Transverse changes after surgically assisted rapid palatal expansion

The aim of this retrospective study was to investigate the amount of skeletal and dental expansion in patients submitted to surgically assisted rapid palatal expansion (SARPE). The sample consisted of 21 patients (14 female and seven male) with a mean age of 25.4 years (range 17.4–41.8 years). Postero-anterior (PA) cephalograms were taken pre-expansion (T1), immediately after expansion (T2), and at post-expansion retention of 120 days (T3). SARPE promoted significant transverse skeletal changes, which were maintained from T2 to T3. Dentoalveolar expansion and dental tipping were also observed in the region of the first molars and first premolars; however the net effect at the first molars was significantly less than that at the first premolars. No statistically significant effect on the width of the nasal cavity was observed. The findings indicate that peculiarities inherent to dental effects may influence the clinical options for SARPE. Skeletal expansions with SARPE were significant and stable. Dental changes were different between molars and premolars. The transverse changes after SARPE should be observed for future procedures related to the retention and the completion of orthodontic treatment.     

手术辅助快速扩弓矫治上颌横向发育不足的临床疗效分析

目的:评价手术辅助快速扩弓矫治成人上颌横向发育不足病例牙齿和基骨的变化。方法:上颌发育不足患者20例(男13例,女7例)按年龄分为扩弓组和手术组,扩弓组(平均年龄12.51±0.82岁)行矫形快速扩弓治疗;手术组(平均年龄19.07±2.54岁)行手术协助快速扩弓治疗。所有患者治疗前后摄头颅定位正侧位片和咬合片,头影测量分析、比较。结果:两组病例均有明显的扩弓效果,手术组牙弓宽度增加更为显著,扩弓组牙弓长度增加明显,但组间均无显著性差异;治疗前后,手术组B点显著后移,而扩弓组B点前移,组间有显著性差异(P<0.05);治疗前后,手术组腭平面后旋,扩弓组腭平面前旋,组间有显著性差异(P<0.01);治疗前后,两组病例上颌切牙均内倾,组间无显著性差异。结论:手术协助快速扩弓治疗成人上颌横向发育不足,可取得良好的扩弓效果;对上下颌骨、上颌切牙在矢状面的改变更有利于III类错畸形的矫正;在病例的选择上,更适用于低角病例。     

手术辅助上颌骨快速扩弓对鼻气道流场特征的影响

目的： 采用计算机数值模拟方法,研究手术辅助上颌骨快速扩弓对鼻腔气流动力学特征的影响。方法： 选择8例上颌骨横向发育不足,伴一侧或双侧后牙反的成人患者进行手术辅助上颌快速扩弓。所有研究对象均在治疗前（T1）、扩弓保持3个月后（T2）拍摄螺旋CT,采用Mimics10.0软件建立上气道三维模型,并利用ANSYS14.0软件系统对三维气道进行网格划分、流场数值模拟以及计算模拟结果的后处理,以获得鼻腔内气流速率、压力,鼻腔各截面面积、鼻腔容积和鼻阻力数据。采用SPSS 16.0 软件包中的配对t检验比较T1、 T2时期鼻气道气流场参数的改变。结果： 扩弓后鼻腔整体流速趋于稳定,流速较治疗前减小;术前鼻腔内多处见湍流形成,而术后则较少见湍流及涡流形成;鼻腔负压绝对值显著减小（P<0.05）,鼻腔横截面积及鼻腔容积增加,且鼻阻力显著降低（P<0.05）。结论： 手术辅助快速扩弓可对鼻气道形态及气流动力学特征产生一定影响,有利于鼻气道通气功能改善。     

采用超声骨刀在局部麻醉下行外科辅助上颌骨快速扩弓术的临床应用

目的 探讨采用超声骨刀在局部麻醉下进行外科辅助上颌骨快速扩弓（SARME）手术的可行性。方法 选择14例上颌骨横向发育不足的患者（其中男性6例,女性8例）为研究对象,在局部麻醉下用超声骨刀行 SARME手术,手术方式采用腭中缝截骨术+侧方骨皮质切开术+双侧翼颌连接截骨术。采用问卷调查方式调查患者的术中感受。结果 所有患者的SARME手术均在门诊手术室采用局部麻醉完成,患者均耐受并配合手术。超声骨刀损伤小,可以精确截骨,术后反应小。问卷调查结果显示,术中没有或者仅感觉到轻度震动感的有8例（占 57.14%）;术中没有或仅感觉到轻度疼痛和牙齿酸痛的有12例（占85.71%）;对超声骨刀的声音无畏惧感或仅有轻度畏惧感的有 11例（占78.57%）。患者术前和术后6个月牙弓宽度的测量值显示手术扩弓的效果非常明显。结论 利用超声骨刀在局部麻醉下行SARME手术是可行的,但需要更多病例的实践和更长时间的随访。     

Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.

Objective

To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).

Material and Methods

Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.

Results

Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.

Conclusions

The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).     

Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea,and their correlations

PurposeTo investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA).Materials and methodsThe study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05.ResultsA 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA.ConclusionIt appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.     

Bone-borne surgically assisted rapid maxillary expansion: A retrospective three-dimensional evaluation of the asymmetry in expansion

Purpose

Asymmetrical expansion occurs in patients treated with Surgically Assisted Rapid Maxillary Expansion (SARME). In the clinical setting, this asymmetrical expansion is seen in multiple directions. However, the frequency, actual directions and amount of asymmetry are unclear. Hence, the aim of this study was to analyze the directions and amount of asymmetrical lateral expansion in non-syndromic patients with transversal maxillary hypoplasia on employing bone-borne transpalatal distraction by means of SARME. Treatment involved corticotomies of all four bony supports, including pterygomaxillary disjunction.

上颌快速扩弓的生物力学研究进展

上颌快速扩弓是临床上常用的治疗方法。上颌骨邻近组织结构复杂,而快速扩弓的矫治力作用于牙和腭部再通过骨和软组织的传导分散到整个上颌骨及其周围组织,因此其生物力学作用机制亦十分复杂。下面就其生物力学原理的国内外研究进展进行综述,以期对临床医师应用该法有所帮助。     

外科辅助上颌骨快速扩弓对鼻气道和上颌复合体影响的系统评价

目的 评价外科辅助上颌骨快速扩弓对鼻气道和上颌复合体的影响.材料和方法 我们计算机检索和手动检索以下数据库:PubMed,ISI Web of Knowledge,Ovid,EBSCO Dentistry & Oral Science Source,Cochrane Library and Cochrane Central Register of Controlled Trials (CENTRAL),纳入采用外科辅助上颌骨快速扩弓治疗的研究,要求受试者人数＞10.依据方法学质量评价量表对纳入的文献进行质量评价.结果 初步检索后获得111篇相关的文献,最终对符合纳入标准且方法学质量评价得分较高的4篇文献的4个结果进行Meta分析.结果表明扩弓后,鼻腔后部容积、使用鼻粘膜减充血剂后鼻腔后部最小横截面积、牙弓前后部宽度均增加显著(P＜0.05).结论 从本研究Meta分析中得出结论:随着上颌基骨和牙槽骨的增宽,外科辅助上颌骨快速扩弓增加鼻腔后部最小横截面积并显著增加鼻腔容积,从而减小鼻气道阻力.     

Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion

ObjectivesTo evaluate changes in dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion (MARME) and observe correlations between changes of upper airway and vertical skeletal pattern in young adults.Materials and MethodsIn this retrospective study, 22 patients (mean age, 22.6 ± 4.5 years; 4 male 18 female) with transverse discrepancy underwent MARME. Cone beam computed tomography was taken before and 3 months after expansion. Vertical and horizontal dimensions and volume of the nasal cavity, nasopharyngeal, retropalatal, retroglossal and hypopharyngeal airway were compared before and after MARME. Correlations between changed volume and dimensions were explored, as well as the vertical skeletal pattern.ResultsNasal osseous width, maxillary width, volume of the nasal cavity and nasopharynx increased significantly (P < .05). Enlarged nasopharyngeal volume correlated with increased nasal width at the PNS plane (P < .05). There were no correlations between expanded volume and maxillary width. No measurements except nasal cavity volume had a correlation with Sum angle. Increased maxillary width correlated negatively with hard palate thickness (P < .05).Conclusions(1) MARME caused an increase in volume of the nasal cavity and nasopharynx, with expansion of nasal osseous width and maxillary width. (2) Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed no direct relation with increased volume. (3) In this study, it was unclear about the association between changes of the upper airway and vertical skeletal pattern because of complex structures. (4) Palate thickness affected skeletal expansion of the maxilla in MARME.     

Dentofacial changes from fan-type rapid maxillary expansion vs traditional rapid maxillary expansion in early mixed dentition: A prospective clinical trial

Objective:To test the null hypothesis that there is no difference between the effects of fan-type rapid (FRME) and rapid maxillary expansion (RME) used with an acrylic bonded expansion appliance on dentofacial structures in early occlusal stages.Materials and Methods:This was a prospective clinical trial. The FRME group had an anterior constricted maxillary width with a normal intermolar width, and the RME group had bilateral constricted maxillary width. The FRME group consisted of 20 patients (mean age, 8.96 ± 1.19 years), and the RME group consisted of 22 patients (mean age, 8.69 ± 0.66 years). Lateral and frontal cephalometric radiographs and dental casts were taken before and after expansion and 3 months after completing treatment for each patient. The data were compared using repeated-measures analysis of variance. The paired-samples t-test was used to evaluate treatment and retention effects, and the independent samples t-test was used to consider the differences between the two groups.Results:The maxilla moved downward and forward in both groups. The nasal cavity and maxillary width were expanded more in the RME group, and there were only a few relapses in this group during the retention period. There was significant labial tipping of the upper incisors in the FRME expansion group. The expansion of intercanine width was similar in both groups, but the expansion of intermolar width was significantly greater in the RME group.Conclusion:The null hypothesis was rejected. There was a difference between the effects of FRME and RME used with an acrylic bonded expansion appliance on dentofacial structures in the early occlusal stages.     

Impact of surgically assisted rapid mandibular expansion on the temporomandibular joint - A retrospective study

This study evaluates the impact of tooth-borne Surgically Assisted Rapid Mandibular Expansion (SARME) on the temporomandibular joint (TMJ) function and condylar morphology.Medical records of patients who received a SARME between 2014 and 2018 are retrospectively reviewed concerning functional problems. Morphological changes of the condyles are analyzed by means of surface registration of 3D reconstructed CBCT scans preoperatively and one-year postoperatively, and correlated to functional outcome.In 68 patients data are complete. The risk of TMJ dysfunction is slightly increased from 18 to 25% at a mean of 14 months after SARME. This is attributed to an increase in the number of minor problems (75–82%). The presence of complaints before SARME is the only identifiable risk factor for also having complaints after the intervention (p = 0.0019). In one patient with pre-existent TMJ dysfunction complaints deteriorated after SARME. After SARME no cases of extended condylar resorption are described. There is no correlation between morphological condylar changes and the prevalence of TMJ dysfunction (p = 0.7121 for appositional and p = 0.3038 for resorptive changes). However, appositional and resorptive changes at the condylar head appear to correlate with growth potential, based on age, gender and skeletal deformity (p < 0.0001 and p = 0.0154 respectively).Within the limitations of the study it seems that SARME does not have a negative impact on TMJ function or condylar integrity and, therefore, the choice for or against this approach can be made without considering consequences for TMJ a major issue for the decision.     

Segment tilting associated with surgically assisted rapid maxillary expansion

This study aimed to evaluate, via computed tomography, the direction and magnitude of the segmental tilting that may occur after surgically assisted rapid maxillary expansion (SARME) in patients with a transverse maxillary deficiency. Thirty adult patients with a transverse maxillary deficiency greater than 5 mm were treated by SARME. The procedures consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopaedic device postoperatively. Axial and coronal images were obtained before and 6 months after SARME to evaluate the segment tilting. The greatest expansion occurred in the most inferior (5.4 ± 1.1 mm) and anterior (4.0 ± 1.3 mm) regions of the maxilla. The expanded segment tilted outward inferiorly and anteriorly in coronal and axial images, respectively. The segment tilting was 2.0 mm (2.3%) inferiorly and 3.1 mm (12.8%) anteriorly. It can be concluded that an outward tilting occurs in the most inferior and anterior portions of the maxilla during SARME procedures. Hence the direction and magnitude of such segmental tilting must be considered preoperatively when determining the surgical objectives.     

Tunnel technique through three vertical buccal incisions to reduce nasolabial changes due to surgically assisted rapid palatal expansion

The aim of this technical note is to present a minimally invasive approach to the maxilla for segmental Le Fort I osteotomy in surgically assisted rapid palatal expansion (SARPE). This approach reduces the nasolabial changes that occur with the traditional circumvestibular approach.     

种植钉辅助上颌快速扩弓治疗年轻成人上颌牙弓狭窄的CBCT分析

目的 探讨种植钉辅助上颌快速扩弓治疗年轻成人上颌狭窄的效果.方法 样本包括15.5～28.0岁上颌骨性狭窄病例10例(男3例,女7例),平均年龄(20.1±5.4)岁.使用种植钉辅助上颌快速扩弓技术,分别于治疗前、扩弓后和保持3个月后拍摄CBCT,并对资料进行统计分析.结果 扩弓后腭中缝前部和后部分别增加3.49 mm和2.94 mm,后部腭中缝增量占扩弓器扩大量的47.9％,后部腭中缝增量占第一磨牙间宽度增量的52.3％.鼻腔宽度、上颌基骨和牙槽宽度扩弓后增加(P＜0.05),且保持三个月后增加量无明显改变.牙槽骨高度变化无统计学意义(P＞0.05).结论 种植钉辅助上颌快速扩弓能有效开展年轻成人腭中缝,矫正骨性牙弓狭窄,并减少牙支抗扩弓引起的副作用.     

Immediate dental and skeletal influence of distractor position on surgically assisted rapid palatal expansion with or without pterygomaxillary disjunction

The outcome of surgically assisted rapid palatal expansion (SARPE) can be affected by pterygomaxillary disjunction (PMD) and the distractor position. In this study, SARPE was performed, with or without PMD, in 20 fresh cadaver heads. Transverse expansion was conducted twice using a bone-borne distractor in the anterior and posterior positions, resulting in four groups (n = 10). Cone beam computed tomography scans were completed before and after SARPE to evaluate maxillary changes. A comparative anterior decrease and posterior increase in midpalatal opening resulted from SARPE with PMD combined with a posteriorly placed distractor. Significant differences in the internal transverse changes were found between the two SARPE techniques combined with an anterior distractor at the level of the premolars and molars for alveolar ridge width (P = 0.040, P = 0.024), and at the level of the molars for the dental crown width (P = 0.017) and corresponding tooth cusp width (P = 0.018). In contrast, using a posteriorly placed distractor led to a significant difference for tooth cusp width only (P = 0.050). No statistically significant differences were found between external transverse changes or between distractor positions. PMD is more important in achieving a more uniform and parallel transverse expansion pattern than the distractor position. However, a posterior distractor seems to intensify the effects of PMD.     

The effect of surgically assisted rapid maxillary expansion on sleep architecture: an exploratory risk study in healthy young adults

Maxillary transverse deficiencies (MTD) cause malocclusions. Rapid maxillary expansion treatment is commonly used treatment for correcting such deficiencies and has been found to be effective in improving respiration and sleep architecture in children with obstructive sleep apnoea (OSA). However, thus far, the effect of surgically assisted rapid maxillary expansion (SARME) treatment on sleep architecture and breathing of normal subjects has not been assessed. We hypothesised that sleep quality will improve after maxillary expansion treatment. The objective of this study is to access the effect of maxillary expansion treatment on sleep structure and respiratory functions in healthy young adults with severe MTD. This is a prospective and exploratory clinical study. Twenty‐eight consecutive young adult patients (15 males and 13 females, mean age 20·6 ± 5·8 years) presenting with severe MTD at the orthodontic examination were recruited into the study. All the participants underwent a standardised SARME procedure (mean expansion 6·5 ± 1·8 and 8·2 ± 1·8 mm, intercanine and intermolar distance, respectively) to correct malocclusion caused by MTD. An overnight in‐laboratory polysomnography, before and after the treatment, was performed. The mean follow‐up time was 9 months. The main outcome parameters were the changes in sleep architecture, including sleep stages, arousals, slow‐wave activity (SWA) and respiratory variables. Before surgery, young adult patients with MTD presented no evidence of sleep breathing problems. At baseline sleep recording, 7 of 28 (25%) had apnoea‐hypopnoea index (AHI) ≥ 5 events per hour. No negative effect of the SARME was observed in questionnaires or sleep laboratory parameters. In the patients with a higher baseline AHI (AHI ≥ 5 h of sleep), we observed a reduction in AHI after surgical treatment (P = 0·028). SARME did not have a negative effect on any sleep or respiration parameters in healthy young individuals with MTD. It normalised the breathing index in the patients with a mild AHI index.     

Influence of activation protocol on perceived pain during rapid maxillary expansion

Objective:To investigate the influence of two different activation protocols on the timing and intensity of pain during rapid maxillary expansion (RME).Materials and Methods:A total of 112 prepubertal patients (54 males and 58 females, mean age 11.00 ± 1.80 years) with constricted maxillary arches underwent RME with two different activation protocols (group 1: one activation/day; group 2: two activations/day). Patients were provided with a numeric rating scale (NRS) and the Faces Pain Scale (FPS) to correctly assess their daily pain.Results:Subjects treated with RME at two activations/day reported statistically significantly greater amounts of pain than subjects treated with RME at one activation/day. Differences related to gender and skeletal maturity were found.Conclusion:The choice of activation protocol influences the perceived pain during RME, and less daily expansion is correlated to less pain. Pain reported during RME could be influenced by skeletal maturity and gender of the subjects under treatment.