Long-term results of surgically assisted maxillary protraction vs regular facemask

Objective:To evaluate the short- and long-term treatment results of rapid maxillary expansion (RME) and surgical assistance during maxillary protraction with a facemask (FM).Materials and Methods:This study was carried out in 28 patients (12 male, 16 female) with maxillary retrognathism, anterior crossbite, and Class III skeletal and dental malocclusion characteristics. Seventeen patients (9 male, 8 female) with mild maxillary retrognathism were treated by RME and FM. The other 11 patients (8 female, 3 male), who had moderate to severe maxillary retrognathism, were treated with surgically assisted FM treatment. Patients treated with RME and FM were recalled after 5.64 years, and the surgically assisted FM group was recalled after 6.08 years. Cephalometric films taken before treatment (T₀), right after maxillary protraction (T₁), and at recall (T₂) were used to evaluate and compare the results.Results:In the short term, good maxillary advancement and a shorter treatment period were achieved with surgically assisted FM therapy. However, in the long term, maxillary advancement and some soft tissue improvements were lost. On the other hand, in the RME and FM protraction group, maxillary advancement and soft tissue improvement were well maintained.Conclusion:In the short term, statistically significant maxillary advancement was achieved with surgically assisted maxillary protraction. However, in the long term, these sagittal changes were not stable, whereas RME and FM provided stability.     

Dentofacial effects of two facemask therapies for maxillary protraction: Miniscrew implants versus rapid maxillary expanders

Objective:To compare the dentofacial effects of maxillary protraction with two facemask therapies in growing Class III patients: facemask in association with miniscrew implants (MSI/FM) and facemask with rapid maxillary expanders (RME/FM).Materials and Methods:Forty-three Chinese patients with Class III malocclusion and maxillary deficiency were randomly assigned to a MSI/FM sample of 20 patients and a RME/FM sample of 23 subjects. The changes in dentofacial cephalometric variables from the beginning (T1) to the end of treatment (T2) were compared with t-test for paired samples in both groups and for independent samples between the two groups.Results:No significant cephalometric differences were observed between the two groups in active treatment effects except for maxillary dental variables. However, significant favorable changes in both maxillary and mandibular skeletal components were noted in two groups after treatment. Sagittal measurements showed the maxilla was advanced, mandibular projection was reduced, and the relative sagittal intermaxillary discrepancy improved. Patients experienced additional unfavorable outcomes of clockwise rotation of the mandible as well as retroclination of the lower incisors. The soft tissue profile was improved remarkably in both groups. Proclination of the maxillary incisors and mesialization of the maxillary dentition were significantly different between the two groups. The increases in U1-SN, U1-VR, and U6-VR were 6.41°, 2.78 mm, and 1.24 mm less in the MSI/FM group than in the RME/FM group, respectively.Conclusions:Compared with the RME/FM therapy, the MSI/FM protocol using a smaller magnitude of protraction force improves skeletal relationships and soft tissue profile and reduces the undesired dentoalveolar effects.     

Short-term effects produced by rapid maxillary expansion and facemask therapy in Class III patients with different vertical skeletal relationships

Objective:To evaluate the dentoskeletal short-term effects of rapid maxillary expansion and facemask therapy (RME/FM) in a sample of Class III patients showing different vertical skeletal relationships.Materials and Methods:Seventy-nine patients (35 females and 44 males) having Class III malocclusion were consecutively treated using RME/FM therapy with application of the protraction force in a downward and forward direction and inclination of about 30° to the occlusal plane. All patients were evaluated at the beginning (T1; mean age, 7.7 years) and at the end (T2; mean age, 9.2 years) of orthopedic therapy and divided into three groups according to their vertical skeletal relationships: normal group (NG), hypodivergent group (HypoG), and hyperdivergent group (HyperG). Statistical comparisons between the three groups were performed on the starting forms (T1), the final forms (T2), and the treatment changes (T1–T2) using the ANOVA with Tukey''s post hoc tests.Results:Favorable modification in terms of maxillary advancement (changes in SNA ranging from 1.4° to 1.8°) and intermaxillary sagittal skeletal relationships (changes in Wits appraisal ranging from 2.5 mm to 3.5 mm) were recorded in all groups. The three groups showed no statistically significant differences in changes in either sagittal or vertical skeletal variables.Conclusions:The various vertical skeletal features do not influence the short-term outcomes of RME/FM therapy.     

Dimensional changes of maxillary sinuses and pharyngeal airway in Class III patients undergoing bimaxillary orthognathic surgery

Objective:To evaluate the pharyngeal airway and maxillary sinus volume changes after mandibular setback surgery combined with maxillary advancement and/or impaction surgery.Materials and Methods:Seventeen Class III skeletal patients (11 females, 6 males) who required bimaxillary orthognathic surgery were selected. Volumetric measurements were performed using cone beam computed tomography (CBCT) scans preoperatively and 3.9 ± 0.87 months postoperatively. All the CBCT scans were assessed and analyzed using MIMICS 14.0 software. Preoperative and postoperative volumes of pharyngeal airway and maxillary sinuses and the relationship between the amounts of surgical movement of the jaws and the above volumes were statistically evaluated.Results:The pharyngeal airway area presented no significant change except for the lower and total pharyngeal airway volumes in males, in whom a significant decrease was observed (4196.27 ± 2061.11 mm³ and 3375.53 ± 3624.67 mm³, respectively). No significant change was observed in the minimal cross-sectional area of the pharyngeal airway. There was a significant decrease in the volume of the maxillary sinuses after the surgery by 3448.09 ± 3315.56 mm³. No correlation was found between the amount of skeletal movement and the change in the volume of pharyngeal airway or maxillary sinuses.Conclusion:There was a significant decrease only for lower and total pharyngeal airway volumes in males and a significant decrease in the volume of the maxillary sinuses.     

Three-dimensional evaluation of upper airway following rapid maxillary expansion: A CBCT study

Objectives:To evaluate, by using cone beam computed tomography, the skeletal, dental, oropharyngeal (OP) airway volume, and nasal passage (NP) volume changes that occur after rapid maxillary expansion (RME).Materials and Methods:Two groups were selected, each with 35 patients (15 males, 20 females), an RME group (mean age, 14.02 ± 1.46 years) and a control group (mean age, 14.10 ± 1.44 years). The RME group consisted of patients with maxillary constriction who were treated with Hyrax palatal expanders, and the control group comprised age- and sex-matched patients who underwent comprehensive orthodontic treatment without the use of a rapid maxillary expander.Results:All of the transverse skeletal (medial orbital width, lateral nasal width, maxillary width, and mandibular width) and interdental (intermolar, interpremolar, and intercanine) parameters were significantly enlarged in the RME group. A statistically significant increase in airway variables was seen in both groups between pretreatment (T0) and final records (T1). The mean increase of NP airway volume for the RME group (1719.9 ± 1510.7 mm³) was twofold compared with the control group (813.6 ± 1006.7 mm³), and no intergroup significant difference was found for the OP volume.Conclusions:Rapid maxillary expansion creates a significant increase in nasal passage airway volume but no significant change in the oropharyngeal airway volume.     

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.     

Comparison of facemask therapy effects using skeletal and tooth-borne anchorage:: A longitudinal retrospective study

ObjectivesTo investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage.Materials and MethodsThis retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated.ResultsSNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1–T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2–T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1–T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group.ConclusionsFacemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.     

Three-dimensional changes of the naso-maxillary complex following rapid maxillary expansion

Objective:To assess the volumetric changes and the maxillary response of the naso-maxillary complex (NMC) following rapid maxillary expansion (RME).Materials and Methods:Thirty consecutive patients (14 males and 16 females) with a mean age at first observation of 9.5 ± 1.8 years for males and of 11.8 ± 1.7 years for females, presenting a posterior unilateral or bilateral crossbite and requiring RME, were selected for the study. Each patient underwent expansion to correct the transverse occlusal relationships. Computed tomography scans were taken before RME (T1) and at the end of the active expansion phase (T2). Measurements were performed on scanned images. The Kolmogorov-Smirnov test was performed; the mean differences between measurements at T1 and T2 were compared using the t-test (α  =  .05).Results:All volumetric, maxillary, transverse skeletal anterior and posterior variables as well as all dental anterior and posterior linear and angular variables representing the NMC displayed statistically highly significant increases after RME (P < .001).Conclusions:After RME the total volume of the NMC increased by 12%, the nasal volume by 17%, and the maxillary volume by 10.6%. The maxillary and the nasal contributions represented 69.75% and 30.25%, respectively.     

Changes in pharyngeal airway dimensions and hyoid bone position after maxillary protraction with different alternate rapid maxillary expansion and construction protocols: A prospective clinical study

Objective:To evaluate the changes in pharyngeal airway dimensions and the position of the hyoid bone after maxillary protraction with different alternate rapid maxillary expansion and construction (Alt-RAMEC) protocols in patients with skeletal class III malocclusion as a result of maxillary retrusion.Material and Methods:The patients with skeletal class III malocclusions were consecutively divided into two groups. Group 1 consisted of 17 patients (11 boys and 6 girls, mean age 11.31 ± 1.71 years) who had the Alt-RAMEC protocol for 5 weeks, and group 2 consisted of 17 patients (10 boys and 7 girls, mean age 11.64 ± 1.24 years) who had the Alt-RAMEC procedure for 9 weeks. In this study, 4 angular and 13 linear measurements were performed to evaluate the skeletal and pharyngeal airway changes that occurred after maxillary protraction.Results:A significant increase in the maxillary growth, inhabitation of mandibular growth, and clockwise rotation of the mandible caused the improvement of the maxillo-mandibular relationship in both groups. Those changes caused a significant increase in the upper pharyngeal airway dimension (P < .01) and affected the vertical position of the hyoid bone in both groups (P < .05 and P < .01, respectively). However, changes that occurred in both groups were found to be similar for all airway variables (P > .05).Conclusion:Upper pharyngeal dimension and vertical position of the hyoid bone were affected by the maxillary protraction with different Alt-RAMEC protocols. There were no statistically significant differences between the groups.     

Effects of symmetric and asymmetric rapid maxillary expansion treatments on pharyngeal airway and sinus volume:: A cone-beam computed tomography study

ObjectiveTo evaluate pharyngeal airway and maxillary sinus volumes following symmetric rapid maxillary expansion (RME) and asymmetric rapid maxillary expansion (ARME) treatment using cone-beam computed tomography (CBCT).Materials and MethodsThe study consisted of 60 patients presenting to the orthodontics clinic with an indication that they required symmetric or asymmetric rapid maxillary expansion treatment. Individuals were included if they were aged 12–15 years and had symmetric (RME group; 14 girls, 16 boys) or asymmetric (ARME group; 16 girls, 14 boys) maxillary deficiency. Maxillary sinus volume (mm³) and pharyngeal airway volume (upper, lower, and total; mm³) were evaluated using CBCT records. The parameters were compared before treatment (T1) and after 3 months in retention (T2).ResultsAll measurements at T2 were increased significantly compared with T1 in the RME group (P < .05). In the ARME group, changes in the lower pharyngeal airway and the nonaffected maxillary sinus volumes (non-affected side of maxillary sinus volumes) were not significant; however, the other measurements increased significantly from T1 to T2 (P < .05). Intergroup comparisons revealed that total pharyngeal airway volume and total maxillary sinus volume changes were significantly greater in the RME group.ConclusionsPharyngeal airway and maxillary sinus volumes increased with both RME and ARME treatment. Both were found to be effective for treating transverse maxillary deficiency.     

Effects of face mask treatment with and without rapid maxillary expansion in young adult subjects

Objectives:To investigate the skeletal, dental, and soft tissue effects of the face mask (FM) treatment with and without rapid maxillary expansion (RME) in young adult subjects with maxillary retrognathia.Materials and Methods:Pretreatment and posttreatment cephalometric radiographs from 32 subjects who had a skeletal Class III malocclusion were analyzed. The subjects were divided into two groups: FM group (N  =  17; 3 male and 14 female subjects; mean [SD] age 14.47 [0.89] years) was treated with FM only, while the RME+FM group (N  =  15; 3 male and 12 female subjects; mean [SD] age 14.67 [1.28] years) was treated with both FM and RME. Ten cephalometric linear and nine angular variables were measured to assess dentofacial changes. Within-group and between-group comparisons were determined by a paired t-test and Student''s t-test, respectively.Results:Forward displacement of the maxilla and a clockwise rotation of the mandible occurred in both groups. The maxillary-mandibular relationship improved and soft tissue changes resulted in a more convex profile. The maxillary incisors were more proclined in the FM group than in the RME+FM group, the only difference between the two groups. Notably, the mandibular incisors moved backward in both groups.Conclusions:Forward movement of the maxilla can be obtained in young adults after face mask treatment. However, there was no difference in this phenomenon between the FM and RME+FM groups.     

New treatment modality for maxillary hypoplasia in cleft patients: protraction facemask with miniplate anchorage

Objective:To present cleft patients treated with protraction facemask and miniplate anchorage (FM/MP) in order to demonstrate the effects of FM/MP on maxillary hypoplasia.Materials and Methods:The cases consisted of cleft palate only (12 year 1 month old girl, treatment duration  =  16 months), unilateral cleft lip and alveolus (12 year 1 month old boy, treatment duration  =  24 months), and unilateral cleft lip and palate (7 year 2 month old boy, treatment duration  =  13 months). Curvilinear type surgical miniplates (Martin, Tuttlinger, Germany) were placed into the zygomatic buttress areas of the maxilla. After 4 weeks, mobility of the miniplates was checked, and the orthopedic force (500 g per side, 30° downward and forward from the occlusal plane) was applied 12 to 14 hours per day.Results:In all cases, there was significant forward displacement of the point A. Side effects such as labial tipping of the upper incisors, extrusion of the upper molars, clockwise rotations of the mandibular plane, and bite opening, were considered minimal relative to that usually observed with conventional protraction facemask with tooth-borne anchorage.Conclusions:FM/MP can be an effective alternative treatment modality for maxillary hypoplasia with minimal unwanted side effects in cleft patients.     

Corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics

Objective:To analyze the treatment effects of corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics in patients with Class III malocclusions.Materials and Methods:The study group consisted of 19 patients with a mean age of 13.12 ± 1.28 years. Initially, patients were monitored for 5 months before treatment to evaluate growth changes. Changes during control, protraction and fixed orthodontic treatment periods were compared with the cephalometric radiographs taken initially, before protraction, after protraction, and after fixed orthodontic treatment. Treatment outcomes also were compared with the growth effects.Results:Sagittal measurements of maxilla showed significant improvements (3.59 ± 1.32 mm) during the protraction period (3.85 ± 1.12 months) whereas no significant changes were seen during the control period. Upper and lower incisor inclinations were increased, and the upper occlusal plane angle showed significant counterclockwise rotation during protraction. Significant soft-tissue changes also reflected the underlying skeletal changes. Maxillary advancement was stable during fixed orthodontic treatment.Conclusion:Compared with control period of the patients, this protocol produced significant improvements in skeletal and soft-tissue structures.     

Changes in soft tissue nasal widths associated with rapid maxillary expansion in prepubertal and postpubertal subjects

Objective:To evaluate changes in the soft tissue width of the nose induced by rapid maxillary expansion (RME). Data on greater alar cartilage (GAC) and alar base (AB) widths were compared with a normative sample within the same age range.Materials and Methods:This prospective study consisted of an RME sample of 79 patients treated with an RME protocol. Mean age at the start of RME treatment was 13.5 years; average duration of treatment was 6.7 months. Patients were grouped into prepubertal and postpubertal groups based on their cervical vertebral maturation (CVM) stage. AB and GAC widths were determined at three separate time points. The normative sample consisted of 437 orthodontically untreated whites, aged 10–16 years. A repeated measures analysis of variance (ANOVA) was used to determine group differences. In addition, independent sample t-tests were used to compare posttreatment nasal width values vs the untreated normative sample.Results:Increases in AB and GAC widths of the nose in the RME sample were less than 1.5 mm. No significant differences were noted in width changes between the prepubertal and postpubertal subgroups. Comparisons of T3 values showed that on average nasal width increases were greater in the RME group than in untreated norms by 1.7 mm for the GAC measure (statistically significant), and by less than 1 mm for the AB measure.Conclusions:RME has no significant clinical effects on the widths of the apical base and the greater alar cartilage of the nose; no differences were observed between the two maturational subgroups.     

Effectiveness of maxillary protraction using a hybrid hyrax-facemask combination: A controlled clinical study

Objective:To evaluate the treatment effects of a hybrid hyrax-facemask (FM) combination in growing Class III patients.Material and Methods:A sample of 16 prepubertal patients (mean age, 9.5 ± 1.6 years) was investigated by means of pre- and posttreatment cephalograms. The treatment comprised rapid palatal expansion with a hybrid hyrax, a bone- and toothborne device. Simultaneously, maxillary protraction using an FM was performed. Mean treatment duration was 5.8 ± 1.6 months. The treatment group was compared with a matched control group of 16 untreated Class III subjects. Statistical comparisons were performed with the Mann-Whitney U-test.Results:Significant improvement in skeletal sagittal values could be observed in the treatment group over controls: SNA: 2.4°, SNB: −1.7°, Co-Gn: −2.3 mm, Wits appraisal: 4.5 mm. Regarding vertical changes, maintenance of vertical growth was obtained as shown by a small nonsignificant increase of FMA and a small significant decrease of the Co-Go-Me angle.Conclusions:The hybrid hyrax-FM combination was found to be effective for orthopedic treatment in growing Class III patients in the short term. Favorable skeletal changes were observed both in the maxilla and in the mandible. No dentoalveolar compensations were found.     

The short-term treatment effects of face mask therapy in Class III patients based on the anchorage device: Miniplates vs rapid maxillary expansion

Objective:To compare the short-term treatment effects of face mask therapy with miniplates (FM-MP) and face mask therapy with rapid maxillary expansion appliance (FM-RME) in growing Class III malocclusion patients with maxillary hypoplasia.Materials and Methods:Twenty patients were allocated into two groups according to the anchorage device: FM-MP group (n  =  10; mean age  =  11.2 ± 1.2 years; miniplates in the zygomatic buttress area) and FM-RME group (n  =  10; mean age  =  10.7 ± 1.3 years; bonded or banded RME). The face mask was applied for 12 to 14 hours/day in both groups with a force of 400 g/side directed 30° downward and forward from the occlusal plane. Lateral cephalograms were taken before (T1) and after FM-MP or FM-RME therapy (T2). Skeletodental and soft-tissue variables were measured. Paired and independent t-tests were performed for statistical analysis.Results:Both groups exhibited significant forward movement of point A and posterior repositioning and opening rotation of the mandible from T2 to T1. The FM-MP group showed significant protraction of orbitale (ΔSNO), and the FM-RME group showed a decrease in overbite and an increase in Björk sum. Comparing the amount of changes between the two groups, the FM-MP group displayed greater forward movement of the maxilla than the FM-RME group (ΔSNA, ΔA to N perp, all P < .05). However, the FM-RME group exhibited a greater opening rotation of the mandible (ΔSNB, Björk sum, all P < .01; ΔPog to N-perp, P < .05) and labioversion of the maxillary incisors (ΔU1-FH, P < .05).Conclusion:FM-MP therapy induces a greater advancement of the maxilla, less posterior repositioning and opening rotation of the mandible, and less proclination of the maxillary incisors than FM-RME therapy.     

Comparison of the effects of face mask treatment started simultaneously and after the completion of the alternate rapid maxillary expansion and constriction procedure

Objective:To test the null hypothesis that there were significant differences for skeletal, dentoalveolar, and soft tissue changes induced by face mask (FM) started simultaneously and after an alternate rapid maxillary expansion and constriction (Alt-RAMEC) procedure.Materials and Methods:Thirty-six patients with Class III malocclusion due to maxillary deficiency were randomly assigned to Group I (FM started after the completion of the Alt-RAMEC) and Group II (FM started simultaneously with the Alt-RAMEC). The screw of the RME appliance was alternately activated and deactivated twice daily (0.20 mm per turn) for 1 week over the course of 8 weeks. The changes observed in both groups were assessed using the cephalometric lateral films and statistically evaluated using the paired t-test and Student''s t-test.Results:Thirty patients completed the present prospective study. No significant differences were observed between the groups. Class III malocclusion and negative overjet were improved by means of skeletal changes in conjunction with upper incisor proclination in both groups. Skeletal contribution to overjet correction in Groups I and II was 91.70% and 86.10%, respectively. Maxilla showed a forward movement of 3.84 mm and 3.02 mm in Groups I and II, respectively.Conclusions:The null hypothesis was rejected. Both groups showed similar results, and, thus, waiting until completion of the Alt-RAMEC procedure for the FM treatment is not necessary.     

Effect of rapid maxillary expansion on monosymptomatic primary nocturnal enuresis

Objective:To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone).Materials and Methods:Nineteen patients with monosymptomatic primary NE, aged 6–15 years, were treated with RME for 10–15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2–3 days before and 2–3 months after the RME period. RME effects on NE were followed for three more years.Results:Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years.Conclusions:This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.     

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate:: A case-series analysis

ObjectivesTo determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP).Materials and MethodsA retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed.ResultsNo changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05).ConclusionsFollowing RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.     

Does rapid maxillary expansion induce adverse effects in growing subjects

Objective:To assess the scientific evidence that rapid maxillary expansion (RME) causes Adverse Effects on the midpalatal suture, vertical dimension, dental and periodontal structures in growing subjects.Materials and MethodsElectronic databases were searched for articles dated through December 2011. The quality of the studies was ranked on a 13-point scale in which 1 was the low end of the scale and 13 was the high end.Results:Thirty relevant articles were identified. The amount of midpalatal suture opening ranged from 1.6 to 4.3 mm in the anterior region and from 1.2 to 4.4 mm in the posterior region. At the end of the active phase, RME resulted in slight inferior movement of the maxilla (SN-PNS +0.9 mm; SN-ANS +1.6 mm), increased tipping of anchored teeth from 3.4° to 9.2° and bending of the alveolar bone from 5.1° to 11.3°. In the long term, RME did not modify the facial growth patterns, and no significant changes on dentoalveolar structures were observed. Of the 30 studies, 2 were medium-high quality, 8 were medium quality, and 20 were low quality.Conclusions:RME always opened the midpalatal suture in growing subjects. The vertical changes were small and transitory. In the long-term evaluation, an uprighting of anchored teeth was observed and periodontal structures were not compromised.