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BMC Oral Health Apr 2022This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion... (Randomized Controlled Trial)
Randomized Controlled Trial
Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): a prospective randomized clinical trial using low-dose CBCT.
BACKGROUND
This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients.
METHODS
This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point.
RESULTS
The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05).
CONCLUSIONS
Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).
Topics: Adolescent; Child; Cone-Beam Computed Tomography; Female; Humans; Male; Maxilla; Neoplasm Recurrence, Local; Palatal Expansion Technique; Palate; Prospective Studies; Spiral Cone-Beam Computed Tomography; Young Adult
PubMed: 35395801
DOI: 10.1186/s12903-022-02138-w -
Minerva Dental and Oral Science Dec 2022Subperiosteal implants were introduced in the last century. Poor clinical results led those implants to be progressively abandoned. Recently, several Authors suggested a...
Subperiosteal implants were introduced in the last century. Poor clinical results led those implants to be progressively abandoned. Recently, several Authors suggested a revival of subperiosteal implants as an alternative to regenerative procedures. The purpose of this study was to describe the clinical application of custom-made additively manufactured subperiosteal implant for fixed prosthetic rehabilitation of edentulous maxilla. Plaster models of the upper and the lower arch were scanned, as well as the mock-up. Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography were processed through the thresholding procedure. The design of the subperiosteal implant was drawn on the stereolithographic model and scanned. Once the digital project of the subperiosteal implant was completed, it was sent to additive manufacturing. After the surgery, the patient was strictly monitored for up to 2 years. The outcomes were assessed based on the incurrence of biological and mechanical complications, postoperative complications, and implant survival. The patient did not suffer from postoperative complications. Neither biological nor mechanical complications occurred during the follow-up period. At the end of the study, the implant was still in function. Custom-made subperiosteal implants could be considered as an alternative to regenerative procedures for the rehabilitation of severe bone atrophy. Further studies are needed in the future to confirm the positive outcome.
Topics: Humans; Dental Implants; Dental Implantation, Endosseous; Mouth, Edentulous; Maxilla; Atrophy
PubMed: 36345834
DOI: 10.23736/S2724-6329.22.04640-X -
International Journal of Environmental... Jan 2021According to classic Hirschfeld studies, the first teeth to be lost are the first and second maxillary molars. After the teeth are extracted and the alveolar process is...
According to classic Hirschfeld studies, the first teeth to be lost are the first and second maxillary molars. After the teeth are extracted and the alveolar process is developed, the maxillary sinus is reabsorbed and pneumatized with a decrease in bone availability in the posterior sector of the maxilla. This process often creates the need to perform regeneration techniques for the placement of implants in this area due to the low availability of bone. The most frequently used and documented technique for the elevation of the sinus maxillary floor is elevation by the side window, as proposed by Tatum. In 1994, Summers proposed a technique that allowed the elevation of the sinus floor from a crestal access using an instrument called an osteotome, as well as the placement of the implant in the same surgical act. The aimed of the study was to evaluate the survival of 32 implants placed in posterior maxilla with bone availability less than 5 mm performing a sinus lift augmentation technique with osteotome without biomaterials. The results of this study show a survival rate of 100% for 32 implants placed in situations with an initial bone availability of 2 to 5 mm without the use of graft material. The infra-drilling technique used offers an increase in the primary stability of implants that allows adequate osteointegration Implants placed were charged at 12 weeks. In all cases, spontaneous bone formation was observed, even in cases where a positive Valsalva maneuver was observed. This proposed technique reduces treatment time and the need for more invasive maxillary sinus augmentation techniques.
Topics: Biocompatible Materials; Maxilla; Maxillary Sinus; Osteotomy; Sinus Floor Augmentation
PubMed: 33513756
DOI: 10.3390/ijerph18031103 -
The Angle Orthodontist Mar 2021To evaluate whether the success of miniscrew-assisted rapid palatal expansion (MARPE), performed in patients with advanced bone maturation is related to factors such as...
OBJECTIVES
To evaluate whether the success of miniscrew-assisted rapid palatal expansion (MARPE), performed in patients with advanced bone maturation is related to factors such as midpalatal suture (MPS) maturation, age, sex, or bicortical mini-implant anchorage.
MATERIALS AND METHODS
Twenty-eight cone beam computed tomography (CBCT) scans of adults and post-pubertal adolescents treated by MARPE were included in the sample. CBCT images before (T0) and after expansion (T1) were used to evaluate the skeletal changes and the success or failure of MARPE. Axial images of MPS were extracted from T0 and classified into one of the five maturation stages. The correlation between MARPE success and the factors of age, sex, MPS maturation, and bicortical mini-implant anchorage was investigated.
RESULTS
Only the age showed a statistically significant negative correlation with MARPE success and all the skeletal measures. There was an 83.3% success rate among individuals aged 15 to 19 years, 81.8% from 20 to 29 years, and 20% from 30 to 37 years. MPS maturation showed a negative correlation with the expansion effect. Subjects with stages B or C of MPS maturation showed a 100% success rate, followed by stage D (62.5%) and stage E (58.3%).
CONCLUSIONS
As age increased, there was a decrease in MARPE success and the skeletal effects of maxillary expansion. Sex and bicortical mini-implant anchorage were not shown to be relevant factors. There was no correlation between MPS maturation and MARPE success; however, it was observed that all cases of MARPE failure were classified as stage D or E of MPS maturation.
Topics: Adolescent; Adult; Cone-Beam Computed Tomography; Cranial Sutures; Humans; Maxilla; Palatal Expansion Technique; Palate; Young Adult
PubMed: 33351888
DOI: 10.2319/051420-436.1 -
Journal of Clinical Periodontology Feb 2021To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function.
MATERIALS AND METHODS
Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri-implant tissues, aesthetics and patient-reported outcomes were assessed.
RESULTS
After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid-facial peri-implant mucosal level, aesthetic and patient outcomes were observed.
CONCLUSIONS
The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255).
Topics: Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Maxilla; Treatment Outcome
PubMed: 33141935
DOI: 10.1111/jcpe.13398 -
Swiss Dental Journal Feb 2021
Topics: Mandible; Maxilla
PubMed: 33559985
DOI: No ID Found -
The Angle Orthodontist Jan 2021To investigate the efficacy of microimplant-assisted rapid palatal expansion (MARPE) to treat skeletal maxillary discrepancies during the post-pubertal growth spurt... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of skeletal maxillary transverse deficiency treated by microimplant-assisted rapid palatal expansion and tooth-borne expansion during the post-pubertal growth spurt stage.
OBJECTIVE
To investigate the efficacy of microimplant-assisted rapid palatal expansion (MARPE) to treat skeletal maxillary discrepancies during the post-pubertal growth spurt stage.
MATERIALS AND METHODS
Sixty patients with skeletal maxillary transverse deficiency during the post-pubertal growth spurt stage were randomly divided into MARPE and Hyrax groups. Thirty patients (mean age: 15.1 ± 1.6 years) were treated using the four-point MARPE appliance; 30 patients (mean age, 14.8 ± 1.5 years) were treated using the Hyrax expander. Cone beam computed tomography scans and dental casts were obtained before and after expansion. The data were analyzed using paired t-tests and independent t-tests.
RESULTS
The success rates of midpalatal suture separation were 100% and 86.7% for MARPE and Hyrax groups, respectively. Palatal expansion and skeletal to dental ratio at the first molar level were greater in the MARPE group (3.82 mm and 61.4%, respectively) than in the Hyrax group (2.20 mm and 32.3%, respectively) (P < .01). Reductions in buccal alveolar bone height and buccal tipping of the first molars were less in the MARPE group than in the Hyrax group (P < .01).
CONCLUSIONS
MARPE enabled more predictable and greater skeletal expansion, as well as less buccal tipping and alveolar height loss on anchorage teeth. Thus, MARPE is a better alternative for patients with skeletal maxillary deficiency during the post-pubertal growth spurt stage.
Topics: Adolescent; Cone-Beam Computed Tomography; Humans; Maxilla; Palatal Expansion Technique; Palate; Tooth
PubMed: 33289835
DOI: 10.2319/041920-332.1 -
Journal of Oral Biosciences Jun 2021The knowledge of nerves and vessels in the maxillofacial region, particularly the anatomical structures in the maxilla, mandible, tongue muscles, and salivary glands, is... (Review)
Review
BACKGROUND
The knowledge of nerves and vessels in the maxillofacial region, particularly the anatomical structures in the maxilla, mandible, tongue muscles, and salivary glands, is essential for dental surgeons. In addition, the structures in the mandibular canal, palate, and maxillary sinus should be understood well.
HIGHLIGHT
The arteries and nerves in the maxillofacial region were observed in this study. Some variations in the origin of the inferior alveolar artery were found. Notably, the variations in the origin of the inferior alveolar artery from that of the external carotid artery and a double origin of the inferior alveolar artery were observed. Thus, the maxillary artery may originate from the external carotid and stapedial arteries. The following points are important. (1)The greater palatine artery is always located deeper than the greater palatine nerve. (2)The posterior superior alveolar artery often runs through the compact bone of the maxilla. Using CT scans, the canal of the artery can be observed. (3)Variations in origins of the inferior alveolar artery have been observed. The origin of the inferior alveolar nerve may differ depending on the course of the maxillary artery.
CONCLUSIONS
Dental practitioners should, therefore, have a comprehensive knowledge of the anatomy of the maxillofacial region and its variations. Without this knowledge, they should not operate on patients.
Topics: Dental Implants; Dentists; Humans; Mandible; Maxilla; Professional Role
PubMed: 33524607
DOI: 10.1016/j.job.2021.01.002 -
Dento Maxillo Facial Radiology May 2022To map the shape, location, and thickness of the focal trough of a panoramic radiography device with a multilayer imaging program.
OBJECTIVE
To map the shape, location, and thickness of the focal trough of a panoramic radiography device with a multilayer imaging program.
METHODS
An acrylic plate (148 × 148 × 3 mm) containing 1156 holes distributed in a matrix of 34 × 34 rows was placed in the OP300 Maxio at the levels of the maxilla and mandible. 20 metal spheres (3.5 mm in diameter) were placed on the holes of the plate under 15 different arrangements and panoramic images were acquired for each arrangement at 66 kV, 8 mA, and an exposure time of 16 s. The resulting panoramic radiographs from the five image layers were exported, the horizontal and vertical dimensions of the metal spheres were measured in all images using the Image J software, and the magnification and distortion rates of the spheres were calculated. All metal spheres presenting a magnification rate lower than 30% in both vertical and horizontal dimensions and a distortion rate lower than 10% were considered to map the focal troughs of each of the five image layers.
RESULTS
All panoramic image layers had a curved shape ranging from 39° to 51° for both dental arches and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to the anterior region of the mandible for all layers. Image layers are thicker at the level of the mandible than those at the level of the maxilla; also, inner layers were thinner and outer layers were thicker.
CONCLUSION
All image layers in the studied panoramic radiography device had a curved shape and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to that of the mandible for all layers.
Topics: Humans; Mandible; Maxilla; Radiography, Panoramic
PubMed: 34757830
DOI: 10.1259/dmfr.20210082 -
Scientific Reports Feb 2022The objective of this study was to evaluate the effect of bone-miniscrew contact percentage (BMC%) and bone quality and quantity on orthodontic miniscrew stability and...
The objective of this study was to evaluate the effect of bone-miniscrew contact percentage (BMC%) and bone quality and quantity on orthodontic miniscrew stability and the maximum insertion torque value (ITV). Orthodontic miniscrews of five different dimensions and several bovine iliac bone specimens were used in the evaluation. Miniscrews of each dimension group were inserted into 20 positions in bovine iliac bone specimens. The experiment was divided into three parts: (1) Bone quality and quantity were evaluated using cone-beam computed tomography (CBCT) and microcomputed tomography. (2) The 3D BMC% was calculated. (3) The ITVs during miniscrew insertion were recorded to evaluate the stability of the orthodontic miniscrews. The results indicated that longer and thicker miniscrews enabled higher ITVs. CBCT was used to accurately measure cortical bone thickness (r = 0.939, P < 0.05) and to predict the bone volume fraction of cancellous bone (r = 0.752, P < 0.05). BMC% was significantly influenced by miniscrew length. The contribution of cortical bone thickness to the ITV is greater than that of cancellous bone structure, and the contribution of cortical bone thickness to BMC% is greater than that of cancellous bone structure. Finally, the higher is BMC%, the greater is the ITV. This study concludes that use of CBCT may predict the mechanical stability of orthodontic miniscrews.
Topics: Animals; Bone Screws; Cancellous Bone; Cattle; Cortical Bone; Humans; Ilium; Maxilla; Stress, Mechanical; Titanium
PubMed: 35181736
DOI: 10.1038/s41598-022-06851-y