Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults.

INTRODUCTION: This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS: The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS: Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS: After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.

Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial.

OBJECTIVES: The aim of this study was to compare the upper airway space changes after miniscrew-anchored maxillary protraction with hybrid (HH) and conventional hyrax (CH) expanders. MATERIAL AND METHODS: The sample comprised Class III malocclusion growing patients that were randomized into two groups of miniscrew-anchored maxillary protraction. The group HH was treated with a hybrid hyrax appliance in the maxilla and two miniscrews distally to the canines in the mandible. Class III elastics were used from the maxillary first molar to the mandibular miniscrews until anterior crossbite correction. The group CH was treated with a similar protocol except for the conventional hyrax expander in the maxilla. Cone-beam computed tomography was obtained before (T1) and after 12 months of therapy (T2). The shape and size of upper airway were assessed. Intergroup comparisons were performed using Mann-Whitney U test (p < 0.05). RESULTS: The group HH was composed of 20 patients (8 female, 12 male) with a mean age of 10.76 years. The group CH was composed of 15 patients (6 female, 9 male) with a mean age of 11.52 years. Anteroposterior and transverse increases of the upper airway were found for both groups. The oropharynx and the most constricted area increased similarly in both groups. CONCLUSIONS: No differences in upper airway changes were observed using protraction anchored on hybrid or conventional hyrax expanders. CLINICAL RELEVANCE: Maxillary protraction anchored on hybrid or conventional hyrax expanders may benefit patients with breathing disorders due to the increase of the upper airway volume and most constricted area. Registration: ClinicalTrials.gov (NCT03712007).

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon.

OBJECTIVE: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2. DESIGN: Cross-sectional. SETTING: Tertiary craniofacial center. PARTICIPANTS: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition. INTERVENTIONS: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs. MAIN OUTCOME MEASURES: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05). RESULTS: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001). CONCLUSION: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.

Orthopedic outcomes of hybrid and conventional Hyrax expanders.

OBJECTIVES: To compare the effects of a hybrid miniscrew-supported expander versus a conventional Hyrax (CH) expander in growing patients. MATERIALS AND METHODS: Forty patients were randomized into two groups: a hybrid Hyrax (HH) expander group using a Hyrax expander with two miniscrews and a CH expander group. The final sample had 18 subjects (8 female, 10 male; initial age of 10.8 years) in the HH group and 14 subjects (6 female, 8 male; initial age of 11.4 years) in the CH group. Cone-beam computed tomography examinations and digital dental models were obtained before expansion and 11 months postexpansion. The primary outcomes included the orthopedic transverse effects of expansion. Intergroup comparison was performed using analysis of covariance (P < .05). RESULTS: Significantly greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width were found for the HH group. No intergroup differences were observed for dental arch width or shape changes. CONCLUSIONS: The HH group showed greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width. No differences were observed for intermolar, interpremolar, or intercanine widths; arch length; or arch perimeter. Arch size and shape showed similar changes in both groups.