Open Bite Research Articles

Improved Superelastic Wire (ISW) Treatment for Skeletal Class III Malocclusion with Anterior Open Bite and Missing Upper Left Incisor

Improved Superelastic Wire (ISW) Treatment for Skeletal Class III Malocclusion with Anterior Open Bite and Missing Upper Left Incisor

Skeletal Anterior Open Bite Attenuates the Chewing-Related Increase in Brain Blood Flow.

The masticatory function of patients with skeletal anterior open bite (OPEN) is reported to be impaired compared with that of patients with normal occlusion (NORM). In this study, we compared brain blood flow (BBF) in patients with OPEN and NORM and investigated the factors related to BBF during mastication in patients with OPEN. The study included 17 individuals with NORM and 33 patients with OPEN. The following data were collected: number of occlusal contacts, jaw movement variables during mastication, and BBF measured with functional near-infrared spectroscopy during chewing. The number of occlusal contacts, maximum closing and opening speeds, closing angle, and vertical amplitude were smaller in the OPEN than in the NORM group. Interestingly, BBF increased less in the OPEN group. Correlation analysis revealed that several parameters, including number of occlusal contacts and closing angle, were correlated with changes in BBF during mastication. These results suggest that not only occlusion but also jaw movement variables and factors related to masticatory muscles contribute to the chewing-related increase in BBF. In conclusion, BBF increases less during mastication in patients with OPEN than in those with NORM. In addition, the higher increase in BBF is correlated with jaw movement. Together, we discovered that OPEN exhibits significant adverse effects not only on masticatory function but also on brain function.

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.

Exploring Temporomandibular Disorders (TMDs) and Occlusion Debate in Dentistry: Biting Into Controversy.

Some conditions known as temporomandibular disorders (TMDs) affectsurrounding muscles and jaw joints. In dentistry, there has been discussion and research on the connection between TMDs and occlusion, which is how the upper and lower teeth meet. Although some dental experts have proposed a direct link between TMDs and occlusion, the specifics of this relationship are still unclear and have many facets. More particularly, the research facets of "occlusion" remain one of the most contentious subjects in TMDs. This abstract aims to provide an overview of TMDs and occlusion, summarizing the key points from the literature. The etiological factors contributing to the TMDs, including occlusal, psychological, and hormonal factors, are also analyzed. The second part of the article includes the concept of malocclusion, emphasizing its significance in masticatory function and overall health. Anterior open and posterior open bites and the potential influence of occlusal factors on TMDs are elucidated.

Association between self-reported oral habits and oral health related quality of life of adolescents in Ibadan, Nigeria.

Oral habits such as nail biting, thumb/digit sucking and teeth grinding could be harmful, and may lead to teeth misalignment, anterior open bite, protruded or flared upper anterior teeth especially if they persist into adolescence. Such orofacial dysfunction may result to impairment of the Oral Health Related Quality of Life (OHRQoL) of an individual. The extent to which oral habits affect the major domains of the self-reported outcomes remains understudied especially during adolescence, a unique period of growth, where there is increased aesthetic desire, increased self-awareness, and unique social and psychological needs. The aim of this study, therefore, was to determine the prevalence of oral habits and its association with oral health related quality of life of adolescents. This cross-sectional study was conducted among 700 adolescents aged 10 to 19 years (with mean age 14.6 (±1.3) years) attending 14 secondary schools in Ibadan, Nigeria. Data were collected using a self-administered questionnaire, which assessed sociodemographic characteristics of the students, oral habits and OHRQoL with Oral Health Impact Profile 5 (OHIP-5). Data were analyzed with SPSS and p value was at <5%. Mann Whitney U statistics was used to test for associations between OHIP-5 scores and presence or absence of oral habits. Logistic regression was used for multivariate analysis. A total of 363 (51.9%; 95%CI = 48.1%-55.6%) bite their nails, 216 (30.9%; 95%CI = 27.5%-34.4%) breathe with their mouth, 122 (17.4%; 95%CI = 14.7%-20.4%) suck their lips, 89 (12.7%; 95%CI = 10.3%-15.4%) grind their teeth together and 32 (4.6%; 95%CI = 3.1%-6.7%) sucked their thumbs. A total of 403 (81.1%) adolescents who engaged in at least an oral habit reported an impairment of their OHRQoL. Painful aching in the mouth was the most frequently affected OHRQoL item reported by the adolescents who engaged in oral habits. Those who sucked their thumbs (OR = 2.3, 95%CI = 1.1-4.7, p = 0.028) and those who sucked their lips were more likely to have poorer OHRQoL (OR = 1.6, 95%CI = 1.1-2.5, p = 0.024). Oral habits were prevalent among the adolescents and affected their OHRQoL. Those who sucked their thumbs and lips were more likely to report poorer OHRQoL than those who did not.

Effects of Occlusal Contact on Maxillary Alveolar Bone Morphology in Patients with and without Anterior Open Bite: A Cross-Sectional Study.

Background/Objectives: Anterior open bite (AOB) is characterized by the absence of occlusal contact between the maxillary and mandibular anterior teeth, while the posterior teeth are in contact when occluded. Here, we aimed to clarify the difference in maxillary alveolar bone morphology in adult patients with and without AOB. Methods: This cross-sectional study was conducted on 50 adults aged 18-39 years: 25 patients without AOB (control group; 13 males and 12 females; age: mean ± standard deviation [SD], 22.2 ± 4.5 years) and 25 patients with AOB (9 males and 16 females; age: 24.2 ± 6.4 years). Using cone-beam computed tomography images, the height of the maxillary alveolar bone crest in the anterior and posterior teeth and thickness of the alveolar cortical bone on the labial and palatal sides were measured and compared between the two groups. An independent t-test and Pearson's correlation analysis were used to examine statistical significance (p < 0.05). Results: The AOB group showed a significantly longer (p = 0.016) posterior alveolar crest and thinner cortical bone on the buccal (p < 0.001) and lingual (p = 0.009) sides of the anterior region and the buccal (p = 0.006) sides of the posterior region than the control group did. Moreover, a significant negative correlation (p = 0.046; r = -0.403) was observed between bite force and cortical bone thickness on the buccal side of the posterior region in the AOB group. Conclusions: It is suggested that the absence of occlusal contact in the anterior area influences the alveolar bone morphology of the maxilla.

The Evaluation of Occlusion Characteristic and Deleterious Oral Habits in 3- to 5-year-old Children

Aim: Malocclusion is a prevalent public health concern, impacting craniofacial growth and development, and significantly affecting the quality of life of children in terms of oral health. This study investigated the prevalence of malocclusion in children aged 3 to 5 years, aiming to understand its occlusal characteristics, deleterious oral habits, correlations, and their parents’ attitudes toward malocclusion. Materials and Method: This cross-sectional study included 275 children aged 3-5 and their parents. The occlusion characteristics of the children participating in the study, including the relationship of the primary molar and canine teeth, overjet, crossbite, deep bite and anterior open bite, were evaluated and recorded by a researcher. A 7-item questionnaire was administered to the parents to collect sociodemographic data and oral health habits of the children's parents. The chi-square test was used for statistical assessment of results. Results: The results revealed that 40.7% of the children had malocclusion during their primary dentition period. It was found that the most common malocclusion was deep bite (15.7%) and harmful oral habits, especially bruxism (16.3%), were commonly observed among children in the researched age group. Conclusion: The results of this study will play an important role in shaping future oral health planning, especially regarding malocclusions seen in the primary dentition. It is thought that the findings from the study will guide strategies to improve oral health and preventive measures.

Chronic secondary orofacial pain as the first symptom of chronic non-bacterial osteomyelitis in the mandible: a case report and literature review

Chronic non-bacterial osteomyelitis clinically manifests with pain, swelling and limitation of movement. When it affects the jaws, it can cause pain, similar to other orofacial conditions, requiring a correct differential diagnosis. The objective of this study was to report a clinical case of chronic secondary orofacial pain as the first manifestation of an inflammatory bone disease located in the mandible, in addition to discussing the diagnostic hypotheses, the pathophysiological aspects and the therapy. A 21-year-old male patient came to the service complaining of pain in the mandible, preauricular and temporal regions bilaterally with one year of evolution, associated with anterior open bite and psychological impairment. So, it was chronic orofacial pain secondary to non-bacterial osteomyelitis with a high rate of bone remodeling. Elevation of pro-inflammatory cytokines can lead to an increased power cycle of nociceptive signaling, chronic inflammation, and bone loss. Pro-inflammatory cytokines that originate in neuronal and glial cells can trigger effects such as chronic hyperexcitability, changes in the phenotypic expression of nociceptors and abnormal processing of noxious signals. The patient is still undergoing treatment and without pain. Careful assessment, ordering tests and multidisciplinary investigation are essential in the care of patients with chronic and complex orofacial pain.

Three-Dimensional Evaluation of Treatment Effects and Post-Treatment Stability of Maxillary Molar Intrusion Using Temporary Anchorage Devices in Open Bite Malocclusion.

Background: We investigated treatment outcomes and post-treatment stability in 10 patients with an anterior open bite and nonsurgical orthodontics. Methods: The patients underwent maxillary molar intrusion using temporary anchorage devices (TADs) to deepen the overbite due to mandibular autorotation. Lateral cephalograms and dental cast models were obtained before treatment (T0), immediately after it (T1), and >1 year after it (T2). Skeletal and dental cephalometric changes and three-dimensional movements of the maxillary dentitions were evaluated. Results: At T0, cephalometric analysis indicated that patients had skeletal class I with tendencies for a class II jaw relationship and a skeletal open bite. During active treatment (T0 to T1), the maxillary first molar intruded by 1.6 mm, the mandibular first molar extruded by 0.3 mm, the Frankfort-mandibular plane angle decreased by 1.1°, and the overbite increased by 4.1 mm. Statistically significant changes were observed in the amount of vertical movement of the maxillary first molar, Frankfort-mandibular plane angle, and overbite. Three-dimensional (3D) dental cast analysis revealed that the maxillary first and second molars intruded, whereas the anterior teeth extruded, with the second premolar as an infection point. In addition, the maxillary molar was tipped distally by 2.9° and rotated distally by 0.91°. Statistically significant changes were observed in the amount of vertical movement of the central incisor, lateral incisor, canine and first molar, and molar angulation. From T1 to T2, no significant changes in cephalometric measurements or the 3D position of the maxillary dentition were observed. The maxillary and mandibular dentitions did not significantly change during post-treatment follow-up. Conclusions: Maxillary molar intrusion using mini-screws is an effective treatment for open bite correction, with the achieved occlusion demonstrating 3D stability at least 1 year after treatment.

Pattern of malocclusion in patients with noma sequelae: The need for orthodontic and orthognathic therapy

Abstract Introduction: Noma is a gangrenous infection that destroys the orofacial structures and leaves the survivors with severe functional, psychosocial, and esthetic impairments. Malocclusion is one of the central sequelae that current Noma care often neglects. Aims: This study aimed to present the pattern of malocclusion in Noma survivors and highlight the role of orthodontic and orthognathic therapy in the management. Materials and Methods: This was a cross-sectional study conducted over 6 months. After obtaining institutional ethical approval, all noma survivors with permanent teeth, including complete upper and lower molars at least on one side, who presented for review were included in the study. Patients’ demographics, Angle class of malocclusion, and various malocclusions were recorded. Data obtained were analyzed using the statistical package for the social sciences (IBM SPSS) version 25. Results: There were 35 (54.7%) males and 29 (45.3%) females in the age range of 12–36 years and a mean ± standard deviation of 22.52 ± 6.01 years. Most patients, 52 (81.3%), have Angle class 1 molar relation. Protrusion of anterior teeth was present in 34 (53.1%), posterior crossbite in 8 (12.5%), upper and lower teeth crowding in 11 (17.2%), isolated upper anterior crowding in 9 (16.7%), isolated lower anterior crowding in 4 (6.3%), and open bite in 5 (7.8%). Other dental malalignments, such as rotations and tooth displacement, were invariably present in 34 (53.1%). Conclusion: Malocclusion in noma survivors constitutes one of the most observable problems of noma sequelae. Orthodontic and orthognathic therapy could promote these patients’ surgical, esthetic, and psychosocial rehabilitation.

Creative biomechanics for complex cases

Orthodontic biomechanics play a crucial role in achieving successful outcomes, especially in complex cases requiring precise control of tooth movements. This article explores force system analysis based on the moments and forces around the center of resistance and emphasizes traditional and contemporary approaches in orthodontic biomechanics, focusing on key tooth movements such as bite opening, space closure, retraction, protraction, intrusion, and extrusion.In complex borderline cases involving nonsurgical treatment, this article addresses the significance of total arch distalization for maximum retraction, total arch intrusion for vertical control, total arch extrusion for enhancing maxillary incisor display, lever arm mechanics for achieving incisor torque control, and total arch protraction for improving the maxillary incisor show.Patient-specific factors, efficient biomechanics, and a comprehensive understanding of the limitations of treatment modalities are emphasized in pursuit of optimal orthodontic outcomes.

Clinical application of a lingual retractor with temporary anchorage devices (TADs) for patients with lip protrusion and anterior open bite

Anterior open bite (AOB) is considered one of the most difficult malocclusions to correct and achieve successful and stable results. Various treatment approaches have been proposed for the treatment of AOB in adults. Intrusion of the entire maxillary dentition is necessary for AOB patients with severe incisor exposure. In previous reports, a labial appliance with temporary anchorage devices (TADs) implanted in various positions has been used to achieve total intrusion of the maxillary dentition. This article describes the design and biomechanics of an anteroposterior lingual retractor (APLR) to attempt retraction of anterior teeth and total intrusion of maxillary dentition after premolar extraction in patients with both lip protrusion and AOB and the functions of each component of APLR is considered. When force is applied between the anterior lever arm of the APLR and a TAD in the midpalatal area, the anterior teeth are intruded and retracted with torque control. Because the direction of the APLR force and the guide bar are not parallel, intrusive force is generated in the posterior teeth. Due to this total intrusion of the maxillary dentition, the mandible is rotated counterclockwise, improving AOB with severe incisor exposure. Various cases are presented in which APLR was applied to AOB patients, and the clinical considerations behind the treatment are explained in detail.

Literature Study : Histopathology Analysis of Rabies Disease (2014 - 2022)

Background: Rabies is a contagious and zoonotic disease caused by Lyssavirus, a neurotropic, negative-sense, single-stranded RNA virus. Rabies infects most mammals through the transmission of saliva from a rabid animal that enters the body of a healthy animal through an open wound, bite, scratch, or direct contact. A post-mortem diagnosis and evaluation are crucial for establishing regional statistical data in order to design a robust strategy for combating rabies. Histopathology has long been known to be an invaluable source of information regarding the destructive impact of rabies in nervous tissue. In addition to other ante-mortem evaluations, a correlation between clinical signs, gross pathological findings, and histopathological findings must be established to achieve the maximum target of combating rabies. Purpose: This study aims to analyze and compare gross pathological findings and histopathological findings in the literature published between 2014 and 2022. Methods: A comparison between gross pathological findings and histopathological findings was conducted on case studies from 2014 to 2022. Anamnesis and clinical signs were obtained as supporting data. The findings were presented as percentage to identify the predominant pathological signs. Results: A review of four case studies revealed that paralysis, hyperesthesia, gait abnormality, and muscle tremor were the most commonly observed signs (50%). Only two case studies revealed gross pathological findings, including meningeal congestion and cerebellar hemorrhage. Eight studies identified the intracytoplasmic negri body in Purkinje cells as the most commonly observed histopathological finding (100%). Conclusion: The primary clinical signs and gross pathological findings associated with rabies are typically regarded as non-specific. Histopathology revealed the intracytoplasmic Negri body in Purkinje cells as the most commonly observed finding (100%).

Clear aligners for class III malocclusion and severe open bite camouflage: A case report

Clear aligners for class III malocclusion and severe open bite camouflage: A case report

The Effectiveness of Aligners in the Treatment of Anterior Open Bite in Adult Patients: A Systematic Review and Critical Appraisal

An anterior open bite is a dental malocclusion, the diagnosis of which is fundamental for its treatment. With the evolution of artificial intelligence, it is possible to treat it through the Invisalign G4 protocol, depending on the degree of severity. The aim of this study was to perform a systematic review, based on the PICO strategy, to evaluate the effectiveness of aligners and accessory devices in adult patients with anterior open bites. The search was carried out in the following databases for publications over the last ten years: PubMed, Web of Science, Cochrane Library, and LILACS. The inclusion criteria were clinical studies evaluating adults with anterior open bites (overbites &lt; 0 mm) and orthodontic studies with aligners. The exclusion criteria were studies of cases with dentofacial deformities, previous orthodontic treatment, history of surgery/trauma, or systemic diseases that affect craniofacial growth, as well as animal studies, reviews, and clinical cases. The selection was carried out separately by two researchers. In the four databases, 108 articles were obtained. By reviewing the titles and abstracts and applying the exclusion criteria, 91 articles were eliminated. The seven resulting articles were submitted to the inclusion criteria, two of which were excluded due to their lack of patients presenting an open bite and the absence of aligner treatment. According to the PRISMA method, five studies were selected. The collected data showed an increase in overbites with the use of aligners. The bias assessment was performed with the ROBINS-I tool, indicating a moderate risk of bias. The included studies demonstrated the effectiveness of aligners in the treatment of adults with mild or moderate open bites; however, due to the lack of scientific evidence, it is necessary to carry out randomized studies with the same standardized variables.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study.

Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren. A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling. The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (β = -.184). Better contextual characteristics (β = -.135) and greater overjet (β = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (β = .154). Psychosocial status mediated the relationship of greater overjet (β = .036), contextual factors (β = .024) and parental/guardian schooling (β = -.027) with TDIs. Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Orthognathic Surgery Trending: Retrospective Ten Years Cases Analysis in Nineveh Province, Iraq.

The study aimed at analyzing patient's case sheets in regard to the incidence of skeletal discrepancy present in cases and its relation with the demographic profile of the sample. All these are chronicled for more than 10 years periods. This is a retrospective study analysis of the orthognathic case sheets for more than 10 years period. The total numbers of patients are 678. Patient's case sheet was already prepared by the Multi-Disciplinary Team Orthognathic Surgery Clinic in Al-Salam Teaching Hospital, which is the only authorized committee in Nineveh Health Directorate. The highest age percentage is between (18 and 27y/76%). Angle class III cases are the uppermost cases (36%) from the total. A significant P value is clear at the level ≤0.05 and ≤0.01 between surgery type and discrepancy in anterior segmental osteotomies (upper and lower) which is performed in bi-maxillary protrusion cases and Angle class II cases (0.01**). Similarly, anterior segmental osteotomies (upper jaw only) which are indicated in both open bite and Angle Class II cases documented as a statistically significant P value (0.02*). The positive correlation is shown in all variables with the disharmony or facial discrepancies. Esthetic and beauty as causes for treatment recorded more than function in relation to time series. This study documents that patients with skeletal class III accounted for the largest percentage (64%) in the study group. A high increase in patients number seeking treatment for their discrepancy is obvious with time from 2009 till 2022.

Breastfeeding and non-nutritive sucking habits as covariates of malocclusion in the primary dentition among Tanzanian children: A cross-sectional study

Introduction: Studies on the effect of feeding practices and sucking habits on malocclusion traits in the primary dentition of pre-schoolchildren from developing countries are scarce. Purpose: Assessing the association of feeding and sucking habits with malocclusion traits, and the association of malocclusion traits with observed oral functional problems. Methods: It was a cross-sectional survey of children aged 3-5 years residing in Kinondoni and Temeke Districts of Dar es Salaam region in Tanzania. Data was analyzed using Statistical Package for Social Scientists, SPSS version 21.0. Univariate analysis was applied to generate frequencies of different variables. Cross tabulations and Chi-square statistics were used to assess bivariate relationships and multivariate analyses were performed by multiple logistic regression. Results: Most pre-schoolchildren (82.5%) were breastfed for less than two years. A history of non-nutritive sucking habits was reported in 28.1% of the children, mostly in boys than girls (33.6% versus 21.8%, respectively. The current non-nutritive sucking habits were reported in 17.8% of the participants. Overall, malocclusion traits were most significantly seen in children who were breastfed for less than two years, compared with those who were breastfed for two years or more (48.5% versus 27.3%, respectively). The presence of various malocclusion traits was significantly found among most of the children who had a history of non-nutritive sucking habits, compared with those who had never performed the habits (65.9% versus 38.6 %, respectively). In the logistic regression analyses, children who were breastfed for a shorter duration (&lt;2 years), their probability of being found with different traits of malocclusion in the primary dentition was almost three times that for those who were breastfed for a longer duration (≥ two years). Also, children who were not actively performing non-nutritive sucking habits were less likely to have an open bite compared with those who were actively performing non-nutritive sucking habits. An open bite in children was significantly associated with speech problems (p&lt;0.01) and swallowing with tongue thrusting (p=0.000). Conclusion and recommendations: Most of the children who were breastfed for a shorter duration and children who had non-nutritive sucking habits were found with various malocclusion, compared with those who were breastfed for a longer duration and those who had no non-nutritive sucking habits. It is crucial to recommend exclusive breastfeeding for up to 6 months and continuation of breastfeeding practice, possibly for up to 2 years of age due to its nutritional, immunological, and stomato-gnathic system developmental benefits.

Properties and Application of the Gummetal Wire for the Treatment of an Open Bite—Brief Narrative Review and Case Report

The swift integration of ‘Gummetal’ into the orthodontic armamentarium can be attributed to its distinct advantages as an entirely new Ti-Nb-based beta titanium alloy. Developed by Toyota Central R&amp;D Labs and publicly revealed in April 2003, this innovative material is rapidly reshaping orthodontic practices. Its sui generis properties allow its use as a potential substitute for the Multi-Loop Edgewise Archwire (MEAW) method. Three-dimensional orthodontic movement using this new alloy could eliminate the disadvantages of the MEAW method, such as its technical complexity and patient discomfort. In our comprehensive review of the current literature, we examined relevant publications sourced from the PUBMED database and explored one seminal work on Gummetal from the journal literature. Characteristic properties of Gummetal, such as its exceptional flexibility, superelasticity, and malleability (approximately 10 times greater than conventional metals), enable seamless formation of bends without posing challenges, thereby allowing precise control over orthodontic force application. Also worthy of mention are Gummetal’s biocompatibility and non-toxic properties, along with its low coefficient of friction. The wire seems to be a relatively easy way to achieve good occlusion. Its usage does not require extensive experience in terms of manual skill, and it is not time consuming. Diligent usage of any prescribed plastics by the patient is crucial to prevent complications and ensure successful orthodontic outcomes.

Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)-A Retrospective Analysis of 185 Cases Treated at a Single Center.

Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.