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Nine facial landmarks used for global alignment (left eye outer, left eye inner, right eye outer, right eye inner, nose tip, nose base middle, mouth left corner, mouth right corner, chin middle)
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Background
Skeletal maxillary expander (MSE) is one of the more recent expander designs being utilized for skeletal expansion by splitting the midpalatal sutures applying forces through palatal micro-implants. Its effects on the soft tissue remain a question asked by both patients and clinicians. The aim of this study was to analyze and quantify so...
Contexts in source publication
Context 1
... initially align the samples, nine manually labeled facial landmarks (left eye outer, left eye inner, right eye outer, right eye inner, nose tip, nose base middle, mouth left corner, mouth right corner, chin middle) were ap- plied on each sample (Fig. 1). These landmarks were only used for initial rough alignment and its purpose is only to decrease the computing resources needed for the actual alignment utilizing each vertex, therefore any inaccuracy was eliminated later on. Global similarity transformation matrix (translation, rotation, scaling) was computed to align all meshes ...
Context 2
... red areas indicate that there were very minimal to none soft tissue changes during the 1-year retention period. Figures 9 and 10 illustrate the p-maps between T0 and T1 time points but using only the samples which have dominantly expanded toward the left and right side, respectively. The left side dominant samples showed significant changes only on the nose and cheek of the left side and there were no significant changes on the right side (Fig. 9). ...
Context 3
... expanded toward the left and right side, respectively. The left side dominant samples showed significant changes only on the nose and cheek of the left side and there were no significant changes on the right side (Fig. 9). Same results were observed for the right side expanded samples with no significant changes occurred on the left side (Fig. ...
Context 4
... further analysis of the statistically significant changes, vector maps showing direction of changes have been made. Figure 11 shows a vector map between T0 and T1 where the red arrows denote vectors with p < 0.01, and the blue ones denote vectors with p < 0.05. The vec- tors shown are a condensed representation where each vector represents an average of all the vectors in a five-unit neighborhood, so as to better visualize the vec- tors' direction. ...
Context 5
... direction. As it is shown in those figures, direction of the vectors is toward lateral and anterior of the face with more dominant forward direction. For more in-depth statistics, the three major regions of significance (nose (refer to paranasal and upper lip re- gions together), right cheek, and left cheek) were chosen to quantify the vectors (Fig. 12a). Table 1 presents the breakdown of the data within each histogram, showing minimum/maximum displace- ments, means, medians, and standard deviations of dis- placement vectors for each region. Based on the means, the displacement magnitude appears to be larger in both right and left cheeks compared to the nose area (paranasal and upper ...
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Citations
... The questionnaires revealed that more than 87.5% of patients who undergo maxillary expansion experience better nasal breathing (18) . The soft tissue change was similar to hard tissue displacement in the lateral directions following RPE this result has also been seen in a prior study that used 3D face scanning (19) . In contrast to a prior study, the significant rise in soft tissue nasal width seen in this investigation was consistent in a 71% ratio with the increases in skeletal width (20) this could be the result of soft tissue compression. ...
... In general, dentofacial orthopedic evaluations of these appliances showed paralel split of the suture and laterally diplacement of the maxillary and zygomatic bones [6, 8-10], while dentoalveolar evaluations exhibit insigni cant or minimal buccal tipping [7,8]. In three studies that evaluated limited soft tissue changes, enlargement of the nose along with forward and downward movement, 1 and forward and lateral movement of the paranasal and cheek area were reported [11,12]. ...
... As a result of the study, in which nasal soft tissues were evaluated, downward and forward movements of the pronasale and subnasale were reported [1]. Abedini et al. [11] used 3dMD face system, which is a very quick stereophotogrammetry system, to capture the face scans of patients treated with MSE 2 expander before skeletal expansion, after skeletal expansion, and 1 year in retention. The results showed signi cant changes in paranasal, upper lip, and at both cheeks with greater magnitude at the cheek area [11]. ...
... Abedini et al. [11] used 3dMD face system, which is a very quick stereophotogrammetry system, to capture the face scans of patients treated with MSE 2 expander before skeletal expansion, after skeletal expansion, and 1 year in retention. The results showed signi cant changes in paranasal, upper lip, and at both cheeks with greater magnitude at the cheek area [11]. In the study of Nguyen et al. [12], in which the pre-and post-expansion CBCT images were superimposed using OnDemand3D software, soft tissue subnasale, A point, labiale superior, chelion, cheekpoint and alar curvature points were investigated. ...
Introduction
The increased resistance of midpalatal, zygomaticomaxillary and pterygopalatine sutures overtime, reduces the dentofacial orthopedic effect of conventional expanders. To adress this, mini-screw-assisted rapid palatal expanders have been created. The aim of this study was to investigate the mid-facial soft tissue changes along with rotational movements of zygomaticomaxillary complex after maxillary skeletal expander(MSE) application.
Materials and Methods
Pre- and post-expansion CBCT images of 17 patients(10 female,7 male) with transversal maxillary deficiency and treated with MSE 2, were enrolled in this retrospective study. Eight skeletal angular measurements were performed in the coronal and axial zygomatic sections. Besides, nineteen linear and 3 angular soft tissue measurements were investigated in the midsagittal plane. All the measuments were performed using OnDemand3D software(CyberMed Inc,Seoul,Korea). Paired-t test was used to compare the pre- and post-expansion outcomes.
Results
In the coronal zygomatic section, the decrease in frontoethmoidal angle and increases in frontozygomatic and zygomaticomaxillary angles revealed the outward rotation of zygomaticomaxillary comples. The increase in maxillary inclination showed the downward rotation of zygomaticomaxillary complex. The increases in frontozygomatic, frontoalveolar and frontodental angles represented greater skeletal expansion and minimal alveolar bone bending and dental tipping. The soft tissue measurements revelaed significant increase in the upper and lower face heights, alar nasal width, nasal tip protrusion, vertical filtrum height, and nasal width angle and a decrease in the facial profile angle.
Conclusion
Downward and outward rotation of the zygomaticomaxillary complex around the fulcrum area above the superior aspect of the frontozygomatic suture caused significant soft tissue changes in the paranal and nasal area.
... Before the pioneering report of Lee [15], treating adult patients with transverse skeletal problems required surgical aid, which increased cost and patient morbidity. After MARPE became a generally-accepted approach, cases with maxillary transverse deficiency or borderline Class III cases could be resolved with non-surgical skeletal expansion and maxillary protraction in adolescent and young adult patients [15,17,[33][34][35][36]. ...
Background
Non-surgical mini-implant assisted rapid palatal expansion, or midfacial skeletal expansion, is a paradigm-shifting concept that in recent years has expanded the envelope of orthopedic movement in the transverse direction for adult patients. Although adding mini-screws to a rapid palatal expander is not complicated, accurate and successful expansion strongly depends on the device’s position and its relation to the resisting structures of the maxillofacial complex.
Case presentation
This article presents a digital workflow to locate the optimal position of the Midfacial Skeletal Expander (MSE) device in a CBCT-combined intraoral scan file and describes how to transfer the MSE position intra-orally with properly sized bands during the device fabrication. The complete digital workflow of MSE fabrication and its application for a Class III orthognathic surgical case is presented in detail.
Conclusions
This report describes a completely digital process that can accurately position the MSE device according to the orientation and morphology of maxillary basal bone, which is crucial in adult cases demand maxillary expansion.
... Actualmente existen pocos estudios que evalúen los efectos inmediatos en tejidos blandos faciales con ERM-SO, 27,28 o aquellos que comparen entre la ERM-SD y ERM-SO; 28,29 y no existe ningún estudio que realice esta comparación en tejidos blandos a largo plazo; solo pocos que evalúan los cambios a nivel nasal. 20,30 Adicionalmente, en los estudios que evalúan los tejidos blandos se utilizan diferentes metodologías para la obtención de imágenes y referencias para la medición de las variables. ...
... Actualmente existen pocos estudios que evalúen los efectos inmediatos en tejidos blandos faciales con ERM-SO, 27,28 o aquellos que comparen entre la ERM-SD y ERM-SO; 28,29 y no existe ningún estudio que realice esta comparación en tejidos blandos a largo plazo; solo pocos que evalúan los cambios a nivel nasal. 20,30 Adicionalmente, en los estudios que evalúan los tejidos blandos se utilizan diferentes metodologías para la obtención de imágenes y referencias para la medición de las variables. ...
... Actualmente, se reconoce la importancia de la estética orofacial y su influencia en el autoestima y la calidad de vida de los pacientes ortodónticos; 64 además, los cambios faciales presentan influencia en la macroestética pero también en la microestética del paciente como simetría de sonrisa o exposición de incisivos. 65 La expansión rápida maxilar en sus diversos diseños también podría impactar en la estética facial, aunque solamente se ha hecho hincapié en sus efectos inmediatos, [22][23][24][25]27,28 solo se ha investigado los cambios en los tejidos blandos a largo plazo usando ERM de soporte dentario. 24,26 El presente estudio es el primero en evaluar y comparar los efectos en los tejidos blandos a largo plazo de la expansión maxilar con soporte óseo (ERM-SO), expansión maxilar con soporte dentario (ERM-SD) y un grupo sin tratamiento (CONTROL). ...
... Main characteristics of the included studies in this systematic review are shown in Table S1. Twelve studies were of the retrospective one-group pretest-posttest design [23,[28][29][30][31][32][33][34][35][36][37][38]. Eight studies were prospective [19][20][21][22][39][40][41][42] and four studies were retrospectively compared with other arch expansion methods [18,26,43,44]. ...
... Most of the remaining studies were retrospective, so the quality was moderate. Six studies conducted posttreatment follow-up [19,28,30,31,33,41]. Seven studies used assessor blinding [18,20,22,23,30,42,43]. ...
... An et al. used 2D frontal photos to find that the alar width also increased [18]. 3D measurement of facial soft tissues is a new direction that can avoid the superimposition and image distortion observed with the 2D radiography technique [28]. Staller et al. found that there are some differences between 2D photos and 3D measurements. ...
Objective
This study aims to assess the short- and long-term changes in the upper airway and alar width after mini-implant -assisted rapid palatal expansion (MARPE) in nongrowing patients.
Methods
Five electronic databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched up to 2 August, 2023 based on the PICOS principles. The main outcomes were classified into three groups: 1) nasal cavity changes, 2) upper airway changes and 3) alar changes. The mean difference (MD) and 95% confidence intervals (CI) were used to assess these changes. Heterogeneity tests, subgroup analyses, sensitivity analyses, and publication bias were also analyzed.
Result
Overall, 22 articles were included for data analysis. Nasal cavity width (WMD: 2.05 mm; 95% CI: 1.10, 3.00) and nasal floor width (WMD: 2.13 mm; 95% CI: 1.16, 3.11) increased significantly. While palatopharyngeal volume (WMD: 0.29 cm ³ , 95% CI: -0.44, 1.01), glossopharyngeal volume (WMD: 0.30 cm ³ , 95% CI: -0.29, 0.89) and hypopharyngeal volume (WMD: -0.90 cm ³ ; 95% CI: -1.86, 0.06) remained unchanged, nasal cavity volume (WMD: 1.24 cm ³ , 95% CI: 0.68, 1.81), nasopharyngeal volume (MD: 0.75 cm ³ , 95% CI: 0.44, 1.06), oropharyngeal volume (WMD: 0.61 cm ³ , 95% CI: 0.35, 0.87), and total volume of the upper airway (WMD: 1.67 cm ³ , 95% CI: 0.68, 2.66) increased significantly. Alar width (WMD: 1.47 mm; 95% CI: 0.40, 2.55) and alar base width (WMD: 1.54 mm; 95% CI: 1.21, 1.87) also increased.
Conclusion
MARPE can increase nasal cavity width, nasal cavity volume, nasopharyngeal volume and oropharyngeal volume for nongrowing patients, but has no significant effect on hypopharyngeal volume. In addition, the alar width also increased. However, the studies included in this meta-analysis were mainly retrospective, nonrandomized and small in number, so the findings should be interpreted with caution and high-quality RCTs need to be studied.
... The midfacial skeletal expander (MSE) is one particular design of MARPE appliance that has been described in the literature since 2014 [12,[20][21][22][23][24][25][26][27][28][29]. There have been many studies on the use and successful application of the MSE in mature patients in recent years [12,21,28]. ...
Background: The Midfacial Skeletal Expander (MSE) produces a greater skeletal effect than its dentoalveolar side effects. The aim of this study was to quantify the stability of the different components of MSE expansion post-orthodontic treatment. Methods: Fourteen subjects (mean age of 20.4 ± 3.5 years) were treated with the MSE. The pre-expansion (T0), post-expansion (T1), and post-treatment (T2) CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified, and angular measurements were generated to assess changes in the zygomaticomaxillary complex (skeletal expansion), dentoalveolar bone (alveolar bone bending), and maxillary first molars (dental tipping). The stability of all three components after orthodontic treatment was also assessed by comparing changes between T0–T1 and T0–T2. Results: Post-expansion, angular measurements showed that skeletal expansion accounted for 87.50% and 88.56% of total expansion, alveolar bone bending for 7.09% and 5.23%, and dental tipping for 5.41% and 6.21% on the right and left sides, respectively. Post-treatment skeletal expansion relapsed by 11.20% and 13.28% on the right and left sides, respectively. Conclusions: The MSE mainly produces skeletal changes with insignificant and negligible dentoalveolar changes immediately after expansion. In the long term, the majority of skeletal expansion was maintained.
... However, there has been limited research on the effects of MARPE on the facial soft tissues. A certain impact on the soft tissue is reported, but the available studies were mostly retrospective [14][15][16] and investigated short-term effects [15][16][17]. Furthermore, in order to accurately assess soft tissues, which are rounded and elastic, three-dimensional (3D) imaging techniques such as 3D stereophotogrammetry facilitate faster, non-invasive, and accurate facial scan images and facial measurements can be evaluated [18,19]. ...
... Even though MARPE has been reported to be highly successful, with increasing emphasis on facial appearance in recent years, some concerns persist and potential undesirable soft tissue changes could be an issue for patients and clinicians [2,12,17]. A limited number of studies has addressed this topic and, while the overall agreement was that the facial soft tissues showed notable positional changes after MARPE, there were differences with regards to the area and magnitude of the effects [14][15][16][17]. Lee et al. evaluated different landmarks around the nasal region and found that the nose tends to widen and move forward and downward, while Nguyen et al. found that both the cheeks and the nose showed lateral and forward movements whereby the nasal width increased by 2.05 mm [16,17]. Abedini et al. reported a displacement in both the paranasal area and cheeks that remained stable after 1 year [14]. ...
... Lee et al. evaluated different landmarks around the nasal region and found that the nose tends to widen and move forward and downward, while Nguyen et al. found that both the cheeks and the nose showed lateral and forward movements whereby the nasal width increased by 2.05 mm [16,17]. Abedini et al. reported a displacement in both the paranasal area and cheeks that remained stable after 1 year [14]. The alar width increase ranged from 0.93 to 2.05 mm [15][16][17]. ...
Objectives:
To evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE).
Materials and methods:
3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS.
Results:
Twenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06).
Conclusions:
Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited.
Clinical relevance:
MARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.
... Studies [31][32][33][34] on soft tissue change after MARPE using MSE resulted in significant lateral and forward movement of the soft tissues of the cheek and alar curvature points on both side in young adults. These changes correlate with the maxillary suture opening at the anterior nasal spine and PNS and suggest that soft tissue changes of the NMC can occur alongside the skeletal change obtained with MARPE. ...
Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilat- eral or bilateral posterior crossbite, narrow, tapering, or high palatal arch.
The development of temporary anchorage devices led to a new generation of tooth-bone-borne ex- pansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion.
This article reviews the age limitation and complication and soft tissue change of nonsurgical maxil- lary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.
... After MARPE became a generally-accepted approach, cases with maxillary transverse de ciency or borderline Class III cases could be resolved with non-surgical skeletal expansion and maxillary protraction in adolescent and young adult patients. 11,13,[32][33][34][35][36] Several researchers have investigated key factors affecting the success rate of MSE, including the appliance itself, the anteroposterior position of mini-implants, the bi-cortical vs. mono-cortical penetration of mini-implants, bone thickness, sex, chronological age, and activation frequency, all of which affect the nal result of expansion. 26,27,37,38 Among them, the bone thickness or density and the gender or age of a patient cannot be controlled. ...
Background
Non-surgical mini-implant assisted rapid palatal expansion, or midfacial skeletal expansion, is a paradigm-shifting concept that in recent years has expanded the envelope of orthopedic movement in the transverse direction for adult patients. Although adding mini-screws to a rapid palatal expander is not complicated, accurate and successful expansion strongly depends on the device’s position and its relation to the resisting structures of the maxillofacial complex.
Case presentation
This article presents a digital workflow to locate the optimal position of the Midfacial Skeletal Expander (MSE) device in a CBCT-combined intraoral scan file and describes how to transfer the MSE position intra-orally with properly sized bands during the device fabrication. The complete digital workflow of MSE fabrication and its application for a Class III orthognathic surgical case is presented in detail.
Conclusions
This report describes a completely digital process that can accurately position the MSE device according to the orientation and morphology of maxillary basal bone, which is crucial in adult cases demand maxillary expansion.
... However, there has been limited research on the effects of MARPE on the facial soft tissues. A certain impact on the soft tissue is reported, but the available studies were mostly retrospective [14][15][16] and investigated short-term effects [15][16][17]. Furthermore, in order to accurately assess soft tissues, which are rounded and elastic of nature, three-dimensional (3D) imaging techniques such as 3D stereophotogrammetry facilitate faster, non-invasive and accurate facial scan images and facial measurements can be evaluated [18,19]. ...
... Even though MARPE has been reported to be highly successful, with increasing emphasis on facial appearance in recent years, some concerns persist and potential undesirable soft tissue changes could be an issue for patients and clinicians [2,12,17]. A limited number of studies has addressed this topic and, while the overall agreement was that the facial soft tissues showed notable positional changes after MARPE, there were differences with regards to the area and magnitude of the effects [14][15][16][17]. Lee [14]. The alar width increase ranged from 0.93 mm to 2.05 mm [15][16][17]. ...
... A limited number of studies has addressed this topic and, while the overall agreement was that the facial soft tissues showed notable positional changes after MARPE, there were differences with regards to the area and magnitude of the effects [14][15][16][17]. Lee [14]. The alar width increase ranged from 0.93 mm to 2.05 mm [15][16][17]. ...
Objectives
To evaluate the midfacial soft tissue changes of the face in patients treated with Miniscrew-Assisted Rapid Palatal Expansion (MARPE).
Materials & Methods
3D facial images and intra-oral scans (IOS) of 29 patients (22 women, 7 men, mean age 25.9 years) were obtained before expansion (T0), immediately after completion of expansion (T1), and one year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0-T1 and overall effects between T0-T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS.
Results
The soft tissue in the regions of the nose, left of philtrum, right of philtrum and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30mm, 0.93mm, 0.74mm and 0.81mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59mm, and then decreased by 0.08mm after one year, but this effect was not significant. The IPW increased by 4.58mm and remained stable one year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06).
Conclusions
Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited.
Clinical Relevance
MARPE is an effective treatment modality to expand the maxilla without notably affecting the midfacial soft tissues.
