Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

Daniel Santos Fonseca Figueiredo, Lucas Cardinal, Flávia Uchôa Costa Bartolomeo, Juan Martin Palomo, Martinho Campolina Rebello Horta, Ildeu Andrade Jr, Dauro Douglas Oliveira, Daniel Santos Fonseca Figueiredo, Lucas Cardinal, Flávia Uchôa Costa Bartolomeo, Juan Martin Palomo, Martinho Campolina Rebello Horta, Ildeu Andrade Jr, Dauro Douglas Oliveira

Abstract

Objective:: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders.

Methods:: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1).

Results:: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05).

Conclusions:: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.

Figures

Figure 1. Rapid maxillary expanders evaluated: A)…
Figure 1. Rapid maxillary expanders evaluated: A) modified Hyrax; B) inverted mini-Hyrax (iMini).
Figure 2. Vertical measurement (FH-ANS).
Figure 2. Vertical measurement (FH-ANS).
Figure 3. Transversal measurements were performed in…
Figure 3. Transversal measurements were performed in the anterior and posterior regions of the maxilla. A) Dental crown width (DCW), dental apices width (DAW), nasal cavity width (NCW) measurements. B) Anterior and posterior MBW measurements. C) Coronal slice showing dental tipping. D) Lateral displacement between cleft and non-cleft sides.

References

    1. Mossey PA, Shaw WC, Munger RG, Murray JC, Murthy J, Little J. Global oral health inequalities challenges in the prevention and management of orofacial clefts and potential solutions. Adv Dent Res. 2011;23(2):247–258.
    1. IPDTOC Working Group Prevalence at birth of cleft lip with or without cleft palate data from the International Perinatal Database of Typical Oral Clefts (IPDTOC) Cleft Palate Craniofac J. 2011;48(1):66–81.
    1. Capelozza L, Filho, De Almeida AM, Ursi WJ. Rapid maxillary expansion in cleft lip and palate patients. J Clin Orthod. 1994;28(1):34–39.
    1. Townend PI. Technique of rapid expansion in patients with cleft lip and palate. Br J Orthod. 1980;7(2):65–67.
    1. Garib DG, Henriques JF, Janson G, Freitas MR, Coelho RA. Rapid maxillary expansion-tooth tissue-borne versus toothborne expanders a computed tomography evaluation of dentoskeletal effects. Angle Orthod. 2005;75(4):548–557.
    1. Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS, Taylor GD. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2008;134(1):8–9.
    1. Lione R, Ballanti F, Franchi L, Baccetti T, Cozza P. Treatment and posttreatment skeletal effects of rapid maxillary expansion studied with low-dose computed tomography in growing subjects. Am J Orthod Dentofacial Orthop. 2008;134(3):389–392.
    1. Ballanti F, Lione R, Fanucci E, Franchi L, Baccetti T, Cozza P. Immediate and post-retention effects of rapid maxillary expansion investigated by computed tomography in growing patients. Angle Orthod. 2009;79(1):24–29.
    1. Christie KF, Boucher N, Chung CH. Effects of bonded rapid palatal expansion on the transverse dimensions of the maxilla a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl):S79–S85.
    1. Weissheimer A, Menezes LM, Mezomo M, Dias DM, Lima EM, Rizzatto SM. Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders A randomized clinical trial. Am J Orthod Dentofacial Orthop. 2011;140(3):366–376.
    1. Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the mid palatal suture. Angle Orthod. 1961;31(2):73–90.
    1. Haas AJ. Palatal expansion just the beginning of dentofacial orthopedics. Am J Orthod. 1970;57(3):219–255.
    1. Chung CH, Font B. Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. Am J Orthod Dentofacial Orthop. 2004;126(5):569–575.
    1. Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970;58(1):41–66.
    1. Silva OG, Filho, Boas MC, Capelozza L., Filho Rapid maxillary expansion in the primary and mixed dentitions a cephalometric evaluation. Am J Orthod Dentofacial Orthop. 1991;100(2):171–179.
    1. Pan X, Qian Y, Yu J, Wang D, Tang Y, Shen G. Biomechanical effects of rapid palatal expansion on the craniofacial skeleton with cleft palate a three-dimensional finite element analysis. Cleft Palate Craniofac J. 2007;44(2):149–154.
    1. Figueiredo DS, Bartolomeo FU, Romualdo CR, Palomo JM, Horta MC, Andrade I, Jr, Oliveira DD. Dentoskeletal effects of 3 maxillary expanders in patients with clefts A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2014;146(1):73–81.
    1. Levrini L, Filippi V. A fan shaped maxillary expander. J Clin Orthod. 1999;33(11):642–643.
    1. Oliveira DD, Bartolomeo FU, Cardinal L, Figueiredo DS, Palomo JM, Andrade I., Jr An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients. J Craniofac Surg. 2014;25(6):e523–e526.
    1. Baccetti T, Franchi L, McNamara JA. The cervical vertebrae maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod. 2005;11(3):119–129.
    1. Subtelny JD, Brodie AG. An analysis of orthodontic expansion in unilateral cleft lip and cleft palate patients. Am J Orthod. 1954;40(9):686–697.
    1. Isaacson RJ, Murphy TM. Some effects of rapid maxillary expansion in cleft lip and palate patients. Angle Orthod. 1964;34(4):143–154.
    1. Tindlund RS, Rygh P, Bøe OE. Intercanine widening and sagittal effect of maxillary transverse expansion in patients with cleft lip and palate during the deciduous and mixed dentitions. Cleft Palate Craniofac J. 1993;30(2):195–207.
    1. Doruk C, Bicakci AA, Basciftci FA, Agar U, Babacan H. A comparison of the effects of rapid maxillary expansion and fan-type rapid maxillary expansion on dentofacial structures. Angle Orthod. 2004;74(2):184–194.
    1. Silva OG, Filho, Montes LA, Torelly LF. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod Dentofacial Orthop. 1995;107(3):268–275.
    1. Silva OG, Filho, Ramos AL, Abdo RC. The infl e of unilateral cleft lip and palate on maxillary dental arch morphology. Angle Orthod. 1992;62(4):283–290.
    1. Braun S, Bottrel JA, Lee KG, Lunazzi JJ, Legan HL. The biomechanics of rapid maxillary sutural expansion. Am J Orthod Dentofacial Orthop. 2000;118(3):257–261.
    1. Cozza P, De Toffol L, Mucedero M, Ballanti F. Use of a modifi expander to increase anterior arch lenght. J Clin Orthod. 2003;37(9):490–495.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi