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      Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: A cone-beam computed tomography study

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          Abstract

          Objective

          The aim of this study was to evaluate the skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion (MARPE) in young adults by cone-beam computed tomography (CBCT).

          Methods

          This retrospective study included 14 patients (mean age, 20.1 years; range, 16–26 years) with maxillary transverse deficiency treated with MARPE. Skeletal and dentoalveolar changes were evaluated using CBCT images acquired before and after expansion. Statistical analyses were performed using paired t-test or Wilcoxon signed-rank test according to normality of the data.

          Results

          The midpalatal suture was separated, and the maxilla exhibited statistically significant lateral movement ( p < 0.05) after MARPE. Some of the landmarks had shifted forwards or upwards by a clinically irrelevant distance of less than 1 mm. The amount of expansion decreased in the superior direction, with values of 5.5, 3.2, 2.0, and 0.8 mm at the crown, cementoenamel junction, maxillary basal bone, and zygomatic arch levels, respectively ( p < 0.05). The buccal bone thickness and height of the alveolar crest had decreased by 0.6–1.1 mm and 1.7–2.2 mm, respectively, with the premolars and molars exhibiting buccal tipping of 1.1°–2.9°.

          Conclusions

          Our results indicate that MARPE is an effective method for the correction of maxillary transverse deficiency without surgery in young adults.

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          Most cited references31

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          Palatal expansion: just the beginning of dentofacial orthopedics.

          A J Haas (1970)
          Article 0 comments Cited 118 times – based on 0 reviews     Review now
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            Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation.

            José Henriques, Daniela Garib, Roberto De Masi … (2006)
            The force delivered during rapid maxillary expansion (RME) produces areas of compression on the periodontal ligament of the supporting teeth. The resulting alveolar bone resorption can lead to unwanted tooth movement in the same direction. The purpose of this study was to evaluate periodontal changes by means of computed tomography after RME with tooth-tissue-borne and tooth-borne expanders. The sample comprised 8 girls, 11 to 14 years old, with Class I or II malocclusions with unilateral or bilateral posterior crossbites Four girls were treated with tooth-tissue-borne Haas-type expanders, and 4 were treated with tooth-borne Hyrax expanders. The appliances were activated up to the full 7-mm capacity of the expansion screw. Spiral CT scans were taken before expansion and after the 3-month retention period when the expander was removed. One-millimeter thick axial sections were exposed parallel to the palatal plane, comprising the dentoalveolar area and the base of the maxilla up to the inferior third of the nasal cavity. Multiplanar reconstruction was used to measure buccal and lingual bone plate thickness and buccal alveolar bone crest level by means of the computerized method. RME reduced the buccal bone plate thickness of supporting teeth 0.6 to 0.9 mm and increased the lingual bone plate thickness 0.8 to 1.3 mm. The increase in lingual bone plate thickness of the maxillary posterior teeth was greater in the tooth-borne expansion group than in the tooth-tissue-borne group. RME induced bone dehiscences on the anchorage teeth's buccal aspect (7.1 +/- 4.6 mm at the first premolars and 3.8 +/- 4.4 mm at the mesiobuccal area of the first molars), especially in subjects with thinner buccal bone plates. The tooth-borne expander produced greater reduction of first premolar buccal alveolar bone crest level than did the tooth-tissue-borne expander.
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              Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism.

              Kee-Joon Lee, Young-Chel Park, Joo-Young Park … (2010)
              A transverse maxillary deficiency in an adult is a challenging problem, especially when it is combined with a severe anteroposterior jaw discrepancy. The demand for nonsurgical maxillary expansion might increase as patients and clinicians try to avoid a 2-stage surgical procedure-surgically assisted rapid palatal expansion followed by orthognathic surgery-and detrimental periodontal effects and relapse. In this regard, a miniscrew-assisted rapid palatal expansion was devised and used to treat a 20-year-old patient who had severe transverse discrepancy and mandibular prognathism. Sufficient maxillary orthopedic expansion with minimal tipping of the buccal segment was achieved preoperatively, and orthognathic surgery corrected the anteroposterior discrepancy. The periodontal soundness and short-term stability of the maxillary expansion were confirmed both clinically and radiologically. Effective incorporation of orthodontic miniscrews for transverse correction might help eliminate the need for some surgical procedures in patients with complex craniofacial discrepancies by securing the safety and stability of the treatment, assuming that the suture is still patent.
              Article 0 comments Cited 68 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Orthod
                Journal ID (iso-abbrev): Korean J Orthod
                Journal ID (publisher-id): KJOD
                Title: Korean Journal of Orthodontics
                Publisher: Korean Association of Orthodontists
                ISSN (Print): 2234-7518
                ISSN (Electronic): 2005-372X
                Publication date (Print): March 2017
                Publication date (Electronic): 25 January 2017
                Volume: 47
                Issue: 2
                Pages: 77-86
                Affiliations
                [a ]Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea.
                [b ]Graduate of Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
                Author notes
                Corresponding author: Yoon Jeong Choi. Assistant Professor, Department of Orthodontics, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel +82-2-2228-3101, yoonjchoi@ 123456yuhs.ac
                Article
                DOI: 10.4041/kjod.2017.47.2.77
                PMC ID: 5359634
                PubMed ID: 28337417
                SO-VID: 4d353988-bb96-42d1-9c2a-c98d7bda9114
                Copyright © © 2017 The Korean Association of Orthodontists.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2016
                Date revision received : 06 July 2016
                Date accepted : 13 July 2016
                Funding
                Funded by: Yonsei University College of Dentistry;
                Award ID: 6-2015-0123
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Dentistry
                Keywords: cone-beam computed tomography,miniscrew-assisted rapid palatal expansion,adults,expansion
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: cone-beam computed tomography, miniscrew-assisted rapid palatal expansion, adults, expansion

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