Treatment Of Maxillary Transverse Deficiency Research Articles

Treatment of maxillary transverse deficiency combined with crossbite and severe crowding using maxillary skeletal expander: a case report

Treatment of maxillary transverse deficiency combined with crossbite and severe crowding using maxillary skeletal expander: a case report

Research progress in the treatment of maxillary transverse deficiency with combined orthodontic-orthognathic approach

In combined orthodontic-orthognathic treatment, the maxillary palatine suture is closed in most patients with insufficient maxillary width, and bony expansion of the maxilla cannot be achieved by dental expansion or rapid palatal expansion (RPE) which causes buccal inclination of the maxillary posterior teeth leading to unstable results. Therefore, segmental LeFort Ⅰ osteotomy and surgically assisted RPE are often used in clinical practice. In recent years, with the application of implant anchorage technology, implant anchorage assisted RPE has been gradually applied in orthognathic treatment. This article reviewed the indications, contraindications, complications, efficacy and long-term stability in different treatment approaches including segmental LeFort Ⅰ osteotomy, surgically assisted RPE and implant-supported maxillary skeletal expansion.

MISMARPE protocol: minimally invasive surgical and miniscrew-assisted rapid palatal expansion

ABSTRACT Objective: The purpose of this article is to present the MISMARPE technique, a new minimally invasive surgical procedure to treat maxillary transverse atresia in adult patients under local anesthesia and on an outpatient basis. Technique description: The technique consists of miniscrew-assisted rapid palatal expansion (MARPE) associated with a minimally invasive approach using maxillary osteotomies, latency and activation periods until the desired expansion is achieved. The present MISMARPE technique was performed in 25 consecutive cases with a success rate of 96%, yielding good skeletal outcomes with minimal trauma. The expander appliances, with their anchorage types, and a description of the surgical steps of the MISMARPE technique are presented. Conclusion: MISMARPE is a new and effective alternative for less invasive treatment of maxillary transverse deficiency in adults, compared to conventional surgery. Emphasis is placed on the importance of systematic and well-established protocols, for executing the procedures safely and predictably.

Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics.

Midpalatal corticotomy-assisted rapid maxillary expansion (MCRME) is a minimally invasive treatment of maxillary transverse deficiency (MTD) in young adults. However, the effect of MCRME on respiratory function still needs to be determined. In this study, we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics (CFD). Twenty patients with MTD (8 males, 12 females; mean age 20.55 years) had cone-beam computed tomography (CBCT) images taken before and after MCRME. The CBCT data were used to construct a three-dimensional (3D) upper airway model. The upper airway flow characteristics were simulated using CFD, and measurements were made based on the CBCT images and CFD. The results showed that the widths of the palatal bone and nasal cavity, and the intermolar width were increased significantly after MCRME. The volume of the nasal cavity and nasopharynx increased significantly, while there were no obvious changes in the volumes of the oropharynx and hypopharynx. CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment. Our results suggest that in these young adults with MTD, increasing the maxillary width, upper airway volume, and quantity of airflow by MCRME substantially improved upper airway ventilation.

Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient.

ABSTRACTIntroduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient.Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

Advance and review: miniscrew-assisted rapid palatal expansion

Rapid palatal expansion (RPE) is commonly used to correct transverse maxillary deficiencies and recognized as a reliable orthopedic procedure in children and adolescents. For adults, however, conventional RPE has been considered rarely successful and can produce undesirable dental effects. Along with the development of digital techniques and mini-implant anchorage, a novel method called miniscrew-assisted RPE (MARPE) has become available for the treatment of maxillary transverse deficiency in older patients recently. In this article, the biomechanical principles and indications of MARPE, the advances in device design, the clinical effects, the matters needing attention and limitations of this method, and the stability after expansion are discussed.

Orthognathic surgical procedures on non-growing patients with maxillary transverse deficiency

The treatment of maxillary transverse deficiency in post-pubertal patients has been an area of disagreement among orthodontists. Much of the controversy is over the timing of when it is appropriate for these patients to be referred to an oral and maxillofacial surgeon for an adjunctive surgical procedure or whether traditional orthodontic mechanics should be attempted. The decision, therefore, by an orthodontist of when to refer a patient for surgery appears to be an individual one. The question then becomes which of the three basic surgical procedures would be most appropriate for the patient. Specifically, consideration must be given to surgically assisted rapid palatal expansion, segmental LeFort I osteotomy, or mandibular midline osteotomy with constriction.

Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review

The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.

Skeletal and dentoalveolar changes in the transverse dimension using microimplant-assisted rapid palatal expansion (MARPE) appliances

Conventional rapid palatal expansion (RPE) has been proven to be a reliable treatment for correcting transverse maxillary deficiency in young patients. However, side effects including dental tipping and risk of periodontal problem limited its application to young patients after the pubertal growth spurt. Surgically assisted rapid palatal expansion (SARPE), a supplement to RPE, could be applied in skeletally mature patients. However, SARPE was an invasive method, and the morbidity, risks and cost related to surgical treatment might discourage many adult patients. The use of Microimplant-Assisted Rapid Palatal Expansion (MARPE) appliance, which can potentially avoid surgical intervention, is gaining popularity in treatment of maxillary transverse deficiency (MTD) in young adolescent patients. However, the literature on the skeletal and dentoalveolar changes with this appliance is scarce. To evaluate the immediate skeletal and dentoalveolar changes in the transverse dimension with the maxillary skeletal expander (MSE), a MARPE appliance with hybrid anchorage, using cone-beam computed tomography (CBCT). Twenty-two patients (11 males and 11 females, mean age 14.97 ± 6.16 years) with transverse maxillary deficiency were treated using the MSE (Biomaterials Korea, Inc., Seoul, Korea). The appliance consisted of a central expansion screw that were welded to four tubes that served as guides for microimplant placement. The microimplants were 1.8 mm in diameter and 11 mm in length. The longer length of microimplants permitted bicortical engagement of the palatal and nasal floor, reducing the force transmitted to the anchored teeth during expansion. The appliance activation varied with age and skeletal maturity of the patient. The expansion was terminated when 2–3 mm of overexpansion was achieved. CBCT scans were taken before treatment (T1) and immediately after expansion (T2). Measurements were taken to evaluate the amount of total expansion, skeletal expansion, and angular dental tipping at the first molar region. A total expansion of 5.41 ± 2.18 mm was achieved, 59.23 ± 17.75% of which was attributed to skeletal expansion (3.15 ± 1.64 mm) with the first molars exhibiting buccal tipping of 2.56 ± 2.64°. The use of MARPE appliances such as MSE can be used to correct transverse maxillary deficiency in adolescent patients with minimal dentoalveolar side effects.

Surgical treatment of maxillary transverse deficiency

Among the occlusal discrepancies, maxillary transverse deficiency is quite common in several reasons. The reasons are comprised of maxillary hypoplasia, thumb sucking habits, non-syndromic palatal synostosis and syndromal patients including cleft patients. Orthodontic treatment is used routinely to correct a deficiency in young patients while it has limitations for a skeletally mature patient. Surgical treatments help provide effective maxillary expansion to correct a deficiency in adults. Surgical methods can be categorized to segmental Le Fort I osteotomy and surgically assisted rapid maxillary expansion(SARME). Both methods seem successful but each method would have its own indication. We give a review on transverse maxillary deficiency and two surgical methods.

Stress distribution and displacement by different bone-borne palatal expanders with micro-implants: a three-dimensional finite-element analysis

The aim of this study was to analyze stress distribution and displacement of the maxilla and teeth according to different designs of bone-borne palatal expanders using micro-implants. A three-dimensional (3D) finite-element (FE) model of the craniofacial bones and maxillary teeth was obtained. Four designs of rapid maxillary expanders: one with micro-implants placed lateral to mid-palatal suture (type 1), the second at the palatal slope (type 2), the third as in type 1 with additional conventional Hyrax arms (type 3), and the fourth surgically assisted tooth-borne expander (type 4) were added to the FE models. Expanders were activated transversely for 0.25mm. Geometric nonlinear theory was applied to evaluate Von-Mises Stress distribution and displacement. All types exhibited downward displacement and demonstrated more horizontal movement in the posterior area. Type 3 showed the most transverse displacement. The rotational movement of dentoalveolar unit was larger in types 1 and 3, whereas it was relatively parallel in types 2 and 4. The stresses were concentrated around the micro-implants in types 1 and 3 only. Type 2 had the least stress concentrations around the anchorage and showed alveolar expansion without buccal inclination. It is recommended to apply temporary anchorage devices to the palatal slopes to support expanders for efficient treatment of maxillary transverse deficiency.

Adult Nonsurgical Maxillary and Concurrent Mandibular Expansion; Treatment of Maxillary Transverse Deficiency and Bidental Arch Constriction

Nonsurgical expansion of the maxillary transarch width in adults to correct posterior crossbite has been thought to be unsuccessful, unstable, and have undesirable side effects. In the first part of this article, 2 patients with bilateral crossbite who achieved 8-11 mm of maxillary expansion are described. Data from a large sample (47 adults) are reviewed and demonstrate successful and stable expansion with insignificant complications. In the second part of this article, nonsurgical maxillary and concurrent mandibular expansion is used in adults for the correction of constriction of both arches. Associated with arch constriction are incisor crowding, deficient anterior arch contour, dark buccal corridors, and lingual inclination of the posterior dentition. This group of signs is defined as bidental arch constriction syndrome, a common, but not previously described, malocclusion. Two cases demonstrate the malocclusion and its treatment. Data from 30 nonsurgical cases and 10 cases in which both jaws were expanded with surgical distraction are reviewed. There were no significant differences in the expansion achieved, as both expansion techniques were equally effective.

Surgical treatment of maxillary transverse deficiency: retrospective study of 14 patients

The diversity of the proposed techniques in the treatment of maxillary transverse deficiency in adults reflects the conflicting opinions about the primary area of resistance to maxillary expansion in the craniofacial skeleton. In order to evaluate the efficiency of the surgical expansion in which no osteotomies of the pterygomaxillary junction were made, we have carried out a retrospective study with 14 patients with maxillary transverse deficiency, who were treated from 2003 to 2006. In the study, models were made prior to and after surgery, and the intercanine and intermolar distances and the improvement of the interocclusal relationships were analyzed. Breathing function and the complications that occurred during and after the surgeries were also analyzed. All expansions were carried out according to pre-surgical planning so that expansion completely corrected the crossbite, resulting in the desired final occlusion for all patients. Intraoperative complications were limited to one Hyrax appliance deformation. Two patients had minor postoperative complications that included wound dehiscence and pain. Improvements in nasal breathing were observed in all patients that complained of breathing problems prior to the surgery. The satisfactory results obtained turns the surgical protocol described in this study recommended for the treatment of maxillary transverse deficiency in adults. Importantly, we found that pterygomaxillary osteotomy is not essential for maxillary expansion. The morbidity of the procedure was low with fairly minor complications, and surgically assisted rapid maxillary expansion was shown to improve nasal breathing.