Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis

Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis

Intercerter comparison of different maxillary expansion modalities in patients with complete cleft lip and palate

Introduction: The maxillary dental arch of patients with unilateral complete cleft lip and palate is generally constricted showing a transversal deficiency that very frequently requires maxillary expansion. Some centers prefer the rapid orthopedic expansion, using the Hyrax appliance while others prefer the slow maxillary expansion and use the quadhelix appliance. The literature is not clear about each expander promotes the best expansion. Purpose: to compare the occlusal effects of rapid and slow maxillary expansion, in patients with unilateral complete cleft lip and palate, using digital models. Methodology: 34 patients in the mixed dentition composed the sample. The rapid maxillary expansion using hyrax appliance was performed in 17 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRCA-USP) and the slow maxillary expansion was performed in 17 patients, using quad-helix appliance, at the Los Angeles Childrens Hospital, University of South California (LOCH-USC). Conventional dental casts was performed before expansion (T1) and 6 months after the expansion (T2), when the appliance was removed. After digitalization of the dental casts (3Shape R700 3D), the maxillary dental arch transverse dimensions, buccolingual inclination of posterior teeth, dental arch perimeter and palate volume was measured. Dependent tests was used to evaluate the changes between phases (p<0.05) and Independent test was used to evaluate the changes between the groups (p<0.05). Conclusions: Both orthopedic expander and the quad-helix produced significant changes in the maxillary arch widths and perimeter. The palate volume increased in the rapid maxillary group and posterior maxillary tooth tipping was bigger in the quad-helix group.FAPES

Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate

Objective: The aim of this study was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate in comparison with non-cleft patients. Methods: The experimental group (EG) was composed of 25 patients with unilateral and complete cleft lip and palate (9 males and 15 females) with a mean age of 10.6 years. The control group (CG) comprised of 27 patients without cleft lip and palate (14 males and 13 females) with a mean age of 9.1 years. Dental models of the maxillary dental arch were obtained immediately preexpansion (T1) and 6 months post-expansion (T2) at the time of appliance removal. Digital dental models were obtained using the 3Shape R700 3D laser scanner (3Shape A/S, Copenhagen, Denmark). Transversal widths, arch perimeter, arch length, palatal depth, palatal volume, canine and posterior tooth inclination were digitally measured. Paired t-test was used to perform interphase comparisons and independent t-test to perform intergroup comparisons (p<0.05). Results: In the experimental group, the expansion produced a ignificant increase of all maxillary transverse measurements, palatal volume, arch perimeter and palatal depth while decreased the arch length. RME caused a buccal tip of posterior teeth in patients with UCLP. No differences were observed between experimental and control groups for all the measurements performed except for the intermolar distance (6-6), which showed a greater increase in patients with cleft. Conclusion: Rapid maxillary expansion showed similar dentoalveolar effects in children with UCLP and without oral clefts.Objective: The aim of this study was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate in comparison with non-cleft patients. Methods: The experimental group (EG) was composed of 25 patients with unilateral and complete cleft lip and palate (9 males and 15 females) with a mean age of 10.6 years. The control group (CG) comprised of 27 patients without cleft lip and palate (14 males and 13 females) with a mean age of 9.1 years. Dental models of the maxillary dental arch were obtained immediately preexpansion (T1) and 6 months post-expansion (T2) at the time of appliance removal. Digital dental models were obtained using the 3Shape R700 3D laser scanner (3Shape A/S, Copenhagen, Denmark). Transversal widths, arch perimeter, arch length, palatal depth, palatal volume, canine and posterior tooth inclination were digitally measured. Paired t-test was used to perform interphase comparisons and independent t-test to perform intergroup comparisons (p<0.05). Results: In the experimental group, the expansion produced a ignificant increase of all maxillary transverse measurements, palatal volume, arch perimeter and palatal depth while decreased the arch length. RME caused a buccal tip of posterior teeth in patients with UCLP. No differences were observed between experimental and control groups for all the measurements performed except for the intermolar distance (6-6), which showed a greater increase in patients with cleft. Conclusion: Rapid maxillary expansion showed similar dentoalveolar effects in children with UCLP and without oral clefts

Prevalence of supranumerary teeth on pre-molars region and their association with third molars

O objetivo do presente estudo foi determinar a prevalência de supranumerários na região dos pré-molares nos estágios de dentadura decídua, mista e permanente, além de verificar sua associação com a presença de terceiros molares. Foram avaliadas radiografias panorâmicas de 1.976 pacientes matriculados no curso de Ortodontia Preventiva e Interceptiva da Profis (Sociedade de Promoção Social do Fissurado Lábio-Palatal), em Bauru-SP. As radiografias foram analisadas em negatoscópio, em ambiente escurecido, por um único examinador que determinou a presença de supranumerários na região dos pré-molares, bem como a presença de terceiros molares. A associação entre o aparecimento de supranumerários e a presença de terceiros molares foi verificada pelo Teste de McNemar. O Teste exato de Fisher foi aplicado para verificar o dimorfismo sexual. Constatou-se uma prevalência de 0,45% de supranumerários na região dos pré-molares na amostra estudada, sendo 11% na maxila e 89% na mandíbula, e não foi observado dimorfismo sexual em relação ao aparecimento dos supranumerários (p=0,32). Nas radiografias avaliadas, foi observado que os quatro terceiros molares estavam presentes sempre que verificada a presença dos supranumerários, detectando uma associação estatisticamente significante (p < 0,01) entre o aparecimento dos pré-molares supranumerários e a presença dos terceiros molares. Concluiu-se que a incidência de pré-molares supranumerários foi baixa na população estudada, e que existe associação entre o aparecimento destes supranumerários com a presença dos terceiros molares.The purpose of the present study was to determine the prevalence of supranumerary teeth on the pre-molar region during the deciduous, mixed and permanent dentition and also verify their association with the presence of third molars. 1.976 panoramic radiographic from patients of the Preventive and Interceptive Orthodontic Course from Profis (Sociedade de Promoção Social do Fissurado Lábio-Palatal), in Bauru-SP were evaluated the radiographies were analysed in viewing box in a dark room by one unique examiner who determined the presence of supranumerary teeth on pre-molars region and also the presence of third molars. The association between the supranumerary and the third molars was verified by the McNemar test. The Fischer's exact test was used to verify the sexual dimorphism. A prevalence of 0,45% of supranumerary teeth on the pre-molars region was found on the sample, 11% on the maxilla and 89% on the mandible. No sexual dimorphism was found (p=0,32). A statistically significant difference (p<0,01) association between supranumerary pre-molars and the presence of third molar was found. The conclusion is that the incidence of supranumerary pre-molar is low on the examined sample and there is an association between the supranumerary pre-molars and the presence of third molars