Influence of rapid maxillary expansion in the stability of anterior open bite treatment.

OBJECTIVES: This study aimed to compare the stability of anterior open bite (AOB) in patients treated with and without rapid maxillary expansion (RME) before fixed palatal crib (PC) therapy in the mixed dentition. MATERIAL AND METHODS: Expansion/palatal crib group (EPC) was comprised of 25 patients (10 male, 15 female, mean initial age of 7.8 years) with AOB treated with RME before PC therapy. Palatal crib group (PC) included 25 patients with AOB (10 male, 15 female, mean initial age of 8.0 years) treated only with PC therapy. Lateral cephalograms were analyzed at pre-treatment (T0), after PC therapy (T1), and 3 years after PC removal (T2) in both groups. AOB relapse was considered when a negative overbite was observed at T2. Intergroup comparisons of interphase changes were performed using t and Mann-Whitney tests (p < 0.05). RESULTS: Treatment and post-treatment alterations showed similar changes in both groups for all cephalometric variables. Overall changes from T0 to T2 were similar between the groups except for the maxillary incisors that tipped lingually in PC group (1.PP = - 3.37°) and labially in EPC group (1.PP = 1.76°). The frequency of AOB relapse was 8% and 4% in the EPC and PC groups, respectively. Treatment time in the EPC group (9.7 months) was shorter (p = 0.024) when compared to the PC group (11.0 months). CONCLUSIONS: In the mixed dentition, stability of AOB treated with RME before fixed PC therapy was similar to PC therapy alone. However, treatment time with fixed PC was slightly shorter in the group treated with RME. CLINICAL RELEVANCE: This study aims to understand if RME performed previously to fixed palatal crib contributes to the index of stability of AOB treatment in the mixed dentition.

Expansão rápida da maxila apoiada em mini-implantes (MARPE) em adulto com fissura labiopalatina / Miniscrew assisted rapid palatal expansion (MARPE) in an adult with cleft lip and palate

A expansão rápida da maxila (ERM) é um procedimento terapêutico frequentemente requerido em pacientes com fissura labiopalatina completa para correção da constrição do arco dentário superior, da mordida cruzada posterior e do desalinhamento dos segmentos maxilares. Quando a janela terapêutica ortopédica é perdida e os pacientes são reabilitados tardiamente em um estágio de maturação óssea avançado, a expansão maxilar assistida cirurgicamente pode ser indicada. Porém, com o advento do MARPE (Miniscrew Assisted Rapid Palatal Expansion), a ERM ortopédica passou a ser uma opção em pacientes adultos sem fissuras labiopalatinas. O objetivo desse trabalho foi desenvolver um design de aparelho expansor com ancoragem esquelética para pacientes com fissuras labiopalatinas. Secundariamente, também se objetivou descrever um caso clínico de uma paciente adulta com fissura completa unilateral não tratada ortodonticamente. A referida paciente do sexo feminino, 24 anos de idade, apresentava má oclusão Classe III severa com mordida cruzada posterior e anterior. Foi realizada ERM com ancoragem esquelética usando um expansor Hyrax ancorado em 2 bandas nos primeiros molares e 4 mini-implantes nas lâminas palatinas distante da fissura palatina. Como não houve ancoragem esquelética suficiente, os resultados obtidos foram predominantemente dentoalveolares. A morfologia singular do paciente com fissura labiopalatina causada por deficiências ósseas no palato e pela presença de mucosa palatina mais espessa exige uma avaliação única para cada paciente. Mais estudos são necessários com o objetivo de detectar singularidades em tecido mole e ósseo, encontrando sítios com suporte suficiente para efeito ortopédico e menores efeitos colaterais. (AU)

Rapid maxillary expansion (RME) is a therapeutic procedure often required in patients with complete cleft lip and palate for correction of the upper dental arch constriction, posterior crossbite and maxillary segments misalignments. When the orthopedic therapeutic window is lost and late rehabilitation procedures are performed with advanced bone maturation stage, surgically assisted maxillary expansion may be indicated. However, with the advent of Miniscrew Assisted Rapid Palatal Expansion (MARPE), orthopedic RME has become an option in adult patients without cleft lip and palate. The aim of this study was to develop an expander device with skeletal anchor for patients with cleft lip and palate. Secondarily, it also aimed to describe a case report of an adult patient with complete unilateral cleft lip and palate not treated orthodontically previously. The female, 24 years old patient, presented severe Class III malocclusion with posterior and anterior crossbite. RME skeletally anchored was performed using a Hyrax expander anchored in 2 bands on the first molars and 4 mini-implants on the palatine bone distant from the cleft palate. As there was not enough skeletal anchorage, the results obtained were predominantly dentoalveolar. The singular morphology of the patient with cleft lip and palate caused by palate bone deficiencies and the presence of thicker palatal mucosa requires a unique assessment for each patient. More studies are needed to detect soft and bone tissue singularities, finding sites with sufficient support for orthopedic effect and minor side effects.(AU)