MISMARPE protocol: minimally invasive surgical and miniscrew-assisted rapid palatal expansion.

OBJECTIVE: The purpose of this article is to present the MISMARPE technique, a new minimally invasive surgical procedure to treat maxillary transverse atresia in adult patients under local anesthesia and on an outpatient basis. TECHNIQUE DESCRIPTION: The technique consists of miniscrew-assisted rapid palatal expansion (MARPE) associated with a minimally invasive approach using maxillary osteotomies, latency and activation periods until the desired expansion is achieved. The present MISMARPE technique was performed in 25 consecutive cases with a success rate of 96%, yielding good skeletal outcomes with minimal trauma. The expander appliances, with their anchorage types, and a description of the surgical steps of the MISMARPE technique are presented. CONCLUSION: MISMARPE is a new and effective alternative for less invasive treatment of maxillary transverse deficiency in adults, compared to conventional surgery. Emphasis is placed on the importance of systematic and well-established protocols, for executing the procedures safely and predictably.

Miniscrew-assisted rapid palatal expansion (MARPE): Factors influencing planning.

OBJECTIVE: This cross-sectional study evaluated the bone thickness on mini-implants insertion site, the factors that influence the digital planning of MARPE appliance (miniscrew-assisted rapid palatal expansion), and its different designs. METHODS: A total of 135 plannings were assessed regarding the size of the expander screw used, the positioning and the type of the mini-implant rings, and their location in relation to the teeth. Bone thickness measurements were assessed in the region of the mini-implants' trajectory. Differences between the sexes was verified using the ANOVA test (5% significance). RESULTS: 73 cases were planned with 4 mini-implants and 62 cases, with 6 mini-implants. In 90% of cases, teeth #16 and #26 were used as supports, and the most used expander screw was 13mm (64.1% of cases). The anterior mini-implants of conventional MARPE showed more pronounced insertion in bone in males (5.9 ± 2mm; p= 0.025). The extra mini-implants (anterior region) were inserted with greater bone thickness in males (11.1 ± 2.3mm) compared to females (9.9 ± 1.8mm; p=0.041). A greater bone thickness was observed in males (10.1 ± 2.1 mm) when using mini-implants in the paramedian region. CONCLUSION: Additional rings allow more pronounced bone insertion. Male patients had greater bone thickness, which may be related to greater difficulty in opening the sutures. The alveolar process region seems to be a satisfactory site for mini-implants to those patients with reduced bone thickness in the paramedian posterior region. MARPE appliance must be customized for each patient, due to bone thickness and anatomical variations.

Dentoalveolar, periodontal and skeletal effects of maxillary expansion techniques assisted by temporary anchorage devices compared with conventional protocols in growing patients with transverse maxillary deficiency: A systematic review and meta-analysis.

OBJECTIVES: To synthesise the dentoalveolar, periodontal and skeletal changes that occur when using maxillary expansion techniques assisted by temporary anchorage devices compared to conventional protocols. METHODS: Five databases and grey literature were consulted, up to December 2023, focusing on intervention designs and excluding other type of studies. The quality assessment was conducted by using the adaptation for orthodontics of the CONSORT statement, the guidelines for reporting non-randomised studies, the RoB-2 tool, and the ROBINS-I tool. A descriptive summary and meta-analysis using RevMan 5.4 were performed. RESULTS: Nine clinical trials were included (n=377 patients, mean age 13.2±0.6) with a diagnosis of transverse maxillary deficiency. The analysed studies showed qualitative dentoalveolar and periodontal changes after expansion, which were greater on the maxillary first premolars in tooth-borne appliances. Meta-analyses for some effects were included from two studies (n=64); patients who used tooth-borne appliances had greater effects of buccal intercoronal width between the premolars with statistically significant differences (Std Mean difference 2.34; 95% CI: 0.04-4.65 p=0.05). Conversely, those patients who used bone-borne or hybrid appliances had greater effects of buccal intercoronal width between molars with statistically significant differences (Std Mean difference -0.64; 95% CI: -1.38-0.10; p=0.09). CONCLUSIONS: According to the studies analysed, all measurements increased in the intervention groups after expansion. Quantitative analyses show different findings at dentoalveolar level when tooth-borne, bone-borne or hybrid appliances are considered. Nevertheless, the results should be taken with caution due to the heterogeneity of the studies. The protocol was registered at PROSPERO (CRD42021283170), with no funding to report.

Expansión dentoalveolar predecible en Ortodoncia con uso de alineadores. Reporte de un caso clínico / Predictable dentoalveolar expansion in orthodontics with the use of aligners. Case Report

Este artículo describe el caso clínico de una paciente de 49 años. Clínicamente se observa Clase II molar derecha, Clase I molar izquierda y Clase I canina de ambos lados. La línea media superior se encuentra desviada hacia el lado izquierdo. Ausencia de piezas 35 y 45. Estrechez de maxilar superior con apiñamiento posterior izquierdo y derecho, apiñamiento anteroinferior. Mordida invertida posterior bilateral. Corredores bucales amplios. Sonrisa consonante, media. Para su tratamiento se indica una primera etapa de 13 alineadores con movimientos de traslación a vestibular y movimientos de torque coronovestibular, donde se planifica una expansión del maxilar superior de 10,99 mm. Al cabo de ocho meses de tratamiento, se observan 5,5 mm de expansión posterior logrados en esta primera etapa. Puede afirmarse que los alineadores son una herramienta efectiva para producir expansión del arco dental. La previsibilidad resultó razonable para el movimiento de expansión con el uso de alineadores.

This article describes the clinical case of a 49 year old female patient. Clinically, right molar class II, left molar class I, and canine class I are observed on both sides. Upper midline deviated to the left side, absence of teeth 35 and 45. Narrowness of the upper jaw with left and right posterior crowding, anteroinferior crowding. Bilateral posterior reverse bite. Negative space. Consonant, medium smile. For its treatment, a first stage of 13 aligners with buccal translation movements and coronobuccal torque movements is indicated, where an expansion of the upper jaw of 10.99 mm is planned. After 8 months of treatment, we can observe 5.55 mm of posterior expansion achieved in this first stage. We can affirm that aligners are an effective tool to produce expansion of the dental arch. Predictability was reasonable for the expansion movement with the use of aligners.

Corrección de la atresia maxilar y del plano oclusal utilizando MARPE y mini-implantes extra-alveolares / Correction of maxillary atresia and occlusal plane using MARPE and extra-alveolar mini-implants

Para el tratamiento no quirúrgico de la atresia maxilar en pacientes con osificación avanzada de la sutura palatina media, existe la alternativa de un disyuntor anclado en mini-implantes. El éxito no está garantizado, pero se puede hacer este intento antes de realizar una expansión asistida quirúrgicamente. Del mismo modo, el uso de mini-implantes extra-alveolares para el movimiento de grupos dentales en la corrección de maloclusiones es algo cada vez más aplicado debido a una mejor accesibilidad. El objetivo de este estudio es presentar el caso de un paciente adulto joven con atresia maxilar tratado con MARPE y la corrección del plano oclusal mediante mini-implantes extra-alveolares. Clínicamente se observó la apertura de la sutura media palatina; radiográficamente, la ligera rotación de la mandíbula en sentido antihorario, la mejora de la inclinación del plano oclusal, la disminución de la inclinación y protrusión de los incisivos superiores e inferiores, y la distalización de los molares mandibulares, estableciendo una relación molar en Clase I. La expansión con MARPE en el caso de este paciente adulto joven con atresia maxilar fue efectiva. Se consiguió la corrección del plano oclusal con el uso de mini-implantes extra-alveolares, así como resultados estéticos y funcionales muy satisfactorios. Entre varias alternativas de tratamiento, la técnica a realizar dependerá de factores como la efiencia, la conservación de los elementos dentales, la colaboración del paciente y la estabilidad.

For the non-surgical treatment of maxillary atresia in patients with an advanced degree of ossification of the midpalatal suture, there is an alternative of an expander anchored in miniscrews. Success is not guaranteed, but this attempt can be made before recommending surgically assisted expansion. Similarly, the use of extra-alveolar miniscrews for dental movement in the correction of malocclusions is something that is increasingly being applied due to better accessibility. The aim of this work is to present the case of a young adult patient with maxillary atresia treated with MARPE and the correction of the occlusal plane through the use of extra-alveolar miniscrews. Clinically, the opening of the midpalatal suture was observed, radiographically, the slight rotation of the mandible in an anti-clockwise direction, the improvement in the inclination of the occlusal plane, the decrease in the inclination and protrusion of the upper and lower incisors, and the distalization of the lower molars establishing a Class I molar relationship. The expansion with MARPE in the case of a young adult patient with maxillary atresia was effective. The correction of the occlusal plane with the use of extraalveolar miniscrews was achieved, as well as very satisfactory aesthetic and functional results. Among various treatment alternatives, the technique to be executed will depend on factors such as efficiency, conservation of dental elements, patient collaboration, and stability.

Three-dimensional assessment of the maxilla after modified surgically assisted rapid expansion: a retrospective study.

OBJECTIVE: This retrospective study aims to assess the three-dimensional dentoskeletal effects and median palatal suture opening pattern in patients undergoing modified surgically assisted maxillary rapid expansion (SARME) without pterygoid plate detachment. METHODS: Twenty-eight patients submitted to modified SARME between 2009 and 2016 were retrospectively evaluated through cone-beam computed tomography (CBCT). Dental and skeletal measurements were taken at three different operative periods (before the expansion - T0; at the end of the activation of the Hyrax device - T1; and six months after the immobilization of the device - T2). Statistical analyses, including ANOVA and Pearson's correlation coefficient, were performed using SPSS software. RESULTS: SARME demonstrated significant transverse maxillary expansion (with an average of 6.05 mm) with a greater impact in the anterior region. Dental measurements, including canine and molar distances, exhibited significant changes over the operative periods. Bone measurements (ANS and PNS) presented small but significant alterations, including a slight inferior displacement of ANS during device activation. The nasal floor width increased, followed by a width reduction after immobilization. The median palatal suture predominantly exhibited a Type II (V-shaped) opening. CONCLUSION: The modified SARME presented a transversal direction increase and a super-lower skeletal displacement, with the anterior region being more affected than the posterior region. There was no change in the anteroposterior direction of the maxilla. Additionally, there was an increase in the linear dental measurements and a decrease in the angular measurement, with a positive correlation between the amount of posterior bone expansion and molar expansion as a result of the treatment in the analyzed period.

Temporomandibular joint disc position and shape in patients submitted to two protocols of rapid maxillary expansion and face mask therapy: A randomized clinical trial.

OBJECTIVE: The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. METHODS: A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05). RESULTS: There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied. CONCLUSION: The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.

Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis.

INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. OBJECTIVE: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. MATERIAL AND METHODS: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. RESULTS: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). CONCLUSIONS: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor.

OBJECTIVE: To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). METHODS: Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21-42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. RESULTS: There was an increase in nasal width with an average of 1.3467mm and an increase in the alar base with an average of 1.7333mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. CONCLUSION: Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. LEVEL OF EVIDENCE: Level 4.

Can rapid maxillary expansion affect speech sound production in growing patients? A systematic review.

Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment.

Effects of SARPE and MISMARPE on correction of transverse maxillary deficiency: A preliminary comparative evaluation.

AIM: The present study was designed to compare, on cone-beam computed tomography imaging, the skeletal and dental effects of the SARPE (Surgically assisted rapid palatal expansion) and MISMARPE (Minimally Invasive Surgical and Miniscrew-Assisted Rapid Palatal Expansion) techniques. MATERIALS AND METHODS: The sample of adult patients with transverse maxillary deficiency (TMD) was divided into two groups, and scans were obtained preoperatively (T0) and immediately after completion of expansion (T1). The posterior and anterior linear transverse distances of the maxilla and the angulation of the maxillary first molars were evaluated. The data were entered into a generalized estimating equations model to verify the postoperative effects of the different techniques. RESULTS: None of the techniques caused any appreciable change in the angulation of the molars. The skeletal changes were similar, with significantly greater gains in the nasal fossa and intermaxillary distance when using the MISMARPE. CONCLUSION: The technique can be an effective and lower morbidity alternative to SARPE.

Effects of rapid maxillary expansion on sleep disturbance scale for children: A longitudinal CASE-series study.

OBJECTIVE: To evaluate the effects of rapid maxillary expansion (RME) on Sleep Disturbance Scale for Children (SDSC) with maxillary atresia. MATERIALS AND METHODS: The sample consisted of 27 paediatric patients evaluated through a Brazilian version of the SDSC, answered by their guardians at the following experimental time points: T0 (before installing the Hyrax expander), T1 (on the day of expander stabilization), T2 (3 months after expander stabilization), T3 (immediately after expander removal, following 6 months of retention), and T4 (3 months post-retention). Multilevel Poisson analysis adjusted for repeated measures was performed to compare outcomes across the assessment time points. RESULTS: The mean age of patients was 9.1 years (SD = 1.46). The total SDSC scores decreased and were statistically significant from T2 onwards (P < .01), with a decrease of 24% at T4 compared with T1 (IRR 0.76; 95% CI 0.69-0.84). The mean scores at T4 were already lower than the cutoff point for risk of sleep disorders. Regarding the specific domains, there was a significant reduction in sleep breathing disorders, sleep-wake transition disorders, and disorders of excessive somnolence as of T2 (P < .01), T3 (P < .05) and T4 (P < .05), respectively. CONCLUSION: RME in children with maxillary atresia had a positive effect on the reduction of total SDSC scores after 3 months of expander stabilization, sustained over 6 and 9 months and significant reduction in sleep breathing disorders domain, sleep-wake transition disorders domain, and disorders of excessive somnolence domain over time points.

Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study.

INTRODUCTION: The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. METHODS: A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. RESULTS: The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P <0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P <0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. CONCLUSIONS: The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Miniplaca palatina versátil: um leque de possibilidades / Versatile mini palatal plate: a range of possibilities

O palato é uma região considerada ideal para a inserção de dispositivos de ancoragem temporária (DAT's). É conhecido por possuir áreas com boa quantidade e qualidade óssea, longe das raízes dos dentes, com uma gengiva de boa qualidade, e dispor de um fácil acesso para uma correta instalação. O objetivo desse artigo é apresentar uma miniplaca palatina com mecânica originada na Coréia do Sul (BOS ­ Biocreative Orthodontic Strategy) como uma alternativa de ancoragem esquelética, por meio de um caso clínico e a demonstração de um passo a passo de sua instalação. Ela se mostra muito útil e eficiente em casos de distalização de molares superiores, mesialização ou intrusão dos mesmos. Por esta versatilidade, aqui no Brasil esta miniplaca recebe o nome de miniplaca palatina versátil (MPV). A MPV representa uma alternativa bastante eficaz em casos onde é necessário ancoragem esquelética sem incisão, se destacando em pontos como: simplicidade de instalação; estética; controle biomecânico; versatilidade e valor acessível. (AU)

The palate is a region considered ideal for the insertion of temporary anchorage devices (DAT's). It is known for having areas with good bone quantity and quality, away from the roots of the teeth, with good quality gums, and having easy access for correct installation. The objective of this article is to present a mini palatal plate with mechanics originated in South Korea (BOS ­ Biocreative Orthodontic Strategy) as an alternative for skeletal anchorage, through a clinical case and a step-by-step and the installation procedure. It proves to be very useful and efficient in cases of maxillary molar distalization, mesialization or intrusion of the same. Due to this versatility, here in Brazil this miniplate is called versatile mini-palatal plate (MPV). The MPV represents a very effective alternative in cases where skeletal anchorage without incision is required, standing out in points such as: simplicity of installation; aesthetics; biomechanical control; versatility and affordable value (AU)

MARPE em adultos e a regeneração da sutura palatina mediana ­ relato de caso / Mini screw assisted rapid palatal expansion in adult patient and mid palatal suture regeneration ­ case report

A expansão rápida da maxila (ERM) representa o procedimento gold-standard para correção da deficiência transversal do arco dentário superior. Porém, a idade é fator limitante para o sucesso da ERM convencional. Recentemente, a expansão rápida da maxila assistida por mini-implantes (MARPE) ampliou o limite de idade para separação da sutura palatina mediana (SPM), permitindo a correção minimamente invasiva da atresia maxilar, em pacientes adultos. O objetivo deste artigo foi relatar um caso clínico de um paciente adulto com mordida cruzada posterior tratado com MARPE, avaliar os efeitos transversais, o reparo da sutura palatina mediana (SPM) e a estabilidade da expansão após 8 meses de contenção. Paciente de sexo masculino, de 25 anos de idade, apresentava-se com mordida cruzada posterior bilateral, má oclusão de Classe III bilateral e estágio de maturação da SPM avançado. Foi indicado o tratamento com MARPE com 4 parafusos, posicionados parassuturalmente, seguido de tratamento compensatório para Classe III. Após a fase ativa da expansão o aparelho foi mantido por 12 meses como contenção. Após os 6 meses foram removidas as hastes do expansor e foi instalado o aparelho fixo, com uso de elásticos intermaxilares O reparo completo da SPM foi observada após um período de 12 meses de contenção. Após a ortodontia corretiva, uma adequada relação oclusal de molar Classe I foi alcançada (AU)

Rapid palatal expansion (RPE) represents the gold-standard procedure for correcting transverse maxillary dental arch deficiency. However, age is a limiting factor for the success of conventional RPE. Recently, mini-implant-assisted rapid palatal expansion (MARPE) has extended the age limit for midpalatal suture (MPS) separation, allowing for minimally invasive correction of maxillary atresia in adult patients. The aim of this article was to report a clinical case of an adult patient with posterior crossbite treated with MARPE, to evaluate the cross-sectional effects, midpalatal suture (MPS) repair and expansion stability after 8 months of retention. A 25-year-old male patient presented with bilateral posterior crossbite, bilateral Class III malocclusion, and advanced PMS maturation stage. Treatment with MARPE with 4 screws, positioned parasuturally, was indicated, followed by compensatory treatment for Class III. After the active phase of expansion, the appliance was kept for 12 months as a retainer. After 6 months, the expander rods were removed and the fixed appliance was installed using inter maxillary elastics. Complete PMS repair was observed after a period of 12 months of retention. After corrective orthodontics, an adequate Class I molar occlusal relationship was achieved (AU)

A expansão rápida da maxila e sua relação com a qualidade de vida em pacientes respiradores bucais / Rapid maxillary expansion and its relation with quality of life in mouth breathing patients

Este estudo avaliou, em curto prazo, mudanças após a expansão rápida da maxila em pacientes respiradores bucais e correlacionou esses achados com a qualidade de vida dos pacientes. Este estudo teve como objetivo avaliar se a expansão rápida da maxila (ERM) está associada à melhora na qualidade de vida pós-tratamento. Foram avaliadas 35 crianças (média de idade 10,3 anos) com respiração bucal com hipoplasia maxilar. Os sintomas subjetivos foram avaliados por questionário padronizado de qualidade de vida, respondido pelos pacientes e seus pais ou responsáveis legais pré e pós-ERM. As condições respiratórias subjetivas do pré-tratamento apresentaram melhora significativa seis meses após a ERM. Concluiu-se que a ERM promoveu melhora na qualidade de vida dos pacientes com respiração bucal e hipoplasia maxilar (AU)

This study evaluated short-term changes after rapid maxillary expansion in mouth breathing patients and correlated these findings with their quality of life. This study aimed to evaluate whether rapid maxillary expansion (RME) is associated with improved post-treatment quality of life. Thirty-five mouth breathing children (mean age 10.3 years old) with maxillary hypoplasia were evaluated. Subjective symptoms were assessed by a standardized quality of life questionnaire, answered by patients and their parents or legal guardians before and after RME. Pre-treatment subjective respiratory conditions showed significant improvement six months after RME. It was concluded that RME improves the quality of life for patients with mouth breathing and maxillary hypoplasia (AU)

Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion.

OBJECTIVE(S): This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS: The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. RESULTS: The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. CONCLUSION: Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.

Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial.

OBJECTIVE: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. METHODS: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. RESULTS: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. CONCLUSIONS: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.