Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders.

BACKGROUND: This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS: Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS: This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS: A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.

Does MARPE therapy have effects on intracranial pressure? a clinical study.

BACKGROUND: We aimed to evaluate possible intracranial pressure (ICP) changes caused by screw activations during active microimplant-assisted rapid palatal expansion (MARPE) therapy of post-pubertal individuals by measuring the optic nerve sheath diameter (ONSD) under ultrasonography (US) guidance. METHODS: This study's participants comprised 15 patients (7 males, 8 females) with posterior crossbite and a mean age of 16.7 years (14.25-20.08 years). The Maxillary Skeletal Expander (MSE) appliance was used to perform MARPE in all patients. Their vital signs (heart rate, mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2)) were recorded. The ONSD was measured by US immediately before the first screw activation (T0), and the measurements were repeated 1 min (T1) and 10 min (T2) after the first activation. In the last session of active MARPE therapy, the same measurement protocol was performed as in the first activation session (T3, T4, and T5). The patients' perceptions of pain during the screw activation were also noted at T1 and T4 using a four-category verbal rating scale (VRS-4). The significant differences among different time intervals performed with the Friedman test (for all tested variables; SpO2, MAP, Heart Rate, VRS-4 and ONSD). Spearman correlation test was used for VRS-4 and ONSD comparisons. The statistical significance level was accepted as p < 0.05. RESULTS: The ONSD values ​​(T1 and T4) relatively increased within 1 min after screw activation but did not reach a statistically significant level (p > 0.05). There was also no significant difference between the initial (T0) and the final (T5) ONSD values ​​during the active MARPE therapy (p > 0.05). CONCLUSION: There is no changes or alterations in intracranial pressure in late adolescents during active MARPE therapy.

Changes of the upper airway and bone in microimplant-assisted rapid palatal expansion: A cone-beam computed tomography (CBCT) study.

OBJECTIVE: To evaluate the changes of maxillary expansion and upper airway structure after microimplant assisted rapid palatal expansion (MARPE) using cone-beam computed tomography (CBCT). METHODS: This retrospective study included 19 subjects (15 females and 4 males) aged 15-29 years old (mean, 19.95±4.39 years) with maxillary transverse deficiency treated with MARPE. CBCT was performed at the initial diagnosis and 3 months after MARPE treatment. Measurements were taken to evaluate the amount of total expansion, skeletal expansion, and dental expansion at the maxillary first premolar (P1), second premolar (P2), first molar (M1), second molar (M2) regions and upper airway changes. RESULTS: After MARPE treatment, the maxillary skeletal base expansion, skeletal expansion, alveolar expansion and dental expansion were achieved at the P1, P2, M1, M2 region. The nasopharyngeal volume significantly increased 8.48% after MARPE treatment compared with that before the treatment (P < 0.05). The change of nasal lateral width (NLW) was also significantly different before and after MARPE (P < 0.05). However, there were no statistically significant change in the oropharyngeal, palatopharyngeal, glossopharyngeal and airway total volume (all P > 0.05). CONCLUSIONS: MARPE can produce more transverse bone expansion, relieve maxillary transverse deficiency and improve upper airway ventilation.

Differential assessment of skeletal, alveolar, and dental components induced by microimplant-supported midfacial skeletal expander (MSE), utilizing novel angular measurements from the fulcrum.

BACKGROUND: In order to assess skeletal expansion, alveolar bone bending, and dental tipping after maxillary expansion, linear and angular measurements have been performed utilizing different craniofacial references. Since the expansion with midfacial skeletal expander (MSE) is archial in nature, the aim of this paper is to quantify the differential components of MSE expansion by calculating the fulcrum locations and applying a novel angular measurement system. METHODS: Thirty-nine subjects with a mean age of 18.2 ± 4.2 years were treated with MSE. Pre- and post-expansion CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified by localizing the interfrontal distance and modified interfrontal distance. Based on the fulcrum, a novel angular measurement method is presented and compared with a conventional linear method to assess changes of the zygomaticomaxillary complex, dentoalveolar bone, and maxillary first molars. RESULTS: From 39 patients, 20 subjects have the rotational fulcrum of the zygomaticomaxillary complex at the most distant points of the interfrontal distance (101.6 ± 4.7 mm) and 19 subjects at the most distant points of the modified interfrontal distance (98.9 ± 5.7 mm). Linear measurements accounted for 60.16% and 56.83% of skeletal expansion, 16.15% and 16.55% of alveolar bone bending, and 23.69% and 26.62% of dental tipping for right and left side. Angular measurements showed 96.58% and 95.44% of skeletal expansion, 0.34% and 0.33% alveolar bone bending, and 3.08% and 4.23% of dental tipping for the right and left sides. The frontozygomatic, frontoalveolar, and frontodental angles were not significant different (P > 0.05). CONCLUSIONS: In the coronal plane, the center of rotation for the zygomaticomaxillary complex was located at the most external and inferior point of the zygomatic process of the frontal bone or slightly above and parallel to the interfrontal distance. Due to the rotational displacement of the zygomaticomaxillary complex, angular measurements should be a preferred method for assessing the expansion effects, instead of the traditional linear measurement method.