Validity and reproducibility of the 3D VECTRA photogrammetric surface imaging system for the maxillofacial anthropometric measurement on cleft patients.

OBJECTIVES: To validate the accuracy and reproducibility of linear measurements of three-dimensional (3D) images and to compare the measurements with the direct anthropometry method on cleft lip and palate (CLP) patients. MATERIALS AND METHODS: Nineteen linear facial measurements were derived from 16 standardized surface landmarks obtained from 37 cleft patients (20 males, 17 females; mean age 23.84 years, standard deviation ± 6.02). They were taken manually with calipers and were compared with the digitally calculated distance on the 3D images captured using the VECTRA-M5 360° Imaging System with pre-marked landmarks. Another pair of 19 linear measurements were computed on the 3D images 2 weeks apart for intra- and inter-observer agreements. Statistical analyses used were paired t test, the Bland-Altman analysis, and the intra-class correlation coefficient (ICC) index. RESULTS: Most of the linear measurements showed no statistically significant differences between the proposed method and direct anthropometry linear measurements. Nevertheless, bias of the 3D imaging system is present in the linear measurements of the nose width and the upper vermillion height. The measurements' mean biases were within 2 mm, but the 95% limit of agreement was more than 2 mm. Intra- and inter-observer measurements generally showed good reproducibility. Four inter-observer measurements, the upper and lower face heights, nose width, and pronasale to left alar base were clinically significant. CONCLUSIONS: Measurements obtained from this 3D imaging system are valid and reproducible for evaluating CLP patients. CLINICAL RELEVANCE: The system is suitable to be used in a clinical setting for cleft patients. However, training of the operator is strictly advisable.

Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review.

OBJECTIVE: This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. MATERIALS AND METHODS: An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. RESULTS: The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. CONCLUSIONS: Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.

Bone-borne accelerated sutural expansion: A microcomputed tomography study in rabbits.

INTRODUCTION: In this study, we evaluated the effect of bone-borne accelerated expansion protocols on sutural separation and sutural bone modeling using a microcomputed tomography system. We also determined the optimum instant sutural expansion possible without disruption of bone modeling. METHODS: Sixteen New Zealand white rabbits, 20 to 24 weeks old, were randomly divided into 4 experimental groups. Modified hyrax expanders were placed across their interfrontal sutures and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax appliances were activated as follows: group 1 (control), 0.5-mm per day expansion for 12 days; group 2, 1-mm instant expansion followed by 0.5 mm per day for 10 days; group 3, 2.5-mm instant expansion followed by 0.5 mm per day for 7 days, and group 4, 4-mm instant expansion followed by 0.5 mm per day for 4 days. After 6 weeks of retention, sutural separation and sutural bone modeling were assessed by microcomputed tomography and quantified. Statistical analysis was performed using Kruskal Wallis and Mann-Whitney U tests and the Spearman rho correlation (P <0.05). RESULTS: Median amounts of sutural separation ranged from 2.84 to 4.41 mm for groups 1 and 4, respectively. Median bone volume fraction ranged from 59.96% to 69.15% for groups 4 and 3, respectively. A significant correlation (r = 0.970; P <0.01) was observed between the amounts of instant expansion and sutural separation. CONCLUSIONS: Pending histologic verifications, our findings suggest that the protocol involving 2.5 mm of instant expansion followed by 0.5 mm per day for 7 days is optimal for accelerated sutural expansion. When 4 mm of instant expansion was used, the sutural bone volume fraction was decreased.

Is there an optimal initial amount of activation for midpalatal suture expansion? : A histomorphometric and immunohistochemical study in a rabbit model.

OBJECTIVE: Accelerated bone-borne expansion protocols on sutural separation and sutural bone formation were evaluated via histomorphometry and immunohistochemistry to determine the optimal initial activation without disruption of bone formation. MATERIALS AND METHODS: Sixteen New Zealand white rabbits were randomly divided into four groups. Modified Hyrax expanders were placed across the midsagittal sutures and secured with miniscrew implants with the following activations: group 1 (control), 0.5 mm expansion/day for 12 days; group 2, 1 mm instant expansion followed by 0.5 mm expansion/day for 10 days; group 3, 2.5 mm instant expansion followed by 0.5 mm expansion/day for 7 days; and group 4, 4 mm instant expansion followed by 0.5 mm expansion/day for 4 days. After 6 weeks, sutural expansion and new bone formation were evaluated histomorphometrically. Statistical analysis was performed using Kruskal-Wallis/Mann-Whitney U tests and Spearman's rho correlation (p < 0.05). RESULTS: The smallest median sutural separation was observed in group 1 (3.05 mm) and the greatest in group 4 (4.57 mm). The lowest and highest amount of bone formation were observed in group 4 (55.82%) and in group 3 (66.93%), respectively. Immunohistochemical analysis revealed significant differences in median levels of alkaline phosphatase and osteopontin expression between all experimental groups. The highest level of these proteins was attained in group 3, followed by groups 2, 1, and 4, respectively. CONCLUSIONS: Sutural appositional bone formation corresponded with the amount of initial expansion to a point. When initial expansion was increased to 4 mm, sutural bone remodeling was disturbed and new bone formation was decreased. The most effective sutural expansion was achieved with 2.5 mm initial activation followed by 0.5 mm expansion/day for 7 days.

Effect of Piezoelectric Sutural Ostectomies on Accelerated Bone-Borne Sutural Expansion.

PURPOSE: The present study investigated the effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion. MATERIALS AND METHODS: Sixteen male New Zealand white rabbits (20 to 24 weeks old) were randomly divided into 4 experimental groups (n = 4): group 1, conventional rapid sutural expansion; group 2, accelerated sutural expansion; group 3, accelerated sutural expansion with continuous ostectomy; and group 4, accelerated sutural expansion with discontinuous ostectomy. All sutural ostectomies were performed using a piezoelectric instrument (Woodpecker DTE, DS-II, Guangxi, China) before expander application with the rabbits under anesthesia. Modified hyrax expanders were placed across the midsagittal sutures of the rabbits and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax expanders were activated 0.5 mm/day for 12 days (group 1) or with a 2.5-mm initial expansion, followed by 0.5 mm/day for 7 days (groups 2 to 4). After 6 weeks of retention, the bone volume fraction, sutural separation, and new bone formation were evaluated using micro-computed tomography and histomorphometry. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests and Spearman's rho correlation (P < .05). RESULTS: Ranking of the median sutural separation was as follows: group 1, 3.05 mm; group 2, 3.97 mm; group 4, 4.78 mm; and group 3, 5.66 mm. The least and most bone formation were observed in groups 1 (63.63%) and 3 (75.93%), respectively. Spearman's correlation showed a strong, positive, and significant correlation (r = 0.932; P < .01) between the new sutural bone formation and amount of sutural separation. CONCLUSIONS: Piezoelectric sutural ostectomies increased the rate of sutural separation and promoted new sutural bone formation/osteogenesis. Continuous ostectomy gave better results than discontinuous ostectomy.