EFFECTIVENESS OF SURGICALLYASSISTED AND ORTHODONTIC EXPANSION OF THE UPPER JAW IN ADOLESCENTS AND ADULTS WITH SKELETAL FORMS OF MALOCCLUSION
DOI:
https://doi.org/10.35220/2078-8916-2023-50-4.20Keywords:
maxillary expansion, skeletal malocclusion, orthodontic treatment, surgically assisted expansion, SARME, orthognathic surgery, radiological examinationAbstract
It is well known that the effectiveness of orthognathic treatment, in particular in transverse maxillary deficiency (TMD) in patients with skeletal anomalies and malocclusion, largely depends on the successful expansion of the jaw. The paper is devoted to the study of clinical cases and analysis of scientific sources in order to determine the most effective approaches to surgically assisted and orthodontic maxillary expansion in adolescent and adult patients with skeletal forms of malocclusion. The review is based on the comparison of orthodontic methods, such as RME, MARPE, and surgically assisted methods, such as SARPE, with an emphasis on their skeletal component and stability of results. Objective of the study. To evaluate the effectiveness of different methods of maxillary expansion in adolescent and adult patients with skeletal forms of malocclusion. In particular, the effectiveness of orthodontic expansion using RME appliances, expansion of the maxilla with distalization of the posterior teeth using devices of our own design, as well as surgically assisted expansion using the SARME method is analysed. Materials and methods. A prospective controlled study on a sample of 75 patients divided into three groups depending on the method of treatment: orthodontic expansion, expansion with distalization of the posterior teeth with a device of its own design and SARME. In order to achieve stable results in the treatment of TMJ, it is important to take an individual approach to the choice of treatment method, taking into account the age characteristics of patients and the condition of the palatal suture. Surgically assisted methods, in particular SARPE, have shown high efficacy in adults, while RME remains the preferred choice for children. Scientific novelty. A comprehensive analysis of various methods of TMJ treatment is presented, in particular, an assessment of the stability of results and the impact on the skeletal component of the deformity. For the first time, the effectiveness and limitations of orthodontic and surgical methods were systematically compared on the basis of the latest scientific data. Conclusions. It has been established that the choice of expansion method should be based on the individual anatomical and skeletal characteristics of the patient. The study emphasises the importance of an integrated approach to the choice of the method of maxillary expansion. It is emphasised that the choice of the method of maxillary expansion in patients with TMJ should be based on evidence-based medicine, taking into account the individual characteristics of the patient. It is noted that further research is needed to compare the efficacy and safety of different methods of maxillary expansion, as well as to develop uniform treatment protocols.
References
Angelieri, F., Cevidanes, L. H. S., Franchi, L., Gonçalves, J. R., Benavides, E., & McNamara Jr, J. A. (2013). Midpalatal suture maturation: Classification method for individual assessment before rapid maxillary expansion. American Journal of Orthodontics and Dentofacial Orthopedics, 144(5), 759–769. https://doi.org/10.1016/j.ajodo.2013.04.022
Angell, E. (1860) Treatment of irregularity of the permanent or adult teeth. Dental Cosmos, 1, 540–544.
Asscherickx, K., Govaerts, E., Aerts, J., & Vande Vannet, B. (2016). Maxillary changes with bone-borne surgically assisted rapid palatal expansion: A prospective study. American Journal of Orthodontics and Dentofacial Orthopedics, 149(3), 374–383. https://doi.org/10.1016/j.ajodo.2015.08.018
Baccetti, T., Sigler, L. M., & McNamara, J. A., Jr (2011). An RCT on treatment of palatally displaced canines with RME and/or a transpalatal arch. European journal of orthodontics, 33(6), 601–607. https://doi.org/10.1093/ejo/cjq139
Bejeh Mir, A., Bejeh Mir, K., Bejeh Mir, M., & Haghanifar, S. (2016). A unique functional craniofacial suture that may normally never ossify: A cone-beam computed tomography-based report of two cases. Indian Journal of Dentistry, 7(1), 48. https://doi.org/10.4103/0975-962x.179375
Betts, N. J., Vanarsdall, R. L., Barber, H. D., Higgins-Barber, K., & Fonseca, R. J. (1995). Diagnosis and treatment of transverse maxillary deficiency. The International journal of adult orthodontics and orthognathic surgery, 10(2), 75–96.
Bortolotti, F., Solidoro, L., Bartolucci, M. L., Incerti Parenti, S., Paganelli, C., & Alessandri-Bonetti, G. (2019). Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials. European Journal of Orthodontics, 42(4), 434–440. https://doi.org/10.1093/ejo/cjz057
Byloff, F. K., & Mossaz, C. F. (2004). Skeletal and dental changes following surgically assisted rapid palatal expansion. European journal of orthodontics, 26(4), 403–409. https://doi.org/10.1093/ejo/26.4.403
Carlson, C., Sung, J., McComb, R. W., Machado, A. W., & Moon, W. (2016). Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult. American Journal of Orthodontics and Dentofacial Orthopedics, 149(5), 716–728. https://doi.org/10.1016/j.ajodo.2015.04.043
Chamberland, S., & Proffit, W. R. (2011). Shortterm and long-term stability of surgically assisted rapid palatal expansion revisited. American Journal of Orthodontics and Dentofacial Orthopedics, 139(6), 815–822.e1. https://doi.org/10.1016/j.ajodo.2010.04.032
Choi, S.-H., Shi, K.-K., Cha, J.-Y., Park, Y.-C., & Lee, K.-J. (2016). Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. The Angle Orthodontist, 86(5), 713–720. https://doi.org/10.2319/101415-689.1
Christie, K. F., Boucher, N., & Chung, C. H. (2010). Effects of bonded rapid palatal expansion on the transverse dimensions of the maxilla: a cone-beam computed tomography study. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 137(4 Suppl), S79–S85. https://doi.org/10.1016/j.ajodo.2008.11.024
Chung, C. H., & Goldman, A. M. (2003). Dental tipping and rotation immediately after surgically assisted rapid palatal expansion. European journal of orthodontics, 25(4), 353–358. https://doi.org/10.1093/ejo/25.4.35
D'Antò, V., Bucci, R., Franchi, L., Rongo, R., Michelotti, A., & Martina, R. (2015). Class II functional orthopaedic treatment: a systematic review of systematic reviews. Journal of oral rehabilitation, 42(8), 624–642. https://doi.org/10.1111/joor.12295
Franchi, L., & Baccetti, T. (2005). Transverse maxillary deficiency in Class II and Class III malocclusions: a cephalometric and morphometric study on postero- anterior films. Orthodontics & craniofacial research, 8(1), 21–28. https://doi.org/10.1111/j.1601-6343.2004.00312.x
Franchi, L., Baccetti, T., & McNamara, J. A., Jr (1999). Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 115(4), 429–438. https://doi.org/10.1016/s0889-5406(99)70264-7
Franchi, L., Baccetti, T., Lione, R., Fanucci, E., & Cozza, P. (2010). Modifications of midpalatal sutural density induced by rapid maxillary expansion: A lowdose computed-tomography evaluation. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 137(4), 486–13A. https://doi.org/10.1016/j.ajodo.2009.10.028
Garrett, B. J., Caruso, J. M., Rungcharassaeng, K., Farrage, J. R., Kim, J. S., & Taylor, G. D. (2008). Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 134(1), 8–9. https://doi.org/10.1016/j.ajodo.2008.06.004
Goldenberg, D. C., Goldenberg, F. C., Alonso, N., Gebrin, E. S., Amaral, T. S., Scanavini, M. A., & Ferreira, M. C. (2008). Hyrax appliance opening and pattern of skeletal maxillary expansion after surgically assisted rapid palatal expansion: a computed tomography evaluation. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 106(6), 812–819. https://doi.org/10.1016/j.tripleo.2008.02.034
Gurgel, J. A., Tiago, C. M., & Normando, D. (2014). Transverse changes after surgically assisted rapid palatal expansion. International Journal of Oral and Maxillofacial Surgery, 43(3),316–322. https://doi.org/10.1016/j.ijom.2013.10.001
Haas, A. J. (1970). Palatal expansion: Just the beginning of dentofacial orthopedics. American Journal of Orthodontics, 57(3), 219–255. https://doi.org/10.1016/0002-9416(70)90241-1
Handelman, C. S., Wang, L., BeGole, E. A., & Haas, A. J. (2000). Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander. The Angle orthodontist, 70(2), 129–144. https://doi.org/10.1043/0003-3219(2000)070<0129:NRMEIA>2. 0.CO;2
Kartalian, A., Gohl, E., Adamian, M., & Enciso, R. (2010). Cone-beam computerized tomography evaluation of the maxillary dentoskeletal complex after rapid palatal expansion. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 138(4), 486–492. https://doi.org/10.1016/j.ajodo.2008.10.025
Lagravère, M. O., Heo, G., Major, P. W., & Flores-Mir, C. (2006). Meta-analysis of immediate changes with rapid maxillary expansion treatment. Journal of the American Dental Association (1939), 137(1), 44–53. https://doi.org/10.14219/jada.archive.2006.0020
Lagravere, M. O., Major, P. W., & Flores-Mir, C.
(2005). Long-term skeletal changes with rapid maxillary expansion: a systematic review. The Angle orthodontist, 75(6), 1046–1052. https://doi.org/10.1043/0003-3219(2005)75[1046:LSCWRM]2. 0.CO;2
Lim, H. M., Park, Y. C., Lee, K. J., Kim, K. H., & Choi, Y. J. (2017). Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion. Korean journal of orthodontics, 47(5), 313–322. https://doi.org/10.4041/kjod.2017.47.5.313
McNamara, J. A., & Bagramian, R. A. (1999). Prospective survey of percutaneous injuries in orthodontic assistants. American Journal of Orthodontics and Dentofacial Orthopedics, 115(1), 72–76. https://doi.org/10.1016/s0889-5406(99)70318-5
Melsen, B., & Melsen, F. (1982). The postnatal development of the palatomaxillary region studied on human autopsy material. American journal of orthodontics, 82(4), 329–342. https://doi.org/10.1016/0002-9416(82)90467-5
Melsen, B., & Rölla, G. (1975). Cura di bambini con elevato numero di carie [Treatment of children with extensive dental caries]. Prevenzione stomatologica, 1(5), 49–55.
Ngan, P., Nguyen, U. K., Nguyen, T., Tremont, T., & Martin, C. (2018). Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study. APOS Trends in Orthodontics, 8, 71–85. https://doi.org/10.4103/apos.apos_27_18
N'Guyen, T., Ayral, X., & Vacher, C. (2008). Radiographic and microscopic anatomy of the mid-palatal suture in the elderly. Surgical and radiologic anatomy : SRA, 30(1), 65–68. https://doi.org/10.1007/s00276- 007-0281-6
Northway, W. M., & Meade, J. B., Jr. (1997). Surgically assisted rapid maxillary expansion: a comparison of technique, response, and stability. The Angle Orthodontist, 67(4), 309–320.doi:10.1043/0003-3219(1997)067<0309:SARMEA>2.3.CO;2
Obwegeser H. L. (1969). Surgical correction of small or retrodisplaced maxillae. The "dish-face" deformity. Plastic and reconstructive surgery, 43(4), 351–365. https://doi.org/10.1097/00006534-196904000-00003
Park, J. J., Park, Y. C., Lee, K. J., Cha, J. Y., Tahk, J. H., & Choi, Y. J. (2017). Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: A cone-beam computed tomography study. Korean journal of orthodontics, 47(2), 77–86. https://doi.org/10.4041/kjod.2017.47.2.77
Persson, M., & Thilander, B. (1977). Palatal suture closure in man from 15 to 35 years of age. American Journal of Orthodontics, 72(1), 42–52. https://doi.org/10.1016/0002-9416(77)90123-3
Poorsattar Bejeh Mir, K., Poorsattar Bejeh Mir, A., Bejeh Mir, M. P., & Haghanifar, S. (2016). A unique functional craniofacial suture that may normally never ossify: A cone-beam computed tomography-based report of two cases. Indian Journal of Dentistry, 7(1), 48–50. doi:10.4103/0975-962X.179375
Steinhauser, E. (1972). Midline splitting of the maxilla for correction of malocclusion. Journal of oral surgery, 30(6), 413-422.
Stuart, D. A., & Wiltshire, W. A. (2003). Rapid palatal expansion in the young adult: time for a paradigm shift?. Journal (Canadian Dental Association), 69(6), 374–377.
Swennen, G.R. (ed.). (2017). 3D Virtual Treatment Planning of Orthognathic Surgery: A Step-by-Step Approach for Orthodontists and Surgeons. Berlin, Heidelberg: Springer. 568 p.
Wehrbein, H., & Yildizhan, F. (2001). The mid-palatal suture in young adults. A radiological-histological investigation. European journal of orthodontics, 23(2), 105–114. https://doi.org/10.1093/ejo/23.2.105
