Nonsurgical Rapid Maxillary Expansion Research Articles

Impact of Non-Surgical and Surgically Assisted Rapid Maxillary Expansion Procedures upon the Periodontium: A Systematic Review

Background: Scarce evidence is available regarding the occurrence and prevalence of hard/soft tissue deficiencies among patients undergoing surgically assisted rapid maxillary expansion (SARME) as compared to non-surgical rapid maxillary expansion (NSRME) approaches. The purpose of this study is to evaluate the effect of NSRME and SARME upon the periodontal structures. Methods: A literature search was performed to identify studies that fulfilled pre-established eligibility criteria, evaluating changes in the periodontium (e.g., probing depths) and hard/soft tissue deficiencies (e.g., bone levels, gingival recession) within patients undergoing NSRME and SARME procedures. Results: A total of 21 articles were included in the present review. Four of them evaluated the outcomes of both NSRME and SARME procedures, while six and eleven studies analyzed NSRME alone and SARME alone, respectively. The incidence of hard (e.g., changes in buccal bone width/height) and soft tissue deficiencies (e.g., gingival recession, keratinized tissue, and clinical attachment level) is slightly increased among patients undergoing maxillary expansion with worsened outcomes during NSRME procedures. Conclusions: The impact of NSRME and SARME upon the periodontium remains inconclusive.

Age-related changes in the midpalatal suture: Comparison between CBCT staging and bone micromorphology

The age-related maturation of the human midpalatal suture is challenging to predict, but critical for successful non-surgical rapid maxillary expansion (RME). While cone-beam computed tomography (CBCT) can be used to categorize the suture into stages, it remains unclear how well the stages predict the actual micromorphology of the palate. To address this clinically relevant question, we used CBCT together with three-dimensional micro-computed tomography (μCT) analysis on 24 human palate specimens from individuals aged 14–34 years. We first classified the specimens into stages (A-E) using CBCT images and then correlated the results with our comprehensive μCT analysis. Our analysis focused on several factors, including bone volume fraction (BV/TV), sutural width, volume, interdigitation, ossification, and their associations with age, CBCT stage, and sex. Our μCT analysis revealed a decrease in sutural width and volume after the age of 20 years, accompanied by sutural closure beginning in the palatal segment. The overall rate of ossification remained low but increased after the age of 20 years. No significant differences were found between males and females. Importantly, we also found no correlation between individual age and CBCT stages. Furthermore, there was no association between CBCT stages and patalal suture volume, ossification and interdigitation.Taken together, our findings cast doubt on the reliability of CBCT stage as a means of predicting skeletal maturity of the palatal suture, as it appears to lack the precision required to accurately assess the true micromorphology of the palatal suture. Future investigations should explore whether alternative CBCT parameters may be more useful in addressing the challenging question of whether RME requires surgical bone weakening.

Three-dimensional palatal morphology and upper arch changes following nonsurgical and surgical maxillary expansion in adults

The objective of this study was to evaluate the effects of nonsurgical rapid maxillary expansion (RME) and surgically assisted RME (SARME) on palatal morphology and upper arch dimensions using three-dimensional (3D) models in skeletally mature patients. Thirty-eight skeletally mature patients with a maxillary transverse deficiency were divided into RME and SARME groups. Nineteen patients in the RME group (mean age, 19.16 ± 2.25 years) were treated using a full-coverage bonded acrylic splint expander; 19 patients in the SARME group (mean age, 20.38 ± 3.36) were treated using the banded palatal expansion appliance with hyrax screws. The 3D models were obtained before and after expansion. The maxillary dental arch widths, maxillary first molar angulation, palatal area, and palatal volume were calculated on the 3D models. All variables showed statistically significant changes after the retention period (P < .001). The maxillary arch width between first premolars (P < .05), the palatal area (P < .01), and the palatal volume (P < .05) significantly increased in the SARME group compared to the RME group. The maxillary first molar tipping in the RME group was significantly higher than that in the SARME group (P < .01). Although SARME has more positive effects in skeletally mature patients, nonsurgical RME can be considered as an alternative by evaluating surgical risks, periodontal status, and the need for skeletal expansion.

Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review

This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.

Effects of laser therapy on patients who underwent rapid maxillary expansion; a systematic review.

Rapid maxillary expansion (RME) is one of the common treatments of transverse maxillary deficiency, and low-level laser therapy (LLLT) is one of the recommended solutions to enhance biological wound or bone healing. This review article aims to answer the following question: "What are the effects of LLLT, on patients who underwent surgical or non-surgical RME, in improving clinical success, wound healing, and bone regeneration?" A search in PubMed, Scopus, Web of Science, and ProQuest databases was performed, with a focus on the appropriate key words. Related articles, up to May 2017, were screened, and the full text of the randomized controlled trials (RCT) were comprehensively read and subjected to quality assessments. A total of 1804 articles were included after the initial search. Four RCTs were eligible in randomization and methodology. The applied wavelength varied from 660 to 830nm with an output range of 40-100mW. Also, the highest exposed energy was 420J/cm2 and the lowest was 100J/cm2. The exposure time differed from 20 to 84s in each defined point in the palate. Based on the RCTs available, LLLT is better to be used at initial phase of RME, because it has some benefits in increasing the rate of bone remodeling.

Midpalatal suture maturation in 11- to 15-year-olds: A cone-beam computed tomographic study.

We used cone-beam computed tomography to evaluate the maturation stages of the midpalatal sutures in children aged 11 to 15years old. Maxillary expansion is successful for most patients in this age group, so we sought to identify the status of suture maturation in these subjects to use as a comparison for the prognosis of rapid maxillary expansion in older patients. Tomographic images in axial sections of the midpalatal sutures from 84 children (40 boys, 44 girls; ages, 11-15years) were classified using a scale denoting the maturation stage of the midpalatal suture (A, B, C, D, and E). The chi-square test was applied to evaluate suture stages by sex and age groups. Stage A was observed in only one 11-year-old girl. Stage B was present at all ages but was more prevalent in those less than 13years of age. Stage C was the most prevalent in all evaluated ages. Stages D and E showed low prevalence rates. There were higher prevalences of the early stages of maturation in boys. The results of this study, which showed dominant prevalence of stage C, suggest that conventional, nonsurgical rapid maxillary expansion performed in patients over 15years old is justified by a satisfactory prognosis when assessment of the sutural status indicates stage C.

Non-surgical rapid maxillary expansion in adult patient: Report and review

Non-surgical rapid maxillary expansion in adult patient: Report and review

Stress distribution analysis during an intermaxillary dysjunction: A 3-D FEM study of an adult human skull

Background:With the increased interest in adult orthodontics, maxillary width problems in the nongrowing patients have been encountered with greater frequency. In view of the negative outlook for successful nonsurgical palatal expansion in adult patients it seemed appropriate to evaluate the biomechanical effects of nonsurgical rapid maxillary expansion (RME) in adults using the finite element method (FEM).Objectives:To evaluate the biomechanical effects of RME on the craniofacial complex as applied to three-dimensional (3D) model of an adult human skull using the finite element method.Settings and Design:The Department of Orthodontics and Dentofacial Orthopedics at Government Dental College and Hospital, Nagpur. The study was done on an analytical model developed from a dry human skull of an adult female with an approximate age of 20 years.Materials and Methods:A 3D finite element analysis of the craniofacial complex was developed from sequential computed tomography scan images. Known transversal (X) displacement with magnitudes of 1, 3, and 5 mm were applied and the displacement and Von-Mises stresses in different planes were studied on different nodes located at various structures of the craniofacial complex.Results:Transverse orthopedic forces not only produced an expansive force at the intermaxillary suture but also high forces on various structures of the craniofacial complex, particularly at the base of the sphenoid bone and frontal process of the zygomatic bone. Lateral bending of the free ends of the pterygoid plates were noted.Conclusion:RME must be used judiciously in adults because of its far-reaching effects involving heavy stresses being noted at the sphenoid bone, zygomatic bone, nasal bone, and their adjacent sutures.

Nonsurgical rapid maxillary expansion effects on craniofacial structures in young adult females. A bone scintigraphy study.

To evaluate the skeletal effects of nonsurgical rapid maxillary expansion (RME) on craniofacial structures with bone scintigraphy in young adult female subjects. The material of the present study consists of scintigraphic records taken from 17 early adult females treated with RME. All patients had a bilateral posterior crossbite, transverse maxillary deficiency, deep palatal vault, and dental crowding at the beginning of the treatment. The age range of the patients was 16.1 to 18.8 years, and the mean age was 17.3 +/- 0.86 years. Bone scintigraphy records were obtained before RME (T1), during the splitting of the midpalatal suture (T2), and after the end of active widening period (T3). Repeated measure analysis of variance was used to assess the differences between the periods. In addition, Bonferroni multiple comparison tests were applied to the measurements at which F values were found to be statistically significant. According to the statistical analysis, significant activity changes were found in all regions studied and in all slices. The metabolic activity in all regions showed significant increases up to the separation of the midpalatal suture (T1-T2), whereas the metabolic activity exhibited a remarkable decrease (T2-T3) after the opening of the midpalatal suture. Scintigraphic records revealed an increase in the regions of interest scores during RME in all regions and all slices. Therefore, it can be speculated that RME has had not only dental effects but also skeletal effects on young adult patients.