the presence of OS were compared. 83% (19) of patients reported compliance with therapy. Of those compliant, 68% (13) had OS and 32% (6) did not ( P = .99). Inter-group comparisons at T1 between compliant and noncompliant showed no significant differences and the non-OS patients started with larger nasolabial angles ( P &lt; .05). At T2, there were no significant cephalometric differences between groups. At T3, compliant patients showed significantly more upper incisor proclination than noncompliant patients. Between OS and non-OS, OS patients had significantly decreased ANB, Wits, convexity, overjet, and FMA and larger nasolabial angles ( P &lt; .05). Patients compliant with PHG showed no difference in the need for OS. However, after orthodontic treatment, compliant patients showed more upper incisor proclination and OS patients with decreased ANB, Wits, convexity, overjet, FMA, and larger nasolabial angles.

Racial Disparities Affect Timing of Alveolar Bone Grafting for Patients With Cleft Lip and Palate: An Analysis of the 2012 Kids’ Inpatient Database

Objective: The timing of alveolar bone graft (ABG) for patients with cleft lip and palate is critical to the success of the operation. Sociodemographic factors have been implicated in delaying surgery for other diagnoses but their impact on patients undergoing ABG is unknown. The purpose of this study is to examine the association of sociodemographic factors on the age of patients undergoing ABG. Methods: The Kids’ Inpatient Database (KID) from 2012 was used to define a cohort of patients with cleft lip and/or palate between the ages of 5 and 14. Patients were selected using ICD-9 procedure codes for repair of oronasal fistula and bone graft. Gender, race, income quartile, hospital region, and type of insurance were used as independent variables. Time to ABG was then calculated as hazard ratios (HR) of having surgery using Cox regression models with 95% confidence intervals. Results: A cohort of 395 patients was identified. Median age at ABG was 9 ± 0.15 years. On univariate analysis, Non-Hispanic Black (NHB) patients underwent surgery later than Non-Hispanic White (NHW) patients (11.13 ± 0.44 years vs 9.67 ± 0.19 years, P = .0026). Patients in the higher 2 income quartiles were more likely to have an early surgery as compared to those in the lowest quartile (9.16 ± 0.43 and 9.32 ± 0.43 years vs 10.20 ± 0.33, P = .016 and 0.043 respectively). No factor was significant on multivariate analysis. Conclusions: Patients who are NHB are associated with delayed time to ABG as compared to NHW. Conversely, those in the upper income quartile by zip code underwent surgery at an earlier age. While this study identifies demographic factors associated with delay of ABG, more research is needed to understand the direct causal effects for this delay in surgery and its implication for future growth and need for orthognathic surgery.

Orthognathic Surgery Rate in Cleft Care.

To determine the true need for orthognathic surgery in patients with repaired cleft lip and/or palate (CL/P) at a high-volume craniofacial center. An institutional retrospective review of patients with CL/P born between 1975 and 2008 was performed. Patients with adequate documentation reflecting cleft care who were ≥ 18 years at the time of last craniofacial/dentistry follow-up were included. Patients with non-paramedian clefts or a comorbid craniofacial syndrome were excluded. Primary outcome variable was the total proportion of patients with CL/P who either underwent or were referred for orthognathic surgery Le Fort I (LF1) to correct midface hypoplasia. Secondary outcome variables were associations between cleft phenotype, midface hypoplasia severity, and number of cleft related surgeries with the eventual LF1 referral/recipiency. One hundred seventy-seven patients with CL/P met inclusion criteria. A total of 90/177 (51%) patients underwent corrective LF1; however, 110/177 (62%) of patients were referred for surgery. Patients with secondary cleft palate involvement were referred for and underwent LF1 at significantly greater rates than those without secondary palate involvement (referred: 65% versus 13%, P = 0.001; underwent: 55% versus 0%, P < 0.001). Patients with bilateral cleft lip/palate were referred for and underwent LF1 at significantly higher rates than those with unilateral cleft lip/palate (referred: 71.0% versus 50.4%, P= 0.04; underwent: 84% versus 71%, P = 0.02). Number of secondary palate surgeries was positively correlated with increased LF1 referral (P = 0.02) but not LF1 recipiency (P = 0.15). The incidence of orthognathic surgery redundant in patients with repaired CL/P was 51% at our institution, marginally above the higher end of previously reported rates. However, this number is an underrepresentation of the true requirement for LF1 as 62% of patients were referred for surgical intervention of midface hypoplasia. This distinction should be considered when counseling families.

Deep learning based prediction of necessity for orthognathic surgery of skeletal malocclusion using cephalogram in Korean individuals

BackgroundPosteroanterior and lateral cephalogram have been widely used for evaluating the necessity of orthognathic surgery. The purpose of this study was to develop a deep learning network to automatically predict the need for orthodontic surgery using cephalogram.MethodsThe cephalograms of 840 patients (Class ll: 244, Class lll: 447, Facial asymmetry: 149) complaining about dentofacial dysmorphosis and/or a malocclusion were included. Patients who did not require orthognathic surgery were classified as Group I (622 patients—Class ll: 221, Class lll: 312, Facial asymmetry: 89). Group II (218 patients—Class ll: 23, Class lll: 135, Facial asymmetry: 60) was set for cases requiring surgery. A dataset was extracted using random sampling and was composed of training, validation, and test sets. The ratio of the sets was 4:1:5. PyTorch was used as the framework for the experiment.ResultsSubsequently, 394 out of a total of 413 test data were properly classified. The accuracy, sensitivity, and specificity were 0.954, 0.844, and 0.993, respectively.ConclusionIt was found that a convolutional neural network can determine the need for orthognathic surgery with relative accuracy when using cephalogram.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds.

It is suggested that dental agenesis affects maxillary protrusion and dental arch relationship in children with unilateral cleft lip and palate (UCLP). In addition, an association between the need for orthognathic surgery and dental agenesis is reported. The aim was to study the impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8-year-old children with UCLP. The sample consisted of individuals with UCLP from Scandcleft randomized trials. The participants had available data from diagnosis of maxillary dental agenesis as well as cephalometric measurements (n = 399) and GOSLON assessment (n = 408) at 8 years of age. A statistically significant difference was found for ANB between individuals with agenesis of two or more maxillary teeth (mean 1.52°) in comparison with those with no or only one missing maxillary tooth (mean 3.30° and 2.70°, respectively). Mean NSL/NL was lower among individuals with agenesis of two or more maxillary teeth (mean 9.90°), in comparison with individuals with no or one missing maxillary tooth (mean 11.46° and 11.45°, respectively). The number of individuals with GOSLON score 4-5 was 47.2% in the group with two or more missing maxillary teeth and 26.1% respectively 26.3% in the groups with no or one missing maxillary tooth. No statistically significant difference was found in the comparison between individuals with no agenesis or with agenesis solely of the cleft-side lateral. Maxillary dental agenesis impacts on craniofacial growth as well as dental arch relationship and should be considered in orthodontic treatment planning.

Determination of prognostic factors for orthognathic surgery in children with cleft lip and/or palate.

To determine the prognostic factors for orthognathic surgery (OGS) in children with cleft lip and/or palate (CL/P) using artificial intelligence (AI) systems. Retrospective cohort study. An orthodontic department at a university dental hospital. This study included 126 patients with bilateral and unilateral CL/P for whom lateral cephalograms were obtained at three time points: 7 (T1), 10 (T2) and 15 (T3) years of age. Cleft type, severity of lip separation at birth, number of missing teeth, sex, palatal repair methods and surgeons, cephalometric variables at T1 and T2, and the total duration of orthodontic treatment were examined as predictors. The need for OGS and skeletal and dental discrepancies at T3 was examined as outcomes. A total of six models were developed, with a mean area under the receiver operating characteristic curve of 0.93. Multiple prognostic factors for OGS were identified. In particular, the number of clefts in the lip and alveolus showed relatively high odds ratios, as did anterior crossbite at T3. Achieving palatal closure with the push-back method, rather than Furlow's method, was also found to be a predictive factor for anterior crossbite at T3, with high odds ratios. The prognostic factors for OGS determined by the AI systems were the number of clefts in the lip and alveolus, the palatal repair method, male sex, several cephalometric variables for the sagittal and vertical dimensions, growth patterns and the number of missing teeth.

Prediction of orthognathic surgery need in children with unilateral cleft lip palate: Dental arch relationships and 5-year-olds' index.

To evaluate whether dental arch relationships at 6years of age can categorize treatment outcome and predict later need for orthognathic surgery in children with unilateral cleft lip and palate (UCLP). A retrospective longitudinal single-centre study. The study sample comprised 70 consecutive non-syndromic children (47 boys) with complete UCLP operated on by pushback techniques during 1981-1989 and followed until early adulthood in the same cleft centre. Dental casts and maxillomandibular relationships were assessed before orthodontic treatment and secondary alveolar bone grafting at mean age 6.1years (range 5.6-6.8) using the 5-year-olds' index and lateral cephalograms. The need for orthognathic surgery was retrieved from patient files. Student's t test, Pearson's correlation, and Kappa statistics were used in statistical analyses. Orthognathic surgery frequency was 41% (29/70). Those needing orthognathic surgery comprised all 3 patients with an index score of 5 (very poor), 14 of 17 (82%) scoring 4 (poor), 10 of 26 (38%) scoring 3 (fair), and 2 of 19 (11%) scoring 2 (good). Of the five patients with index score 1 (excellent), none needed osteotomies. The mean index score was 2.9. The score was significantly better in those without orthognathic surgery (2.4 versus 3.6). A significant negative correlation existed between the 5-year-olds' index and cephalometric angles ANB and anb. The use of 5-year-olds' index may help to predict treatment outcome and the clinical need for orthognathic surgery especially in patients with the lowest and highest index scores.

Microimplant Assisted Rapid Palatal Expansion: A Comprehensive Review

Maxillary transverse deficiency routinely requires expansion of the palate. In prepubertal patients, Rapid Maxillary Expansion (RME) is a reliable treatment modality. However, in skeletally mature patients due to progressively interdigitated mid palatal suture, decreased elasticity of bone and increased stiffness of the osseous articulations of the maxilla with the adjoining bones, palatal expansion becomes challenging. Patients are frequently suggested to opt for more invasive procedures, like the Surgically Assisted Rapid Palatal Expansion (SARPE). The quest for minimally invasive expansion appliances with pure orthopaedic movement led researchers to incorporate mini-implants with conventional RME. Microimplant Assisted Rapid Palatal Expansion (MARPE) maximises skeletal expansion and minimises dentoalveolar undesirable effects and obviates the need for orthognathic surgery. This comprehensive review aims to discuss MARPE as an effective, non surgical, minimally invasive treatment modality for skeletally mature patients with maxillary transverse insufficiency. Furthermore, various designs of MARPE with different placement sites, lengths, and numbers of miniscrews along with the latest technological advancements to improve diagnosis and treatment planning using CBCT and intraoral scan, as well as the use of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology to custom fabricate three dimensional (3D) miniscrew insertion surgical guide, 3D laser-printed metallic mini-implant to enhance implant placement accuracy and comfort were discussed along with the clinical significance and limitations of the MARPE. Maxillary Skeletal Expander (MSE) is a unique lineage of MARPE when combined with facemask results in distraction osteogenesis like movement of midface and forms a promising basis for non surgical orthopaedic treatment modality for skeletal class III mature patients. Bone-anchored maxillary expansion appliances provide better vertical control, especially beneficial for hyperdivergent skeletal pattern patients. MARPE significantly increases transverse widths of the nasal floor, nasopharyngeal volume and significantly lowers mean nasal airway resistance thereby facilitating nasal breathing. MARPE results in greater orthopaedic expansion and safety, with fewer undesirable effects and high success rates.

An audit to assess compliance with facial sensation data collection and risk of paraesthesia following orthognathic surgery at Morriston Hospital

Introduction: Patients undergoing orthognathic surgery need to be fully informed of the risks of surgery, one of which is injury to the sensory branches of the trigeminal (V) nerve, resulting in temporary or permanent paraesthesia. This audit looked at the compliance with post-operative facial sensation data collection over the last 3 years and analysed the risk of paraesthesia following orthognathic surgery over a 1-year period.

Orofacial clefts: treatment based on a multidisciplinary approach

Orofacial clefts: treatment based on a multidisciplinary approach