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      Effect of Rapid Maxillary Expansion on Glenoid Fossa and Condyle-Fossa Relationship in Growing Patients (MEGP): Study Protocol for a Controlled Clinical Trial

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          Abstract

          Aims and Objectives:

          Rapid maxillary expansion (RME) is an orthodontic nonsurgical procedure aiming at increasing the width of the maxilla by opening mainly the intermaxillary suture in patients presenting a transverse maxillary skeletal deficiency. The objectives of the current prospective controlled clinical and radiographic study are to evaluate the hypothesis that RME in growing patients will result in radiographic changes at the level of interglenoid fossa distance, condyle-fossa relationship, and nasal cavity widths compared to the group who received no treatment initially and served as untreated control.

          Materials and Methods:

          In this prospective controlled clinical and radiographic study, forty healthy growing patients selected from a school-based population following a large screening campaign, ranging in age between 8 and 13 years, presenting a maxillary constriction with bilateral crossbite, and candidates for RME are being recruited. The first group will include participants willing to undergo treatment ( n = 25) and the other group will include those inclined to postpone ( n = 15).

          Results:

          The primary outcome is to compare radiologically the interglenoid fossa distance and the condyle-fossa relationship; nasal cavity width will be a secondary outcome. A multivariable analysis of Covariance model will be used, with the assessment of the time by group interaction, using age as covariate. The project protocol was reviewed and approved by the Ethics Committee of the Lebanese University, National Institute in Lebanon (CUEMB process number 31/04/2015). The study is funded by the Lebanese University and Centre National de Recherche Scientifique, Lebanon (Number: 652 on 14/04/2016).

          Conclusion:

          This prospective controlled clinical trial will give information about the effect of RME on the glenoid fossa and condyle-fossa relationship and its impact on the nasal cavity width.

          Trial Registration:

          Retrospectively registered in BioMed Central (DOI10.1186/ISRCTN77788053).

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          Most cited references26

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          Image analysis and superimposition of 3-dimensional cone-beam computed tomography models.

          Three-dimensional (3D) imaging techniques can provide valuable information to clinicians and researchers. But as we move from traditional 2-dimensional (2D) cephalometric analysis to new 3D techniques, it is often necessary to compare 2D with 3D data. Cone-beam computed tomography (CBCT) provides simulation tools that can help bridge the gap between image types. CBCT acquisitions can be made to simulate panoramic, lateral, and posteroanterior cephalometric radioagraphs so that they can be compared with preexisting cephalometric databases. Applications of 3D imaging in orthodontics include initial diagnosis and superimpositions for assessing growth, treatment changes, and stability. Three-dimensional CBCT images show dental root inclination and torque, impacted and supernumerary tooth positions, thickness and morphology of bone at sites of mini-implants for anchorage, and osteotomy sites in surgical planning. Findings such as resorption, hyperplasic growth, displacement, shape anomalies of mandibular condyles, and morphological differences between the right and left sides emphasize the diagnostic value of computed tomography acquisitions. Furthermore, relationships of soft tissues and the airway can be assessed in 3 dimensions.
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            Comparison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion.

            To test the hypothesis that there is no difference in the active treatment effects for maxillary advancement induced by bone-anchored maxillary protraction (BAMP) and the active treatment effects for face mask in association with rapid maxillary expansion (RME/FM). This is a study on consecutively treated patients. The changes in dentoskeletal cephalometric variables from start of treatment (T1) to end of active treatment (T2) with an average T1-T2 interval of about 1 year were contrasted in a BAMP sample of 21 subjects with a RME/FM sample of 34 patients. All subjects were prepubertal at T1. Statistical comparison was performed with t-tests for independent samples. The BAMP protocol produced significantly larger maxillary advancement than the RME/FM therapy (with a difference of 2 mm to 3 mm). Mandibular sagittal changes were similar, while vertical changes were better controlled with BAMP. The sagittal intermaxillary relationships improved 2.5 mm more in the BAMP patients. Additional favorable outcomes of BAMP treatment were the lack of clockwise rotation of the mandible as well as a lack of retroclination of the lower incisors. The hypothesis is rejected. The BAMP protocol produced significantly larger maxillary advancement than the RME/FM therapy.
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              Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis.

              A small maxilla and/or mandible may predispose children to sleep-disordered breathing, which is a continuum of severity from snoring to obstructive sleep apnea. Preliminary studies have suggested that orthodontic treatments, such as orthopedic mandibular advancement or rapid maxillary expansion, may be effective treatments. The aim is to investigate the efficacy of orthopedic mandibular advancement and/or rapid maxillary expansion in the treatment of pediatric obstructive sleep apnea. Pubmed, Medline, Embase, and Internet were searched for eligible studies published until April 2014. Articles with adequate data were selected for the meta-analysis; other articles were reported in the qualitative assessment. Data extraction was conducted by two independent authors. A total of 58 studies were identified. Only eight studies were included in the review; of these, six were included in the meta-analysis. The research yielded only a small number of studies. Consequently, any conclusions from the pooled diagnostic parameters and their interpretation should be treated carefully. Although the included studies were limited, these orthodontic treatments may be effective in managing pediatric snoring and obstructive sleep apnea. Other related health outcomes, such as neurocognitive and cardiovascular functions have not yet been systematically addressed. More studies are needed with larger sample size, specific inclusion and exclusion criteria and standardized data reporting to help establish guidelines for the orthodontic treatment of pediatric obstructive sleep apnea.
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                Author and article information

                Journal
                J Int Soc Prev Community Dent
                J Int Soc Prev Community Dent
                JISPCD
                Journal of International Society of Preventive & Community Dentistry
                Medknow Publications & Media Pvt Ltd (India )
                2231-0762
                2250-1002
                Mar-Apr 2018
                24 April 2018
                : 8
                : 2
                : 130-136
                Affiliations
                [1 ]Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, Lebanese University, Hadath, Lebanon
                [2 ]Department of Prosthodontics, School of Dentistry, Lebanese University, Hadath, Lebanon
                [3 ]Department of Orthodontics School of Dentistry, Paris Diderot University, Paris, France
                [4 ]Department of Biostatistics and Epidemiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
                Author notes
                Address for correspondence: Dr. Mona Sayegh Ghoussoub, Department of Orthodontics, School of Dentistry, Lebanese University, Hadath, Lebanon. E-mail: mona_gsoub@ 123456yahoo.fr
                Article
                JISPCD-8-130
                10.4103/jispcd.JISPCD_458_17
                5946521
                a091b8de-29a4-468a-863a-1ca4a2a07f57
                Copyright: © 2018 Journal of International Society of Preventive and Community Dentistry

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 31 December 2017
                : 15 January 2018
                Categories
                Original Article

                breathing,condyle-fossa relationship,cone beam computed tomography,glenoid fossa,nasal width,rapid maxillary expansion

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